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Fritz, Johanna
Publications (7 of 7) Show all publications
Asenlof, P., Igelstrom, H., Sandborgh, M. & Fritz, J. (2018). INTEGRATION OF PHYSIOTHERAPY IN BEHAVIORAL MEDICINE INTERVENTION RESEARCH. International Journal of Behavioral Medicine, 25(Suppl 1:1), S3-S3
Open this publication in new window or tab >>INTEGRATION OF PHYSIOTHERAPY IN BEHAVIORAL MEDICINE INTERVENTION RESEARCH
2018 (English)In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 25, no Suppl 1:1, p. S3-S3Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
SPRINGER, 2018
National Category
Physiotherapy Psychology
Identifiers
urn:nbn:se:mdh:diva-41222 (URN)10.1007/s12529-018-9740-1 (DOI)000446532700014 ()
Available from: 2018-10-25 Created: 2018-10-25 Last updated: 2018-10-26Bibliographically approved
Fritz, J., Söderbäck, M., Sandborgh, M. & Söderlund, A. (2018). The complexity of integrating a behavioral medicine approach into physiotherapy clinical practice. Physiotherapy Theory and Practice
Open this publication in new window or tab >>The complexity of integrating a behavioral medicine approach into physiotherapy clinical practice
2018 (English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040Article in journal (Refereed) Published
Abstract [en]

Introduction and Aim: The implementation of a behavioral medicine (BM) approach in physiotherapy is challenging, and studies regarding the determinants are sparse. Thus, the aim of this study was to explore determinants of applying a BM approach in physiotherapy for patients with persistent pain across the micro-, meso-, and macro-levels. Methods: A qualitative multiple-case study design was used. Data were collected from four cases through semi-structured interviews with physiotherapists (PTs), patients, and managers; observations of video-recorded treatment sessions; and reviews of local directives and regulations. Data were analyzed with inductive content analysis and cross-case analysis, followed by mapping to the domains of determinants at the micro-, meso-, and macro-levels within the Implementation of Change Model. Results: Similar determinants were found across the cases. At the micro-level, these determinants concerned the PTs’ ambivalence toward a BM approach, a biomedical focus, embarrassment asking about psychosocial factors, BM knowledge, skills for applying the approach, and self-awareness. Others concerned the patients’ role expectations of the PT, patients as active or passive agents in the treatment process, patients’ focus on biomedical aspects, and confidence in the PT. At the meso-level, support from managers and peers, allocation of time, and expectations from the organization were identified as determinants. No determinants were identified at the macro-level. Conclusion: The complexity of integrating a BM approach into physiotherapy clinical practice arises from multiple determinants functioning as both facilitators and barriers. By selecting strategies to address these determinants, the implementation of a BM approach could be supported.

Keywords
Behavioral medicine,  physiotherapy,  clinical practice,  determinant,  facilitator,  barrier
National Category
Medical and Health Sciences
Research subject
Physiotherapy
Identifiers
urn:nbn:se:mdh:diva-41172 (URN)10.1080/09593985.2018.1476996 (DOI)29847287 (PubMedID)2-s2.0-85047962277 (Scopus ID)
Funder
AFA Insurance, 12169
Available from: 2018-10-15 Created: 2018-10-15 Last updated: 2019-06-18Bibliographically approved
Fritz, J., Söderlund, A., Wallin, L., Almqvist, L. & Sandborgh, M. (2018). THE EFFECT OF FACILITATION WHEN IMPLEMENTING A BEHAVIORAL MEDICINE APPROACH IN PHYSICAL THERAPY PRIMARY HEALTH CARE. International Journal of Behavioral Medicine, 25, S38-S38
Open this publication in new window or tab >>THE EFFECT OF FACILITATION WHEN IMPLEMENTING A BEHAVIORAL MEDICINE APPROACH IN PHYSICAL THERAPY PRIMARY HEALTH CARE
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2018 (English)In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 25, p. S38-S38Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
SPRINGER, 2018
National Category
Physiotherapy Psychology
Identifiers
urn:nbn:se:mdh:diva-41223 (URN)000446532700125 ()
Available from: 2018-10-25 Created: 2018-10-25 Last updated: 2018-10-25Bibliographically approved
Fritz, J., Söderlund, A., Almqvist, L., Wallin, L. & Sandborgh, M. (2017). Implementation of a behavioural medicine approach in physiotherapy – a process evaluation.. In: World Confederation of Physical Therapy (WCPT) Congress, Cape Town, South Africa, 2-4 July, 2017.: . Paper presented at World Confederation of Physical Therapy (WCPT) Congress, Cape Town, South Africa, 2-4 July, 2017..
Open this publication in new window or tab >>Implementation of a behavioural medicine approach in physiotherapy – a process evaluation.
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2017 (English)In: World Confederation of Physical Therapy (WCPT) Congress, Cape Town, South Africa, 2-4 July, 2017., 2017Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Background: A behavioural medicine approach in physiotherapy for patients with persistent musculoskeletal pain is recommended based on evidence. The approach aims at an individually tailored treatment targeting motor behaviour, cognition, disability and active patient involvement. The behavioural medicine approach is complex and it is challenging in implementation to achieve clinically relevant behaviours in physiotherapy. Process evaluation is an essential part of designing and testing implementation interventions to improve the quality of the implementation. However, studies evaluating the implementation process of a behavioural medicine approach in physiotherapy are sparse.

Purpose: To explore the implementation process of a behavioural medicine approach in physiotherapy.

Methods: Qualitative and quantitative methods were used. 15 physiotherapists working in six primary health care units were consecutively included. A theory based implementation intervention was tailored to the participating individual physiotherapists. Active and multifaceted implementation strategies were used during a total of seven days spread over a six months implementation period. The main implementation strategies were external facilitation and peer-learning. Ten two-hours outreach sessions were offered to each unit. The physiotherapists were encouraged to use individual goal setting and video recordings of treatment sessions to facilitate feedback and reflection during the sessions with the external facilitator. Process data were collected using semi-structured interviews, self-reports of time allocation for different implementation strategies and documented individual goals. Qualitative content analysis and quantitative frequency scorings were used for data analyses.

Results: In median the physiotherapists participated in 9 (3-10) out of 10 sessions with the external facilitator. Discussing clinical experiences of the behavioural medicine approach together with the external facilitator was perceived as valuable. These discussions stimulated reflection and problem solving, and was also experienced as a reminder for practicing skills in behavioural medicine. Video recordings of treatment sessions were used by ten of the physiotherapists at 17 out of 57 possible sessions. Video recordings were experienced as too complicated to use in relation to the gains. Lack of time was also considered as a barrier for using video recordings. Individual goal-setting from one session to the next with the external facilitator was frequently used by all the participants. Relevant skills for the goals were practiced in between the sessions. However, goal setting was not considered important by the physiotherapists. In median the physiotherapists spent 3.25 (0-9.5) hours for peer discussions. Peer discussions were a strategy that the physiotherapists wanted to continue with, even after the implementation intervention period. Even though the physiotherapists had permission from the manager to spend time on the implementation intervention, it was challenging for the physiotherapists to prioritize the implementation intervention before patient care.

Conclusion(s): External facilitation and peer discussions were perceived as important strategies for stimulating practice of behavioural medicine skills in physiotherapy. Further, peer discussions could stimulate sustainability of the implementation. The physiotherapists needed support to use the designated time for the implementation.

Implications: Quantitative and qualitative analyses of the implementation process is useful for understanding the mechanisms of impact for the implementation intervention, how outcomes were achieved and for future replications.

Keywords
behavioural medicine, physical therapy, implementation, process evaluation
National Category
Medical and Health Sciences
Research subject
Physiotherapy
Identifiers
urn:nbn:se:mdh:diva-41203 (URN)
Conference
World Confederation of Physical Therapy (WCPT) Congress, Cape Town, South Africa, 2-4 July, 2017.
Funder
AFA Insurance, 12169
Available from: 2018-10-21 Created: 2018-10-21 Last updated: 2018-10-24Bibliographically approved
Sandborgh, M., Söderbäck, M. & Fritz, J. (2017). The intention – action gap when using a behavioral medicine approach in physiotherapy for patients with persistent musculoskeletal pain.. In: World Confederation of Physical Therapy (WCPT) Congress, Cape Town, South Africa, 2-4 July, 2017: . Paper presented at World Confederation of Physical Therapy (WCPT) Congress, Cape Town, South Africa, 2-4 July, 2017.
Open this publication in new window or tab >>The intention – action gap when using a behavioral medicine approach in physiotherapy for patients with persistent musculoskeletal pain.
2017 (English)In: World Confederation of Physical Therapy (WCPT) Congress, Cape Town, South Africa, 2-4 July, 2017, 2017Conference paper, Poster (with or without abstract) (Refereed)
National Category
Medical and Health Sciences
Research subject
Physiotherapy
Identifiers
urn:nbn:se:mdh:diva-41204 (URN)
Conference
World Confederation of Physical Therapy (WCPT) Congress, Cape Town, South Africa, 2-4 July, 2017
Funder
AFA Insurance, 12169
Available from: 2018-10-21 Created: 2018-10-21 Last updated: 2018-10-24Bibliographically approved
Fritz, J., Elvén, M. & Moberg, J. (2015). Från klinikbesök till klinikhandledning: Om verksamhetsförlagd utbildning i fysioterapeutprogrammet vid Mälardalens Högskola. Västerås
Open this publication in new window or tab >>Från klinikbesök till klinikhandledning: Om verksamhetsförlagd utbildning i fysioterapeutprogrammet vid Mälardalens Högskola
2015 (Swedish)Report (Other academic)
Place, publisher, year, edition, pages
Västerås: , 2015. p. 18
National Category
Educational Sciences Physiotherapy
Identifiers
urn:nbn:se:mdh:diva-38362 (URN)
Available from: 2018-01-29 Created: 2018-01-29 Last updated: 2018-01-29Bibliographically approved
Sandborgh, M., Dean, E., Denison, E., Elvén, M., Fritz, J., von Heideken Wågert, P., . . . Söderlund, A. Integration of Behavioral Medicine Competencies into Physical Therapy Curriculum in an Exemplary Swedish Program: Rationale, Process and Ten-year Review. Physiotherapy Theory and Practice
Open this publication in new window or tab >>Integration of Behavioral Medicine Competencies into Physical Therapy Curriculum in an Exemplary Swedish Program: Rationale, Process and Ten-year Review
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(English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040Article in journal (Refereed) Epub ahead of print
Abstract [en]

In 2004, Mälardalen University, Sweden, introduced a new undergraduate entry-level physiotherapy program. Program developers constructed the curriculum with behavioral medicine content that reflected the contemporary definition and values of the physiotherapy profession aligning it with current best practices, evidence, and the International Classification of Functioning, Disability, and Health (ICF). The new curriculum conceptualized movement and function as modifiable behaviors in that they reflect behavioral contingencies, perceptions, beliefs, and lifestyle factors as well as pathophysiology and environmental factors. The purpose of this article is to describe how one university accordingly structured its new curriculum and its review. We describe the rationale for the curriculum's behavioral medicinecontent and competencies, its development and implementation, challenges, long-term outcomes, and its related research enterprise. We conclude that physiotherapy practiced by our graduates augments that taught in other programs based on accreditation reviews. With their expanded practice scope, graduates are systematically practicing within the constructs of health and function conceptualized within the ICF. Our intent in sharing our experience is to exemplify one university's initiative to best prepare students with respect to maximizing physiotherapy outcomes as well as establish a dialogue regarding minimum standards of behavioral medicine competencies in physiotherapy education and practice.

National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:mdh:diva-41326 (URN)10.1080/09593985.2018.1488192 (DOI)29927660 (PubMedID)
Available from: 2018-11-13 Created: 2018-11-13 Last updated: 2018-12-05Bibliographically approved
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