The significance of social rules in group training sessions

Abstract

Purpose: To identify what types of social rules are involved in group interventions led by physiotherapists (PTs), and how these rules influence individual recovery.

Methods: Eight patients; six women and two men, which had recently undergone elective hip or knee replacement surgery, were recruited as informants from an intervention group that investigated effect of task specific exercise. The data comprise observational notes from group training sessions and one-on-one semi-structured interviews with the eight patients. Observational notes contributed to the development of the research questions. The interviews were audio-recorded and transcribed, and a theoretically-oriented analytical approach guided by performance theory was conducted to identify the rules.

Results: Several implicit rules for behavior when attending this group intervention were identified. The compulsory style enhances recovery in an explicit manner.

Conclusion: When giving advice and home exercise PTs must acknowledge that the roles patients are subtly exposed to during the actual clinical encounter are probably quite different from the roles the patients can merge into outside the therapy context. This might shed some light on the notion of patient adherence/concordance.

The significance of social rules in group training sessions.

Implications for Rehabilitation

• Health professionals should be aware of the implicit social regulations of the clinical encounter. They will influence whether and how patients adhere to advice.

• By acknowledging that patients have different roles to merge into, depending on context, health professionals may significantly broaden our understanding of patient adherence and compliance.

• The social rules identified in this study contribute to individual recovery processes. We encourage health professionals to regard “group dynamics” as something that is going on during the group session, and worthwhile taking advantage of when planning and implementing group interventions.

Keywords:

• Physiotherapy
• recovery
• concordance
• Goffman
• health behavior
• role

Acknowledgments

The authors thank Kristi Elisabeth Heiberg and Vigdis Bruun-Olsen for fruitful discussions throughout the process of conducting the study and writing this article. We also thank Professor Nina Vøllestad and researcher Wenche Bjorbækmo for a final reading.

Disclosure statement

The authors report no declarations of interest.

Funding

We thank the Norwegian Fund for Post-Graduate training in Physiotherapy, who financially supported the first author.