Mobilizing Knowledge in Physiotherapy

Critical Reflections on Foundations and Practices

David A. Nicholls, Karen Synne Groven, Elizabeth Kinsella, Rani Anjum, David A. Nicholls, Karen Synne Groven, Elizabeth Anne Kinsella, Rani Lill Anjum

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000217773
• Edition: 1
• Topic: Medicine
• Subtopic: Physiotherapy, Physical Medicine & Rehabilitation

Mobilizing Knowledge in Physiotherapy: Critical Reflections on Foundations and Practices is a collection of 15 collaboratively written critical essays, by 39 authors from 15 disciplines and seven countries. The book challenges some of the most important contemporary assumptions about physiotherapy knowledge, and makes the case for much more critical theory, practice, and education in physiotherapy health and social care.

The book challenges the kinds of thinking that have traditionally bounded the profession and highlights the ways in which knowledge is now increasingly fluid, complex, and diffuse. The collection engages a range of critical social theories and interdisciplinary perspectives from within and without the profession. It includes sections focusing on evidence, practice, patient perspectives, embodiment, culture, diversity, digital worlds, and research methods. The book makes an important contribution to how we think about mobilizing knowledge, and it speaks to a diverse audience of academics, practitioners, educators, policy-makers, and students - both within physiotherapy and from a range of related health and social care disciplines.

This book will be a useful reference for scholars interested in conceptions of professional knowledge, and the theory of professional education and practice in physiotherapy and beyond.

1
Introduction

David A. Nicholls, Karen Synne Groven, Elizabeth Anne Kinsella, and Rani Lill Anjum

This manuscript began its life at a book launch for Manipulating Practices, the first-ever edited collection of critical physiotherapy writings. In February 2018, just two months after the book had been released online, some of the authors gathered at the Litteraturhuset, in Oslo, to formally launch the book and celebrate its success. Achieved in part because it was open access and therefore freely available, more than 6,000 people had downloaded the book, and today it has been accessed by more than 20,000 people, making it the most-accessed text in publisher Cappelen Damm’s history. Perhaps it was appropriate, then, that at the book launch, four eminent scholars offered critical commentaries. Two of the discussants – Dr Rani Lill Anjum and Professor Per Koren Solvang – commended the book, describing it as an important contribution to critical physiotherapy, but also suggested that because it focused on physiotherapy authors looking critically at physiotherapy practice, it was rather inward looking. It would be good, they suggested, to also have a text that encouraged physiotherapists to be more outward looking. And so, at the end of that meeting, a plan was hatched to begin work on a follow-up to Manipulating Practices and to find a way to be more exoteric.

Professors Karen Synne Groven and Dave A. Nicholls met in Sydney in June 2018 for the In Sickness and In Health conference, and while there, decided that we would invite contributions for a second book from physiotherapists on the condition that they collaborate with a non-physiotherapy author. And with the first book focusing on practices, we wanted to focus this book on knowledge. We then invited interdisciplinary scholars Dr Rani Lill Anjum and Professor Elizabeth Anne Kinsella to join us on the editorial team. Both were close to the Critical Physiotherapy Network (CPN), both were established scholars interested in epistemological questions relevant to professional knowledge, and neither was a physiotherapist, so our editorial team reflected our focus on epistemology and honoured our commitment to be more outward looking.

We were somewhat nervous about our call for abstracts because critical physiotherapy studies are still in their infancy, and we had no idea whether we had exhausted our field with the first book. We need not have worried. We received 49 diverse and powerful chapter proposals from all over the world for this (second) book, which gave us the enviable but no less difficult task of selecting for the collection.

Our production schedule began mid-2019, and authors completed their chapters by February 2020. As had been the case with the first book, the response from the authors and the quality and diversity of their work has been breathtaking. This is particularly gratifying given that this is still virgin territory for a lot of physiotherapists.

Although critical writings in medicine, nursing, and psychology have been the norm for nearly half a century now, and medical sociology is a vibrant scholarly field, critical physiotherapy studies really only began in earnest in 2014 with the formation of the CPN. Since then, there has been a dramatic increase in the number of articles, editorials, blog posts, social media posts, conference presentations, and even a handful of long-form manuscripts produced that give voice to critical physiotherapy. There can be little doubt now that critical physiotherapy is a sub-discipline in its own right, and the publication of this book offers evidence of an emerging, vibrant, critical community of scholars, keen to be a positive force for an ‘otherwise’ physiotherapy.

But the success of critical physiotherapy as a field of study in recent years does not mean anyone can rest on their laurels. No one can have any doubt that we are at the crossroads of one of the most exciting and challenging points in the history of the profession and healthcare generally. Health systems around the world are in flux; we have unprecedented access to health knowledge and information technology that could transform everyone’s work. We have healthcare happening in myriad locations, perhaps only a relatively small portion of which is regulated. We have a looming climate catastrophe and the ever-present threat of globalised pandemics. We have a world map that is being reshaped demographically and transformed attitudes towards our bodies, health, movement, relationships, and meaning. Who knows what physiotherapy will look like in 50 years’ time. All we can say is that it will be very different from today.

So how does this book make a contribution to this epochal debate? First, as with all of us, we can try in our own modest way to engage in these discussions; to be a part of the polis and have our voice heard. Second, we can offer ideas that may never have been articulated before; we can say things that may have been too difficult or disallowed or not visible in the past. Third, we can make our mark, literally in print. We can stand for something. Perhaps that something is greater diversity, tolerance, and inclusion, or perhaps it is a call for greater clarity, precision, and definition. And finally, we can come together and give voice to ideas that we believe can and do make a difference.

When Donald Schon wrote The Reflective Practitioner 35 years ago, he was doing far more than guiding practitioners to engage in reflection on their practices: his insights were far more radical. He was pointing to the limits of technical knowledge as a guiding rationality for the professions and calling for recognition of the epistemological significance of other forms of knowledge, particularly those generated through reflection in and on professional practices.

Many of the chapters in this collection illuminate this seemingly radical proposition, that knowledge generated through various forms of reflection, critical reflection, and critical reflexivity is epistemologically significant. Knowledge generated through critical forms of reflection in and on practice is shown throughout this collection to render important epistemological contributions that expand the borders of our understandings, that radically shift how we think about what it is to mobilize knowledge in physiotherapy education and practice.

Knowledge comes to the fore in this collection, not as something situated in a distant, technical, objectivist, universalist, foundationalist milieu, nor as something to be ‘implemented’ by practitioners onto service users. Rather knowledge reveals itself here through radically constituted dialogue that brings attention to the practice-based experiences, disjunctures, tensions, ruptures, reflections, and insights of practitioners and service users, in conversation with critical social theoretical and philosophical perspectives, to generate new forms of knowledge that are palpable and compelling in their logic and relevance to professional education and practice.

As a collection, the various perspectives presented here make visible and bring to the centre a number of hidden, or marginalized, yet epistemically significant perspectives. This work mobilizes knowledge by redressing past epistemic imbalances, by reclaiming the space for marginalized perspectives, by re-centring important conversations from the periphery, by ‘showing’ the significance of practice-based perspectives through exemplars and conversations with philosophy and critical social theory. Through this broad recognition of the knowledge contributions of people, theories, discourses, and concepts at the periphery, this work moves us closer to epistemic justice and to more inclusivity in our quest to generate and mobilize knowledge across divides.

Where Manipulating Practices focused on a broad range of philosophical and theoretical questions, broadly applied to physiotherapy practice, Mobilizing Knowledge concentrates on some of the epistemological questions now surrounding physiotherapy. These questions were raised by Monika Nerland, writing in Trede and McEwan’s Educating the Deliberate Professional, who argued that the future for professions like physiotherapy relies on their ability to respond to the transformations now taking place in knowledge production and distribution (Nerland, 2016). Implicit in these arguments is the belief that the epistemological presuppositions that once provided orthodox professions with their social status are in decline, being replaced by a heterodox matrix of complex assemblages and discourses that call into question and open conversations concerning the fabric of professional curricula, codes of conduct, practice theories, and socially validated roles. Mobilizing Knowledge steps into this space by bringing together scholars in and around the field of physiotherapy who are challenging the kinds of knowledge that have traditionally bounded the profession.

The book’s founding premise is that the world in which physiotherapy now operates is evolving rapidly, and so it is axiomatic that physiotherapists will need to be open to new kinds of knowledge and new ways of thinking. There are works in this volume, then, that explore:

• Historical development of physiotherapy knowledge
• Ways in which physiotherapists have claimed particular kinds of knowledge and marginalised others
• Links between physiotherapy knowledge in theory and in practice
• Emerging knowledges being deployed by educators, practitioners, and researchers
• Rethinking the significance of practice-based knowledges and epistemologies of practice in physiotherapy
• Students’ experiences of knowledge acquisition
• Challenges of adapting physiotherapy to new kinds of knowledge
• Alter-, cross-, inter-, meta-, multi-, pluri-, post-, and trans-disciplinary contributions to knowledge generation
• Possibilities for radically rethinking what physiotherapy is or can be
• Synergies, collaborations, and fruitful boundary breaches that may transform physiotherapy thinking and practice
• Ruptures, disruptions, interruptions, disjunctures, and disorientations that invite reflection on the boundaries of physiotherapy knowledge
• Cultural, economic, philosophical, political, social, or spiritual challenges to physiotherapy’s traditional biomedical worldview
• Radical and critical emancipatory challenges to western, androcentric, heteronormative, colonial, sanist, and ableist hegemonies
• Methods for developing, evaluating, implementing, and critiquing physiotherapy knowledge
• Knowledge and physiotherapy curriculum
• Knowledge as a limiting factor in transforming future practice
• Emerging research methodologies that challenge bio-scientific and interpretivist modes of knowledge production
• Consideration of epistemic justice in relation to whose testimonies are privileged and legitimated and whose testimonies may be silenced or excluded in physiotherapy practice

Overall, we hope to provoke, prompt, and prime the profession, however modestly, for a transformation that may exceed anything we could have imagined even six years ago when the CPN was formed. To that end, we have brought together 39 authors across 15 chapters, from seven countries and more than 14 disciplines. As well as physiotherapy academics, clinicians, researchers, and doctoral students, the collection includes authors who are health service users and authors from medical anthropology, philosophy, non-fiction, community health, speech and language therapy, social work, occupational therapy, sociology, education, child protection, photography, dietetics, and psychology.

We see that, although all the chapters start from the perspective of physiotherapy, each chapter actually tackles some deeper, more general issues that have relevance far beyond physiotherapy. The book is thus an example of how one can use critical reflection as a methodology to mobilize a profession, contribute to the transformation of epistemic insights, and broaden conceptualizations of knowledge and thus avoid becoming locked into a dogmatic mindset where the epistemic premises, such as concepts, approaches, and methods, are simply decided by the dominating paradigm. In this sense, this book is as much a contribution to the philosophy of science and ethics as it is a contribution to critical scholarship in physiotherapy.

The book opens with Dave and Jon Nicholls’ chapter ‘Beyond Empathy: How Physiotherapists and Photographers Learn to Look’, which explores physiotherapists’ traditional biomedical and normative ways of looking at bodies. Drawing inspiration from contemporary photography, especially the work of amateur photographer Frank Weedon, they argue for a change of focus – a focus in which an empathic and relational approach is acknowledged. Such a shift in focus is paramount, they argue, in order for the profession to develop in a more reciprocal relationship with their patients.

In the next chapter, ‘Bodily Ways of Knowing: How Students Learn About and Through Bodies During Physiotherapy Education’, Anne Gudrun Langaas and Anne-Lise Middelthon argue for the centrality of bodily knowledge in physiotherapy education. The authors argue that education must move beyond technical, theoretical, biomedical, and communicative domains to also focus on the cultivation of physiotherapists’ bodily knowledge. Theoretical constructs such as Polanyi’s tacit knowledge, Sheets-Johnstone’s primacy of movement, and Despret’s insights that having a body entails being affected by other entities are used to draw attention to the relationship between embodiment and knowledge generation. The authors examine how students learn both about and through bodies – how bodies are shaped and what bodies do – in physiotherapy education. This chapter calls for educational approaches that make the centrality of bodily knowledge and its importance to competent physiotherapy practice more explicit.

Next, in ‘Care in Physiotherapy – A Ghost Story’, Birgitte Ahlsen, Alette Ottesen, and Clemet Askheim make a compelling case for re-centring ‘care’ in physiotherapy practice. The authors draw on practice-based vignettes from a physiotherapist’s encounters with a patient; in dialogue with the Roman myth of Cura (or Care); and theoretical insights from Freud, Heidegger, and Mol to show how ‘care’ is latent and repressed in physiotherapy practice. They argue that this is a result of a predominant emphasis on biomedical perspectives and a focus on the body that excludes mind and soul. The authors contend that the logic of choice and the logic of care frequently come into collision and that this results in the suppression of care and a failure to acknowledge its importance. The chapter makes visible the ways in which care is central to what it means to be human and consequently to the practice of physiotherapy and to the recovery of the profession. This work opens an important dialogue concerning the need to make space for care in physiotherapy practice.

‘Rethinking Recovery’ by Anne Marit Mengshoel and Marte Feiring explores two different understandings of recovery: disease- and outcome-oriented, compared with process- and experience-oriented. While recovery as an outcome motivates current evidence-based practice, where the goal of therapy is its curative effect, the same cannot apply to many chronic conditions. Here, recovery is seen as the process of coming to terms with and adapting to the new situation, which would motivate a more person-centred and individualized approach to therapy. The authors discuss how the two understandings may be integrated or co-produced. They use examples from physiotherapy, but the insights apply generally to all health professions.

Kate Waterworth, Dave A. Nicholls, Lisette Burrows, and Michael Gaffney’s chapter ‘Physiotherapy for Children and the Construction of the Disabled Child’ embarks on a historical examination of the physiotherapy profession. Exploring the construction of particular forms of knowledge, the authors explore how notions of normality and otherness gained ground following World War II, inspiring physiotherapists to give priority to children’s rehabilitation potential. In this era, two discourses emerged shaping contemporary physiotherapy: the disabled child as having ‘potential’ and the disabled child as not normal. These discourses are, however, problematic, as they create what the authors term a particular social identity for disabled children – that of the ‘other’. In order to change this emphasis, the authors argue for the need to expand physiotherapists’ knowledge base through a number of post-critical perspectives.

The chapter ‘Learning From Biology, Philosophy, and Sourdough Bread: Challenging the Evidence-Based Practice Paradigm for Community Physiotherapy’, written by Satu Reivonen, Finlay Sim, and Cathy Bulley, invites us to critically review the philosophical foundations of the current paradigm of evidence-based practice. More specifically, the authors show that whether one thinks of knowledge and evidence in terms of controllable, context-independent static entities (things, substances) or as highly complex, context-dependent, dynamic, and non-linear processes, one’s choice will affect the way evidence is understood, generated, and used to inform complex care plans for individuals with multiple long-term conditions.

Guided by indigenous Métis worldview and knowledge, Liris Smith, Sylvia Abonyi, Liz Durocher, TJ Roy, and Sarah Oosman challenge what they term a predominant ‘Eurocentric focus’ in physical therapy. In their chapter, ‘Mâmawi-Atoskêwin, “Working Together in Partnership” – Challenging Eurocentric Physical Therapy Practice Guided by Indigenous Métis Worldview and Knowledge’, Smith and co-authors argue that contemporary physiotherapy has grown within western paradigms of thought and epistemology. In this process, however, the profession has failed to acknowledge alternative knowledge systems, such as those practised by Indigenous populations. In this chapter, the authors propose possibilities for innovatively rethinking the practice of physical therapy in partnership with Indigenous communities. In particular, they suggest applying an ‘ethical space’ approach to collaboratively working within a northern Canadian Métis community to co-create research and practice. Bridging the strengths of Western and Indigenous worldviews, they pinpoint what is paramount in meeting the needs and priorities of healthy ageing in the Métis community while acquiring new perspectives that transform contemporary physical therapy practice.

In ‘Feeling Good About Yourself? An Exploration of FitBit “New Moms Community” as an Emergent Space for Online Biosociality’, Alma Viviana Silva Guerrero and Wendy Lowe explore the competitive self-policing, physical accomplishments, and existential tensions experienced by women post-partum. Analysing a community of women engaging in a FitBit community site, the authors draw on feminist post-structural praxiographic research to examine the motivations, frustrations, self-imposed judgements, and aspirations of women as they engage with thei...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Contents
• List of figures
• List of tables
• List of contributors
• Acknowledgements
• 1 Introduction
• 2 Beyond empathy: how physiotherapists and photographers learn to look
• 3 Bodily ways of knowing: how students learn about and through bodies during physiotherapy education
• 4 Care in physiotherapy – a ghost story
• 5 Rethinking recovery
• 6 Physiotherapy for children and the construction of the disabled child
• 7 Learning from biology, philosophy, and sourdough bread – challenging the evidence-based practice paradigm for community physiotherapy
• 8 Mâmawi-atoskêwin “working together in partnership” – challenging Eurocentric physical therapy practice guided by Indigenous Métis worldview and knowledge
• 9 Feeling good about yourself? An exploration of FitBit “new moms community” as an emergent space for online biosociality
• 10 Disability as expertise: mobilizing a critique of school-based physical therapy for integrating disability studies into physical therapy professionalization
• 11 A person-centred and collaborative model for understanding chronic pain. Perspectives from a pain patient, a practitioner, and a philosopher
• 12 Finding the right track: embodied reflecting teams for generous physiotherapy
• 13 Why care about culture? Encountering diversity in a paediatric rehabilitation context: reflections on epiphanies and transformative processes
• 14 Using Deleuze: language, dysphasia, and physiotherapy
• 15 How are we doing? Placing human relationships at the centre of physiotherapy
• Index