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The binary opposition between childhood developmentalism and the sociology of childhood is unproductive due to childhood research's uncritical adoption of childhood concepts of 'agency', and 'ethics', with minimal relational consideration of children and childhood socio-materialities. Popular childhood methods warrant critical discussions about their underlying assumptions of 'children's voices', how researchers consider 'data'. In light of innovative childhood methodologies, it raises the question for researchers of how to ethically engage with young children in both study design and dynamic fieldwork practices. This work attends to these layered epistemological-pragmatic debates through the example of an encounter between a 5-year-old child and a novice researcher during which death and dying are discussed. By closely examining the developments in theoretical conceptualisation, research protocol(s) design, and fieldwork experiences, this work highlights that childhood research is always becoming, thus requiring researchers to be able to both 'protocol' and 'un-protocol'. Juxtaposing the dynamic 'important ethical moments' and procedural ethics guidelines through new materialist and affective lenses, this work argues that materiality and response-ability are key in understanding children's agency, childhood ethics, and the assemblage composed of children, researcher, and childhood socio-materialities in childhood research. [ABSTRACT FROM AUTHOR]

Introduction: Trauma is common and may lead to lasting adverse effects on health. Trauma-informed practice does not treat trauma but uses a strengths-based approach to encourage engagement in services. Objective: To understand how physiotherapy attends to trauma-informed principles. Methods: This qualitative ethnographic study was set in an Australian hospital. Three data collection methods were used, including observations of clinical practice, interactive reflexive group discussions with physiotherapists, and interviews with patients. Data analysis included an initial inductive phase followed by thematic mapping to trauma-informed principles. Critical reflexivity was used throughout to examine how the authors' perspectives and assumptions affected the analysis. Results: Twelve observations of consultations, ten interviews with people receiving physiotherapy, and five group discussions with physiotherapists were conducted. Themes produced within each of five principles of trauma-informed care included: Safety: not just a number, uncertainty beyond managing physical risks, upbeat approach as default needs balance, pragmatic environments inadequate; Trustworthiness: touch needs further consideration, assumed consent; Choice: limited options; Collaboration: let's do it together, variable consideration of the patient as expert, task focus, pushing the "right" treatment, missing insight into power imbalance; Empowerment: extending function and independence, building nonphysical skills but lack of clarity. Conclusion: Physiotherapy incorporates crucial aspects of trauma-informed care, but opportunities exist to enhance physiotherapists' skills and knowledge, particularly in relation to non-physical safety considerations. [ABSTRACT FROM AUTHOR]

Established research supports collaborative patient-clinician communication as a means of improving pain management and decreasing opioid use by patients with chronic pain. However, much of this scholarship emphasises clinicians' capacities to shape and improve communication; limited research investigates patients' roles in this process. Drawing on 40 ethnographic observations of patient-clinician interactions, clinical spaces and case conferences within one specialist pain clinic in Brisbane, Australia, this paper investigates how and why patients present themselves in particular ways within consultations. Our theoretical lens combines concepts from Goffman on patienthood and stigma with Foucauldian theories of pastoral and disciplinary power. Findings suggest that elements of the clinical environment – namely posters – usher patients towards presenting in what we conceptualise as the 'good pain patient' role. In this role, patients demonstrate that they are moral, responsible, and contributing members of society. Yet, such a role is problematic to opening communication, with the role constraining what is socially acceptable for patients with chronic pain to say, do, or feel. In recognising how clinical contexts facilitate problematic good pain patient presentations, this paper directs attention to the spatial and relational nature of implicit clinical expectations and constrained good pain patient presentations. [ABSTRACT FROM AUTHOR]

Introduction: Individuals identifying as lesbian, gay, bisexual, transgender, queer, intersex, asexual and other related identities (LGBTQIA+) experience challenges with healthcare, including physiotherapy. To understand potential contributions to poor experiences, this study explored physiotherapists' experiences and perspectives about working with members of LGBTQIA+ communities. Methods: This study employed a qualitative research design, suitable for exploring the experiences and perspectives of individuals within the physiotherapy context. The sample consisted of physiotherapists working in Australia who participated in a larger survey study. Data were collected via semi-structured interviews which were audio-recorded and transcribed verbatim. Data analysis was conducted using a relativistic and queer theoretical framework with a reflexive thematic approach. Results: Eighteen physiotherapists with diverse sexual orientations participated in the interviews. While all participants identified as women or men, not all used binary gender pronouns. Five key themes were developed: 1) "anti-discrimination" regarding choice of language and providing safe environments; 2) "current and historical discrimination" against LGBTQIA+ individuals; 3) "taking an equality approach" when working with LGBTQIA+ patients; 4) "knowledge of LGBTQIA+ health" in a broad sense and specifically with transgender and gender-diverse people; and 5) "managing own reactions" with respect to individual biases and discomfort. Conclusion: Underpinning all themes was the overarching concept of cis/hetero/endonormativity. Assuming normativity when working with LGBTQIA+ patients, is likely to have negative effects on patients' mental health, the therapeutic relationship and quality of care. In order to improve diversity, safety, inclusion and equity of care for LGBTQIA+ individuals, it is vital that normativity within physiotherapy is challenged. [ABSTRACT FROM AUTHOR]

Background: Despite Australia's multiculturalism, physiotherapists from minority ethnic groups, including Muslim women, may experience social exclusion in physiotherapy training based on research in other countries. Objective: Explore Muslim women's experiences of physiotherapy education in Australia and how these experiences could be improved (if needed). Methods: Qualitative research approach. Data were produced through semi-structured interviews and analyzed with reflexive thematic analysis. Results: Eleven participants were interviewed. Four main themes were produced: 1) omnipresent concerns about disrobing, physical proximity and touch in mixed-gender settings; 2) physiotherapy seen as a culturally inappropriate profession for Muslim women; 3) prevalence of an "Aussie" student environment; and 4) lack of systemic inclusivity. Suggestions to improve inclusivity, involved: systemically embedding measures such as alternatives for disrobing and proximity between genders; and promoting diverse social activities. Conclusion: Results suggest Australian physiotherapy education lacks systemic cultural sensitivity for Muslim women. To reduce the burden for change being placed on Muslim women students, culturally responsive institutional protocols and staff training could be established. [ABSTRACT FROM AUTHOR]

There has been a significant focus on medical interventions to improve sexual function and support other aspects of sexuality after spinal cord injury. However, it is not well understood what non-medical approaches are described within existing literature. This study sought to identify, summarise and describe existing literature on non-medical approaches to sexuality following spinal cord injury. This scoping review included studies identified by systematic searching of 10 databases. Findings were thematically analysed in order to summarise and report the results. Thirty articles met the inclusion criteria. Three themes were identified, including: the importance of individuality and timing, the health care professional role, and, provision of non-medical interventions and strategies. Analyses suggested the importance of providing individualised client-centred care and utilising a team approach. Many non-medical interventions and strategies were identified; however, most studies discussed that information provided and/or access to information is limited. Although non-medical approaches may be used in practice, provision of support appears to be limited with no consistent approach. Practice implications include the importance of addressing individualised factors, broadening scope of practice, and increasing the resources available for clients and professionals. Non-medical approaches to support sexuality after a spinal cord injury exist, however, there appears to be no consistent approach. Individualised person-centred care which addresses personal factors and includes intimate partners is essential when supporting sexuality. The health care professional team should seek to address the wider understanding of sexuality which extends beyond a purely medical focus. More sexuality resources and training should be available for both people with spinal cord injuries and health care professionals. [ABSTRACT FROM AUTHOR]

To explore patient perspectives of the integrated intervention (intervention arm) of a recent randomised clinical trial that found clinically relevant and sustained benefits of a physiotherapist delivered integrated stress inoculation training (SIT) and exercise for people with acute whiplash-associated disorders (WAD) and at risk of poor recovery. Twelve patients from the 53 who participated in the SIT and exercise arm of a randomised controlled trial (StressModex RCT) participated in semi-structured interviews. Data were analysed using inductive thematic analysis. Five main themes were identified: "balance between the physical and psychological components," "dealing with stress," "coping with the injury," "pain relief and return to function," and "elements enhancing therapeutic alliance." The majority of patients found the SIT techniques to be helpful in managing stress and pain, coping with their injury, and returning to function. The patients also found the exercises useful and acknowledged the importance of both the physical and the psychological aspects of whiplash injury. Patients with acute WAD at risk of poor recovery welcomed the inclusion of psychological strategies as part of physiotherapy treatment. The patients nominated both the psychological (SIT) component and exercise as assisting them with their stress, pain, and recovery. Physiotherapists could consider including strategies targeting early stress responses in their management of patients with acute WAD. [ABSTRACT FROM AUTHOR]

Low back pain (LBP) is the leading cause of disability worldwide. Clinical research advocates using the biopsychosocial model (BPS) to manage LBP, however there is still no clear consensus regarding the meaning of this model in physiotherapy and how best to apply it. The aim of this study was to investigate how physiotherapy LBP literature enacts the BPS model. We conducted a critical review using discourse analysis of 66 articles retrieved from the PubMed and Web of Science databases. Analysis suggest that many texts conflated the BPS with the biomedical model [Discourse 1: Conflating the BPS with the biomedical model]. Psychological aspects were almost exclusively conceptualised as cognitive and behavioural [Discourse 2: Cognition, behaviour, yellow flags and rapport]. Social context was rarely mentioned [Discourse 3: Brief and occasional social underpinnings]; and other broader aspects of care such as culture and power dynamics received little attention within the texts [Discourse 4: Expanded aspects of care]. Results imply that multiple important factors such as interpersonal or institutional power relations, cultural considerations, ethical, and social aspects of health may not be incorporated into physiotherapy research and practice when working with people with LBP. When using the biopsychosocial model with patients with low back pain, researchers narrowly focus on biological and cognitive behavioural aspects of the model. Social and broader aspects such as cultural, interpersonal and institutional power dynamics, appear to be neglected by researchers when taking a biopsychosocial approach to the care of patients with low back pain. The biopsychosocial model may be inadequate to address complexities of people with low back pain, and a reworking of the model may be necessary. There is a lack of research conceptualising how physiotherapy applies the biopsychosocial model in research and practice. [ABSTRACT FROM AUTHOR]

Increasingly, people turn to online sources for health information, creating human-non-human relationalities. Health websites are considered accessible in scope and convenience but can have limited capacity to accommodate complexities. There are concerns about who gets to 'assemble' with these resources, and who is excluded. Guided by Ahmed's socio-political theories of emotions, we questioned our feelings as we intra-acted with a consumer information website about back pain (MyBackPain). This encouraged us to approach resource evaluation in a way that alters conventional rational/cognitive judgement processes. Our inquiry was 'supra-disciplinary' involving public health, sociology, allied health and consumer collaborators. Specifically, we considered relationality – the feelings circulating between bodies/objects and implicated in MyBackPain's affective practices; impressions – the marks, images or beliefs MyBackPain makes on bodies/objects; and directionality – how these intra-actions pushed in some directions and away from others. Although Ahmed would likely not consider herself 'post-humanist', we argue that her socio-political theories of how objects and emotions entangle are of great interest to furthering critical post-human understandings of health. Rather than threatening decision-making, we suggest that feelings (and their affects) are central to it. The article demonstrates the productive potential of critical post-human inquiry in identifying/countering 'othering' possibilities, and catalysing a 'nomadic shift' towards new human-non-human formations. [ABSTRACT FROM AUTHOR]

Purpose: In this paper, we critically investigate the implementation of person-centered care with the purpose of advancing philosophical debates regarding the overarching aims and delivery of rehabilitation. While general agreement exists regarding person centered care's core principles, how practitioners reconcile the implementation of these principles with competing practice demands remains an open question. Materials and methods: For the paper, we drew on post-qualitative methods to engage in a process of "diffractive" analysis wherein we analyzed the micro-doings of person-centered care in everyday rehabilitation work. Working from our team members' diverse experiences, traditions, and epistemological commitments, we engaged with data from nine "care events" generated in previous research to interrogate the multiple forces that co-produce care practices. Results: We map our analyses under three categories: scripts mediate practice, securing compliance through "benevolent manipulations", and care(ful) tinkering. In the latter, we explore the notion of tinkering as a useful concept for approaching person centered care. Uncertainty, humility, and doubt in one's expertise are inherent to tinkering, which involves a continual questioning of what to do, what is best, and what is person centered care within each moment of care. The paper concludes with a discussion of the implications for rehabilitation and person-centered care. Determinations of what constitutes good, better, or best rehabilitation practices are inevitably questions of ethics. Person-centered care is promoted as good practice in rehabilitation because it provides a framework for attending to the personhood of all engaged in clinical encounters. Post-critical analyses suggest that multiple interacting forces, conditions, assumptions, and actions intersect in shaping each rehabilitation encounter such that what constitutes good care or person-centered care cannot be determined in advance. "Tinkering" is a potentially useful approach that involves a continual questioning of what to do, what is best, and what is person-centered care within each moment of care. [ABSTRACT FROM AUTHOR]

Parents of autistic children involved in the Relationship Development Intervention (RDI) receive support and guidance in developing the parent-child relationship and play the key role in successfully delivering this therapeutic intervention. Despite there being emerging evidence that supports RDI’s effectiveness at improving child outcomes, little is known about the parental experiences of this intervention. This study aimed to explore parents’ experiences of RDI and its perceived outcomes for their autistic child and the family. Semi-structured individual interviews were conducted with 12 participants, and the data was thematically analysed, using an inductive approach. The analysis generated three themes: 1) It empowers the parents; 2) Gradual transformation of family life; and 3) Changes in children and family. Parents reported that RDI was time consuming but supported them to meet their children’s needs, having positive impacts on parent-child relationships. This is one of the first studies that explored the parental experiences of RDI, despite it being a parent-focussed intervention. The findings add to the growing evidence to support the efficacy of RDI. While RDI is in its early stage of building evidence, it may be a promising alternative approach for families of autistic children. [ABSTRACT FROM AUTHOR]

In this article, we discuss a number of important considerations that we have encountered in the process of researching health stigma topics as “outsiders”: researchers (personally) unfamiliar with the experience or topic under study. In particular, we discuss the importance of the following: a reflective stance, challenging negative representations, flexible and sensitive recruitment strategies, validating experiences of stigma, and participant control and power. We see these points as particularly important in the context of researching stigma as outsiders, where our privilege may contribute to unhelpful, narrow, de-politicized or overly simplistic representations of particular “groups” or experiences. We share these considerations in hope of assisting other researchers to reflect on, and articulate, how they negotiate their positionings within their research and the ways in which they shape and construct the research agenda and, by implication, the people or topics under examination. [ABSTRACT FROM AUTHOR]