On the inside of a walking skill programme for patients who have undergone total hip or knee
arthroplasty: A qualitative study
Sammanfattning
A walking skill intervention was reported by two randomized controlled trials (RCTs) to be
effective in improving walking for patients who had undergone total hip or knee arthroplasty. When
studying non-pharmacological interventions, addressing outcomes as well as developing insights
into how the intervention is tailored to the specific context is recommended. The purpose of this
study was to examine how and why adjustments to a walking skill intervention were made in clinical
situations. Field and reflection notes from two physiotherapists’ self-observations of 50 training
sessions performed during 6 months were analysed. The field notes were subjected to thematic
analyses. The paper describes how walking skills were improved and normalized through a series of
adjustments. The adjustments were made according to how the patients’ aspirations differed, what
impairments the physiotherapists considered important to improve, the severity of the impairments
and how they influenced the patients’ ability to walk. To enable the patient to perform the programme,
the physiotherapists applied a mixture of theoretical and practical knowledge in their reasoning, and
considerable creativity was shown in finding appropriate exercises to meet each patient's needs.
Individualized adjustments dependent on the programme may give insight into a greater complexity
of practice than reported in RCTs.