Communication between stroke patients and physiotherapists : a conversation analysis
This thesis reports an ethnomethodological, conversation analytic study of communication between stroke patients and physiotherapists. The study sought to describe and explicate patterns of conduct by which therapists and patients communicate about treatment activities during therapy sessions. Analysis included a comparison between practices observed in the data and current published recommendations for good practice. The data consist of 74 treatment sessions that were video-recorded in four English hospitals. The 21 patient participants were undergoing inpatient rehabilitation for stroke. Most were recorded on four occasions over a two-week period. Their disabilities varied, but all could speak and understand at least short sentences in English. Each of the ten therapist participants was employed at senior level and used treatment approaches that are prevalent in the UK. Analysis involved repeated viewing of data and transcription of talk and body movement. It focused on three areas that emerged as central to physiotherapy interactions: The nature of treatment activities and of participation in them Achievement (success and failure) in these activities Reasons, goals and purposes underlying them Consistent with conversation analytic studies in other settings, we found that each communication practice in physiotherapy has a range of interactional effects, and that these are locally constructed and accomplished. Therefore, rather than generating „blanket prescriptions‟ about „good‟ and „bad‟ interactional practices, our study contributes to enhancing practitioners‟ understanding of the contingencies and underlying orientations that shape communication conduct, and raising their awareness of the effects of different means of achieving various interactional tasks in physiotherapy. We argue that these understandings can contribute to improvements in the practice and training of physiotherapy communication. Our study contributes to ethnomethodological and conversation analytic knowledge regarding methodological strategies for researching lay professional interactions, and to sociological understandings about the organisation of conduct in clinical interactions, particularly the role of orientations to managing physical incompetence and its implications.