Demystifying Qualitative Research for Musculoskeletal Practitioners Part 3: Phenomeno-what? Understanding What the Qualitative Researchers Have Done

"It's kind of just like a never-ending cycle": Young people's experiences of co-existing chronic musculoskeletal pain and mental health conditions

Chronic musculoskeletal pain (CMP) imposes a significant burden on young people (16-24yrs), impacting their physical, social, and emotional wellbeing and functioning during a critical developmental period as they transition from adolescence to young adulthood. The prevalence of mental health conditions also peaks around this age group, with CMP and mental health conditions being frequently comorbid. Existing epidemiological evidence recognises the relationship as bidirectional; however, there is little in-depth qualitative evidence about how young people experience living with co-existing CMP and mental health conditions. A Constructivist Grounded Theory approach was used. Young people, 16-24 years, living in Australia with self-reported co-existing CMP and mental health conditions were invited to participate in interviews to explore their lived and health care experiences. Twenty-one young people were included (5 men, 1 transgender person, 1 non-binary person, and 14 women). A core category of 'a feedback loop of pain and mental health', characterised the interconnectedness of CMP and mental health in these young people. This feedback loop was influenced both helpfully and unhelpfully by intrapersonal factors (emotions, cognitions, behaviours), interpersonal factors (healthcare interactions, relationships, and sense of self) and their personal context (societal discourse about pain, and mental health including stigma and environmental factors). 'A feedback loop of pain and mental health' suggests the need for a whole person, interdisciplinary approach that is titrated to the needs of the young person and addresses both CMP and mental health concurrently. Further research is needed to test the clinical utility of such a model. PERSPECTIVE: This study highlights the complex bidirectional feedback loop between chronic musculoskeletal pain and mental health in young people aged 16-24. These findings emphasise the need for interdisciplinary, whole-person approaches to concurrently address both conditions. Future research should explore the clinical utility of such models.

Experiences of People With Persistent Nonspecific Neck Pain Who Used Immersive Virtual Reality Serious Games in the Home Setting: A Qualitative Study

OBJECTIVE

The purpose of this study was to explore the experiences of individuals with persistent nonspecific neck pain who used immersive virtual reality (VR) serious games at home for 2 weeks.

METHODS

In this descriptive qualitative study, semi-structured one-on-one interviews were conducted at the participant's home after the 2-week period. Interviews were analyzed using qualitative content analysis. Sample size was determined using the information power concept (where "information power" refers to the amount of relevant information the sample provides for addressing the research question).

RESULTS

Eleven adults with continuous or recurrent nonspecific neck pain participated in the study. Three main categories were identified. The first revolves around the home environment, revealing that participants had mixed perceptions about being at home, yet held a positive perspective on the utilization of immersive VR in that setting. The second pertains to immersive VR as a novel technology, indicating its overall comfort, user-friendliness, and varying degrees of immersion and presence experienced by the participants. The third focuses on exercising in immersive VR, drawing comparisons with conventional exercises, exploring the facilitators and barriers to usage, and addressing various aspects of integrating this technology into rehabilitation.

CONCLUSION

Immersive VR was deemed comfortable for almost all participants and easy to use. Participants found exercising in immersive VR motivating and enjoyable, compared to conventional exercises. The home environment proved suitable for using immersive VR, though challenges included autonomy and reduced human contact. Participants highlighted facilitators and barriers in using immersive VR serious games, as well as immersive VR's rehabilitation potential. They also underscored the crucial role of physical therapists for guidance, remote supervision, and personalized treatment.

IMPACT

These findings could help clinicians to better understand the experiences of individuals with persistent nonspecific neck pain when using immersive VR, as well as its use at home. This understanding can improve patient care and optimize the effectiveness of immersive VR as a treatment method.

Sociocultural constructs and sensorimotor control: a scoping review examining implications for anterior cruciate injury

OBJECTIVE

There is a need to explore the many factors that may have a more subtle influence on, or relationship with, sensorimotor control as it pertains to anterior cruciate ligament injury risk. Due to well-established sex/gender-related differences in sensorimotor control, a close examination of key sociocultural constructs is warranted. This scoping review examined the connection between sociocultural constructs and sensorimotor control.

DESIGN

Scoping review.

DATA SOURCES

The following databases were searched: PubMed, Embase, Scopus, CINAHL Complete, Academic Search Complete, Pre-Prints Database and Rehabilitation Reference Center from inception to September 2023. Additionally, relevant grey literature was identified.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Two blinded reviewers independently performed screening, study selection and data extraction. Original references in English, Spanish and German reporting on sociocultural constructs and motor task performance were included.

RESULTS

Data were extracted from 68 included articles. Stereotype threat, gender and race have been examined more than other sociocultural constructs. Sensorimotor control was assessed in upper and lower quarter tasks and physical activity (PA). Task assessment methods varied, often focusing on task completion or completion speed. It is evident that sociocultural constructs influence sensorimotor control, but the exact mechanism remains unclear.

CONCLUSION

Sociocultural constructs can influence sensorimotor control and PA. Future research should further explore this connection as it relates to biomechanical profiles associated with increased injury risk. Additionally, sociocultural construct inventory scores could be added to existing injury screening programmes to create a more gendered approach to risk mitigation.

Exploring the influence of hospital context on acute care physical therapy fall prevention practice: A qualitative study

BACKGROUND

Falls are a significant concern for hospitals and patients. The risk of falls is particularly heightened around the period of hospitalization. Physical therapy (PT) is commonly consulted for hospitalized patients at-risk for falls, yet it is unknown how the hospital context influences fall prevention practice among physical therapists.

PURPOSE

To explore the perspectives of acute care physical therapists on fall prevention practices within hospital settings and examine how specific contextual factors influence their practice patterns and the effectiveness ofPT interventions.

METHODS

A prospective qualitative study using collaborative qualitative data analysis was conducted through semi-structured interviews with acute care physical therapists nationwide. Interviews focused on therapists' perceptions of fall prevention practices, PT intervention effectiveness, and the influence of hospital context.

RESULTS

We derived three primary themes and ten subthemes. First, mobility promotion was identified as central to fall prevention, requiring a system-wide culture involving multidisciplinary teams, particularly nursing staff. Second, systemic factors, such as time constraints, institutional priorities, high patient volumes, staff availability, equipment availability, and the physical environment, were found to limit optimal PT practice for fall prevention. Third, the effectiveness of PT interventions was context-dependent, with therapists adapting their practices to maximize impact within systemic constraints. Notably, clinical experience seemed to mitigate some practice limitations.

CONCLUSIONS

Despite the acknowledged benefits of PT, systemic factors often prevent therapists from implementing effective fall prevention interventions. Addressing these contextual barriers and developing standards of practice may enhance patient safety and the overall success of fall prevention efforts in hospitals.

"I Have Faith in God That I Will Get Better"-The Multidimensional Perceptions and Expectations of Patients With Chronic Shoulder Pain: A Qualitative Analysis of Common Sense

OBJECTIVE

This descriptive qualitative study aimed to gain insights into the expectations of individuals with chronic shoulder pain and to investigate how different levels of disability may influence their beliefs and expectations regarding improvement.

METHODS

This qualitative study utilized the Common Sense Model as its theoretical framework. Conducted within a public physical therapy clinic, individuals with chronic shoulder pain who were awaiting the initiation of the treatment were included. Participants, female and male (aged 30-69 years), were purposefully sampled. Thirty participants, categorized into 2 groups based on the Shoulder Pain and Disability Index (SPADI) scores, underwent semi-structured interviews. Group 1, lower SPADI scores (0-60), had 10 participants, and Group 2, higher SPADI scores (61-100), had 20 participants. Thematic analysis and inductive coding were employed to analyze the interviews.

RESULTS

Common themes emerged in both groups: the use of medical terms for understanding the diagnosis and the multidimensional impact of pain. The last 2 themes differed between groups. Notable differences included Group 1's focus on resources for pain relief and positive expectations with physical therapy, while Group 2 emphasized rest, religion as a resource for pain relief, and God's role in improvement.

CONCLUSION

These findings highlight the complexity of beliefs and expectations among patients with chronic shoulder pain. Individuals with greater disability often incorporated religious beliefs into their coping strategies, but they held lower recovery expectations and reported negative treatment experiences. These insights have implications for tailoring patient-centered care approaches.

IMPACT

This study underscores the need for health care providers to consider the multidimensionality of recovery expectations, which can significantly influence patient outcomes. Clinicians can reflect on this knowledge to optimize treatment strategies and improve patient prognosis.

Parental practices and perspectives on health and digital technology use information seeking for children aged 0-36 months

BACKGROUND

Parents commonly seek information to support the health and well-being of their children. The increasing availability of health information online and social changes related to the COVID-19 pandemic may have changed what information is sought, from whom, where, and why. This qualitative study explored parents' practices and perspectives on seeking health and digital technology use information for their young children.

METHODS

Twenty parents, living in Australia (7 rural, 3 remote, and 10 metropolitan), with children aged 0-36 months completed a semi-structured interview.

RESULTS

Parents commonly turned to friends and family and online sources to access health information for their young children. For all types of health information, including digital technology use, themes were identified surrounding aspects of information sources participants valued and accessibility of health services. Perceived credibility and trustworthiness, relatability with other parents, ease of accessibility and convenience, and actionable, bite-sized information were valued. Reduced accessibility to health services due to COVID-19 and geographical location, and need for agency in managing their child's health influenced parents' choice of source of information. Few participants actively sought information about digital technology use for their young child, with the main focus on screen time.

CONCLUSION

Interactions with family and friends and online sources are important to parents when accessing health information for their child. Parents valued information sources which they considered trustworthy, credible, and relatable, as well as easily accessible and convenient. SO WHAT?: Dissemination of health information reflecting these values may empower parents during this early stage of parenthood.

Experiences of patients with Parkinson's disease belonging to an association. A qualitative approach

INTRODUCTION

Parkinson's disease (PD) affects the physical, cognitive, emotional, and social domains of people who suffer it. A good strategy for patients is to belong to an Association, using the services they offer.

OBJECTIVE

The aim of this study was to explore the experiences and perceptions of patients with PD in a Parkinson's Association.

METHODS

A sample of participants with PD who met the inclusion criteria was selected through purpose and theoretical sampling. Semi-structured qualitative interviews were used to collect the data, which was analyzed by thematic phenomenological analysis. Different strategies such as triangulation between researchers were used to ensure methodological rigor.

RESULTS

The data analyzed from 10 participants led to two themes: the context of the Association, where the importance of interdisciplinary treatments and the relationship with other patients is collected; and how they see their future, which describes the future perspectives that patients with PD have.

DISCUSSION

Patients agree on the importance of belonging to the Association, feeling part of a group, while benefiting from receiving therapies from the interdisciplinary team. The Association plays a relevant role in the evolution of the disease, as it influences how patients imagine their future. Developing strategies based on a good therapeutic alliance with professionals at the service of patients promotes the empowerment, adherence and continuity of treatments at home, which results in improving the quality of life of patients with PD.

"It helps and it doesn't help": maternal perspectives on how the use of smartphones and tablet computers influences parent-infant attachment

As families increase their use of mobile touch screen devices (smartphones and tablet computers), there is potential for this use to influence parent-child interactions required to form a secure attachment during infancy, and thus future child developmental outcomes. Thirty families of infants (aged 9-15 months) were interviewed to explore how parents and infants use these devices, and how device use influenced parents' thoughts, feelings and behaviours towards their infant and other family interactions. Two-thirds of infants were routinely involved in family video calls and one-third used devices for other purposes. Parent and/or child device use served to both enhance connection and increase distraction between parents and infants and between other family members. Mechanisms for these influences are discussed. The findings highlight a new opportunity for how hardware and software should be designed and used to maximise benefits and reduce detriments of device use to optimise parent-infant attachment and child development.Practitioner Summary: Many families with infants regularly use smartphones and tablet computers. This qualitative study found that how devices were used either enhanced or disrupted feelings of parent-infant attachment. Practitioners should be aware of the potential beneficial and detrimental impacts of device use among families given implications for attachment and future child development.

Carpal tunnel syndrome in the workplace. Triggers, coping strategies, and economic impact: A qualitative study from the perspective of women manual workers

BACKGROUND

Carpal tunnel syndrome (CTS) may lead to significant work limitations, especially in female manual workers. There is scarce evidence on the perspective of female manual workers with CTS.

PURPOSE

To explore the perspective of female workers who suffer from CTS regarding triggers, coping strategies, and economic impact.

STUDY DESIGN

A qualitative phenomenological study was conducted involving 18 manual workers with CTS diagnosed by the neurology service of a public hospital.

METHODS

Purposive sampling was applied, and data were collected using in-depth interviews and researchers' notes. An inductive thematic analysis was applied to identify themes reflecting the participants' experience. Guba and Lincoln criteria were applied to establish the trustworthiness of the data.

RESULTS

The mean age of participants was 40.06 years (SD 9.86). Four themes were identified: (a) coping with work limitations; (b) work activities that aggravate symptoms; (c) relationships at work; and (d) the economic burden of CTS. The effect of work on CTS, daily constraints, work situations that trigger the symptoms, and the strategies used by participants to adapt to their work are described. In addition, they recounted how relationships with managers and coworkers are modified and how CTS affects family finances.

CONCLUSIONS

The findings describe aggravating factors among working women, coping strategies used, and the social and occupational impact of CTS.

Patients' Views on AI for Risk Prediction in Shared Decision-Making for Knee Replacement Surgery: Qualitative Interview Study

BACKGROUND

The use of artificial intelligence (AI) in decision-making around knee replacement surgery is increasing, and this technology holds promise to improve the prediction of patient outcomes. Ambiguity surrounds the definition of AI, and there are mixed views on its application in clinical settings.

OBJECTIVE

In this study, we aimed to explore the understanding and attitudes of patients who underwent knee replacement surgery regarding AI in the context of risk prediction for shared clinical decision-making.

METHODS

This qualitative study involved patients who underwent knee replacement surgery at a tertiary referral center for joint replacement surgery. The participants were selected based on their age and sex. Semistructured interviews explored the participants' understanding of AI and their opinions on its use in shared clinical decision-making. Data collection and reflexive thematic analyses were conducted concurrently. Recruitment continued until thematic saturation was achieved.

RESULTS

Thematic saturation was achieved with 19 interviews and confirmed with 1 additional interview, resulting in 20 participants being interviewed (female participants: n=11, 55%; male participants: n=9, 45%; median age: 66 years). A total of 11 (55%) participants had a substantial postoperative complication. Three themes captured the participants' understanding of AI and their perceptions of its use in shared clinical decision-making. The theme Expectations captured the participants' views of themselves as individuals with the right to self-determination as they sought therapeutic solutions tailored to their circumstances, needs, and desires, including whether to use AI at all. The theme Empowerment highlighted the potential of AI to enable patients to develop realistic expectations and equip them with personalized risk information to discuss in shared decision-making conversations with the surgeon. The theme Partnership captured the importance of symbiosis between AI and clinicians because AI has varied levels of interpretability and understanding of human emotions and empathy.

CONCLUSIONS

Patients who underwent knee replacement surgery in this study had varied levels of familiarity with AI and diverse conceptualizations of its definitions and capabilities. Educating patients about AI through nontechnical explanations and illustrative scenarios could help inform their decision to use it for risk prediction in the shared decision-making process with their surgeon. These findings could be used in the process of developing a questionnaire to ascertain the views of patients undergoing knee replacement surgery on the acceptability of AI in shared clinical decision-making. Future work could investigate the accuracy of this patient group's understanding of AI, beyond their familiarity with it, and how this influences their acceptance of its use. Surgeons may play a key role in finding a place for AI in the clinical setting as the uptake of this technology in health care continues to grow.

Leveraging the construct of physical literacy to promote physical activity for youth with obesity - A qualitative analysis of physical therapists' perceptions

Background

Promoting physical activity has been identified as a pillar of obesity treatment and prevention. However, youth with obesity often present with physical, affective, and environmental barriers to physical activity engagement. The construct of physical literacy, which has garnered international attention as a holistic approach to understanding human movement, may improve physical activity promotion strategies for youth with obesity. However, literature has shown that healthcare providers are not engaged with the construct of physical literacy.

Methods

This qualitative study utilized a phenomenological approach and interpretivist epistemology. Three phases of data collection included member checks, semi-structured interviews, and a focus group with physical therapists treating youth with orthopedic and sport injuries. Simultaneous data collection and inductive analysis was designed to identify themes reflecting how participants utilized the construct of physical literacy to promote physical activity in a clinical setting.

Results

Four overarching themes were identified in our analysis as strategies for promoting activity and physical literacy development: 1) Movement Experience, 2) Individualized Care, 3) Movement Momentum, and 4) External Factors.

Conclusion

The findings from this study highlight the usefulness of applying a physical literacy lens within physical activity promotion efforts among youth, which may be particularly important for youth with obesity. A high value was placed on the affective and behavioral determinants of physical activity. By applying a physical literacy lens, healthcare providers treating youth with obesity may be better equipped to address barriers and promote participation in physical activities that are enjoyable and build confidence. The findings from this study provide a foundation for future studies examining how healthcare providers can leverage the construct of physical literacy to improve physical activity outcomes among youth.

Understanding the Non-Surgical Treatment Experience of Female Patients with Carpal Tunnel Syndrome: A Qualitative Study

Carpal tunnel syndrome (CTS) is a peripheral neuropathy of the upper extremity, characterized by pain, loss of strength, and decreased fine motor function. This study describes the experiences of women with CTS who received non-surgical treatments. A qualitative phenomenological study was undertaken. Purposive sampling was used. Women with clinical and electromyographic diagnoses of CTS were included. Eighteen in-depth interviews were conducted among women with CTS, and field notes were kept. The Giorgi's approach was used for qualitative analysis of the data collected. Five themes emerged: (a) Seeking help and waiting for a diagnosis, (b) trying non-surgical therapeutic options, (c) avoiding invasive options, (d) treatment expectations, and (e) relationships with clinicians. The women described how diagnoses were delayed because women delay seeking help and referrals to medical specialists. Women avoid surgical options and prefer to opt for more conservative approaches, such as splinting or physical therapy. The main reason for avoiding surgical treatment is the fear of limitations and that surgery will not fully eliminate the symptoms. Conflicts may arise in the relationship with the clinician, and they demand to be able to participate in the decision-making process.

Facing symptoms and limitations: a qualitative study of women with carpal tunnel syndrome

BACKGROUND

Carpal tunnel syndrome (CTS) is a neuropathic pain condition characterised by pain, paresthesia, loss of strength and disability.

OBJECTIVE

To explore the experiences of women with CTS regarding the management of symptoms and limitations.

METHODS

A qualitative phenomenological study was conducted. Women with a clinical and electromyographic diagnosis of CTS recruited from the Neurology Department of a Public Hospital were included. Purposeful sampling was performed. Data were collected using in-depth interviews and researchers' field notes. Analysis proposed by Giorgi was used.

RESULTS

A total of 18 women with CTS were included. Two themes emerged: a) Living with CTS symptoms and limitations: describing the symptoms experienced, triggers of their symptoms and how they define CTS. Also, describing the difficulties that they experience on a daily basis, at home when handling tools, communicating, driving, and at work; and b) developing daily strategies for managing limitations: developing potential daily strategies to overcome daily limitations and/or compensate for them, and seeking professional help.

CONCLUSIONS AND SIGNIFICANCE

Current results provide insight on how symptoms and daily limitations are experienced by a group of women with CTS. These findings could help occupational therapists to understand the day-to-day difficulties and the reasons for developing certain strategies.