Embodiment, tailoring, and trust are important for co-construction of meaning in physiotherapy after stroke: A qualitative study.
Marianne Sivertsen, Hanne De Jaegher, Ellen Christin Arntzen and 2 others
PMID 35306716WHAT IT FOUND
Stroke survivors valued trust and engagement over specific exercises.
They wanted to be pushed and corrected, interpreting exertion as progress. Assessment and goal-setting were often tacit, with patients trusting therapists to decide what mattered, rather than seeking explicit explanations.
Key findings
01Participants valued trust in the physiotherapist's professional judgment more than explicit goal-setting or assessment details.
02Patients interpreted high-intensity exertion and fatigue as evidence of progress and normality, which maintained their motivation.
03Goal-setting was frequently tacit and implicit, especially in outpatient settings, rather than explicitly discussed with patients.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was conducted in Norway, so findings may not generalize to other healthcare systems. Participants were excluded if they had severe aphasia or more severe disabilities, limiting applicability to these groups. Recruitment delays due to the pandemic meant some interviews occurred up to 38 weeks post-inclusion, potentially introducing recall bias. The sample size (19) is small, though saturation was claimed.
Declared interests
Three authors developed the I-CoreDIST intervention and were investigators in the parent RCT, but were not involved in treating participants. The study was approved by the Regional Committee for Medical Research Ethics North Norway.
The easy way to misread this
Do not assume patients do not care about goal-setting. While many accepted tacit goals, this reflects trust in the therapist's judgment, not a lack of interest. Explicitly discussing goals may still be beneficial, particularly for those who do not feel this trust.