Background Evidence-based practice has increasingly been recognized as a priority by professional physiotherapy organizations and influential researchers and clinicians in the field. Numerous studies in the past decade have documented that physiotherapists hold generally favorable attitudes to evidence-based practice and recognize the importance of using research to guide their clinical practice. Research has predominantly investigated barriers to research use. Less is known about the circumstances that actually support use of research by physiotherapists. This study explores the conditions at different system levels that physiotherapists in Sweden perceive to be supportive of their use of research in clinical practice. Methods Patients in Sweden do not need a referral from a physician to consult a physiotherapist and physiotherapists are entitled to choose and perform any assessment and treatment technique they find suitable for each patient. Eleven focus group interviews were conducted with 45 physiotherapists, each lasting between 90 and 110 minutes. An inductive approach was applied, using topics rather than questions to allow the participants to generate their own questions and pursue their own priorities within the framework of the aim. The data were analyzed using qualitative content analysis. Results Analysis of the data yielded nine favorable conditions at three system levels supporting the participant’s use of research in clinical practice: two at the individual level (attitudes and motivation concerning research use; research-related knowledge and skills), four at the workplace level (leadership support; organizational culture; research-related resources; knowledge exchange) and three at the extra-organizational level (evidence-based practice guidelines; external meetings, networks, and conferences; academic research and education). Conclusions Supportive conditions for physiotherapists’ use of research exist at multiple interdependent levels, including the individual, workplace, and extra-organizational levels. Research use in physiotherapy appears to be an interactive and interpretative social process that involves a great deal of interaction with various people, including colleagues and patients.

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The purpose of this study was to explore how physiotherapists working in stroke care understand their role(s) in the context of clinical practice and how this is mediated by their post-licensure educational experiences. Specifically the study focused on their experiences with the Bobath Concept, a well-developed post-licensure neurology physiotherapy program. This study was oriented within sociocultural theory as a way to understand how the experiences and interactions of physiotherapists mediate their professional practice and their sense of professional identity in a way not previously studied in physiotherapy literature. In order to honour the voices of the participants, this study drew on hermeneutic phenomenology and used a principled data analysis tool to present an understanding of the interrelationships involved in stroke care from their perspectives. Four physiotherapists participated in this study by responding in writing and orally to a clinical case and participating in an in-depth interview regarding their professional roles and experiences. The findings suggest that these physiotherapists understand the Bobath Concept as a professional stance which informs their practice and contributes to an ethos of caring, which is reflected in the ways they understand their roles in clinical practice.

The objective of the thesis was to evaluate the quality of diabetes care in the Canadian Forces by determining the extent to which physicians adhere to recommendations outlined in the 2008 Canadian Diabetes Association (CDA) clinical practice guidelines. In addition, the effect of patient age, sex, rank and size of base on quality of care was assessed and the accuracy of a diagnosis of diabetes in an extract of the electronic medical record (EMR) was evaluated. Fourteen bases within the Canadian Forces were selected for investigation, representing roughly half of the Canadian Forces population. Cases of diabetes were ascertained based on laboratory criteria following a chart review. Twenty-one CDA guideline recommendations were considered. The Canadian Forces demonstrated greater than 75% adherence with each of 9 recommendations, 50-75% adherence with each of 7 recommendations and less than 50% adherence with each of 5 recommendations. The overall adherence with all applicable recommendations per patient was 60.3% (SE 0.66). Age, sex, rank and size of base were not important factors influencing guideline adherence. The sensitivity of a diabetes diagnosis in an extract of the EMR was 84.5%, the specificity was 99.8%, the positive predictive value was 85.1% and the negative predictive value was 99.8%. This is similar to the performance of provincial and national diabetes registries. The quality of diabetes care in the Canadian Forces compared favourably with that of the civilian population within Canada and internationally. The creation of a diabetes registry is expected to lead to further improvements in diabetes care.

In this study the subjective experience of psycho-analytic essence is approached through an examination of conscious and unconscious representations of self-in-work (Dreyfus, 1991). The study begins with an heuristic identified as the psycho-analytic moment, a transitory self-state arising in the course of conducting a psycho-analysis and felt to correspond to occasions of right, expert, good or exemplary therapeutic practice. The study advances to an examination of the lived experience of clinical psycho-analysis through a set of structured and unstructured interviews with two psycho-analysts. The study’s general approach incorporates a revised version of Goethe’s delicate empiricism as adapted by Hoffman (1989). The methods for interviewing participants and for analyzing transcripts were designed to access unconscious communications regarding subjective experience. Interview procedures combined phenomenological and free-associative narrative techniques: Procedures for transcript analysis were developed from literary studies, psycholinguistics, psycho-analysis and grounded theory. The analysis of participants’ utterance led to the hypothesis that an unconscious configuration of inference and memory gives shape to the subjective experience of composite elements of psycho- analytic practice. This hypothesized coherence of unconscious memory and process structures is identified as a structural metaphor. The structural metaphor is posited to underwrite the verisimilitude of lived experience, personal idiom and aesthetic within the clinical encounter. Thus, the structural metaphor is hypothesized to shape not only the psycho-analyst’s representations of his or her way of being-in-work and linguistic deportment within the interview setting, but to also shape the subjective experience of psycho-analytic practice. Thus reconsidered, the psycho-analytic moment is viewed as an existential moment in the ongoing phenomenology of lived experience, occasioned by a convergence of unconscious identity and experience within the clinical field. This existential moment is taken to be indicative of the presence of something essential about self, work or self-in-work, as a result of a set of psychological, affective and visceral factors that arise in this moment of convergence. However, the psycho-analytic moment is assigned little epistemic value in identifying properties of psycho-analysis as a discipline or a practice, instead reflecting the structural metaphor that underlies the experience of that practice.

The overall aim of this thesis was to characterize patient-physician communication in oncology care with focus on the content and quality of the consultations from the perspectives of patients, oncologists and observer. Further, the aim was to explore oncologists’ perceived barriers against psychosocial communication in out-patient consultations. Finally, the aim was to evaluate different methods for evaluating communication in this setting. Routine oncology out-patient consultations from two different hospitals were audio-recorded. After the consultations, patients and oncologists perceptions of the content and quality of the communication were assessed using a self-report questionnaire. A nation-wide survey was performed to assess oncologists’ perceived barriers against psychosocial communication. Finally, the audio-recorded consultations were used for evaluating inter-rater reliability and feasibility of two different communication analysis instruments. Patient-physician consultations in oncology care are focused on the physical aspects of disease and treatment, both in terms of how often these issues were discussed and in terms of the amount of time spent on discussing them. Psychosocial issues, such as the disease’s effects on patients’ emotional or social functioning, are not always discussed during consultations, and the time spent on such discussions is limited. When psychosocial issues are discussed during the medical consultations, they are most often patient-initiated. Reasons for why psychosocial aspects are seldom discussed during the medical consultations can be the barriers concerning this kind of communication perceived by a large majority (93%) of the oncologists. Barriers against psychosocial communication were identified at organizational levels (including guidelines, routines, and resources) and individual levels (including physicians’ knowledge and attitudes). Furthermore, this thesis shows that there are methods with high feasibility and reliability for evaluating the content of patient-physician communication, in large study samples in oncology care. The method (observation/self-report) and perspective (patient, physician, and observer) used when evaluating communication affects the results. This needs to be considered when choosing evaluation methods in intervention studies. There are reasons to continue to evaluate, promote and implement promising ways of achieving better communication in clinical practice. Research should focus on how to overcome barriers against psychosocial communication.

This study investigated the extent to which occupational therapists (OT) use the Internet as a clinical resource and as a tool for communication with clients. It also identified barriers and facilitators associated with Internet use. A survey was mailed to all occupational therapists registered with the College of Occupational Therapists of Ontario. Our findings based on 1382 respondents show that a large percentage of occupational therapists currently use the Internet for clinical purposes. A majority of respondents reported using the Internet to meet their practice needs, primarily for looking up relevant clinical information, and less commonly as a communication tool with their clients. Greater Internet use was associated with younger age and fewer years of practice. Having a computer station, a work culture fostering Internet use, accessible technical support, paid time and credible ratings of websites were five most influential factors on Internet use in OTs’ clinical practice.

This study investigated the extent to which occupational therapists (OT) use the Internet as a clinical resource and as a tool for communication with clients. It also identified barriers and facilitators associated with Internet use. A survey was mailed to all occupational therapists registered with the College of Occupational Therapists of Ontario. Our findings based on 1382 respondents show that a large percentage of occupational therapists currently use the Internet for clinical purposes. A majority of respondents reported using the Internet to meet their practice needs, primarily for looking up relevant clinical information, and less commonly as a communication tool with their clients. Greater Internet use was associated with younger age and fewer years of practice. Having a computer station, a work culture fostering Internet use, accessible technical support, paid time and credible ratings of websites were five most influential factors on Internet use in OTs’ clinical practice.

In this study the subjective experience of psycho-analytic essence is approached through an examination of conscious and unconscious representations of self-in-work (Dreyfus, 1991). The study begins with an heuristic identified as the psycho-analytic moment, a transitory self-state arising in the course of conducting a psycho-analysis and felt to correspond to occasions of right, expert, good or exemplary therapeutic practice. The study advances to an examination of the lived experience of clinical psycho-analysis through a set of structured and unstructured interviews with two psycho-analysts. The study’s general approach incorporates a revised version of Goethe’s delicate empiricism as adapted by Hoffman (1989). The methods for interviewing participants and for analyzing transcripts were designed to access unconscious communications regarding subjective experience. Interview procedures combined phenomenological and free-associative narrative techniques: Procedures for transcript analysis were developed from literary studies, psycholinguistics, psycho-analysis and grounded theory. The analysis of participants’ utterance led to the hypothesis that an unconscious configuration of inference and memory gives shape to the subjective experience of composite elements of psycho- analytic practice. This hypothesized coherence of unconscious memory and process structures is identified as a structural metaphor. The structural metaphor is posited to underwrite the verisimilitude of lived experience, personal idiom and aesthetic within the clinical encounter. Thus, the structural metaphor is hypothesized to shape not only the psycho-analyst’s representations of his or her way of being-in-work and linguistic deportment within the interview setting, but to also shape the subjective experience of psycho-analytic practice. Thus reconsidered, the psycho-analytic moment is viewed as an existential moment in the ongoing phenomenology of lived experience, occasioned by a convergence of unconscious identity and experience within the clinical field. This existential moment is taken to be indicative of the presence of something essential about self, work or self-in-work, as a result of a set of psychological, affective and visceral factors that arise in this moment of convergence. However, the psycho-analytic moment is assigned little epistemic value in identifying properties of psycho-analysis as a discipline or a practice, instead reflecting the structural metaphor that underlies the experience of that practice.

The purpose of this study was to explore how physiotherapists working in stroke care understand their role(s) in the context of clinical practice and how this is mediated by their post-licensure educational experiences. Specifically the study focused on their experiences with the Bobath Concept, a well-developed post-licensure neurology physiotherapy program. This study was oriented within sociocultural theory as a way to understand how the experiences and interactions of physiotherapists mediate their professional practice and their sense of professional identity in a way not previously studied in physiotherapy literature. In order to honour the voices of the participants, this study drew on hermeneutic phenomenology and used a principled data analysis tool to present an understanding of the interrelationships involved in stroke care from their perspectives. Four physiotherapists participated in this study by responding in writing and orally to a clinical case and participating in an in-depth interview regarding their professional roles and experiences. The findings suggest that these physiotherapists understand the Bobath Concept as a professional stance which informs their practice and contributes to an ethos of caring, which is reflected in the ways they understand their roles in clinical practice.