David Nicholls

Auckland University of Technology | AUT · Discipline of Physiotherapy

Critical physiotherapy has been a rapidly expanding field over the last decade and could now justifiably be called a professional sub-discipline. In this paper we define three different but somewhat interconnected critical positions that have emerged over the last decade that share a critique of physiotherapy's historical approach to health and ill...

Background: Global environmental change is fundamentally altering the composition and functioning of our planetary ecosystem. Effectively presenting the largest threat to the health of present and future generations, these changes and their health impacts are forcing us to think and practice healthcare in much broader terms than ever before. Obje...

The convergence of large datasets, increased computational power, and enhanced algorithm design has led to the increased success of machine learning (ML) and artificial intelligence (AI) across a wide variety of healthcare professions but which, so far, have eluded formal discussion in physiotherapy. This is a concern as we begin to see acceleratin...

We live in a world in which global warming, pollution, social injustice, inequity and population health fundamentally influence each other. As a result, health and health care can no longer be thought of and practiced in an isolated manner. All healthcare professions must educate their current and future colleagues with the necessary understanding...

Background The history of physiotherapy in Latin America has received little attention thus far in the English-speaking literature. In this paper, we draw on narratives from activists, educators, and professional leaders who have been instrumental in shaping the development of physiotherapy in Argentina, Colombia, and Ecuador. Physiotherapists in t...

The history of physiotherapy can be seen as a history of boundary conflict, as the profession sought to first establish, then maintain, its distinctive professional identity. Traditional approaches to the sociology of the professions support this, seeing professionalization as an ongoing process of enclosure, encroachment, and conflict. Recent work...

Background: Neurasthenia was one of the most commonly diagnosed disorders in the later years of the 19th century. Its most widely used treatment, known as the Rest Cure, relied heavily on physical therapies, but little is known about the practitioners who administered the treatment. In this paper, I argue that the nurse-masseuses who delivered the...

The fundamental role of ontology, epistemology, and ethics is widely recognised across the healthcare professions. Yet what is less known in physiotherapy is how ontology and epistemology potentially undermine the ethical intentions of our theories and practices. In this article, we draw on the work of 20th-century philosopher Emmanuel Levinas to h...

Ethics is ever-present in all aspects of human interaction and, in any physiotherapy situation there is an inherent claim to act and care for the patient in the best possible way. The physiotherapy profession is provided with rules, guidelines and codes to support and ensure ethical professional conduct. In recent decades however, physiotherapy lit...

Recent years have seen increased interest in post-disciplinary practice and thinking, and this interest has taken a number of forms. There have been calls for reform of longstanding disciplines like news media and medicine, as well as the emergence of new disciplines like events management and software development. These emerging fields have a dive...

Background: Historically, avoiding any association with prostitution was paramount in the process of making physiotherapy a recognised profession, and maintaining boundaries around intimacy, sexuality and ethics has been an important aspect of physiotherapy since the beginning of the profession. Objectives: Against this background, we explore how m...

A patient-centred approach has gained increasing interest in medicine and other health sciences. Whereas there are discussions about the meaning of a patient-centred approach and what the concept entails, little is known about how the patient as a person is understood in patient-centred care. This article investigates understandings of the patient...

In this editorial, we argue that critical thinking, research, and scholarship are essential to understanding and practicing rehabilitation, and yet they are underrepresented in the existing rehabilitation literature. By using the term critical, we are referring to research and scholarship that draw from social theory to examine pervasive taken-for-...

Aged care is becoming an increasingly significant feature of health care, but it is not an area physiotherapists have traditionally favored. Aging populations of increasingly chronically ill people represent the most important community of need in health care however, and so physiotherapists risk being marginalized if they do not adapt their practi...

Exercise has a long history as a therapeutic modality and has existed, in some form, in all cultures throughout recorded history. In recent years, therapeutic exercise has taken on new significance as a relatively low cost medical intervention designed to improve people’s health and well-being and reduce the downstream effects of comorbidity. Drawi...

Available from: https://press.nordicopenaccess.no/index.php/noasp/catalog/book/29

Physiotherapy is arriving at a critical point in its history. Since World War I, physiotherapy has been one of the largest allied health professions and the established provider of orthodox physical rehabilitation. But ageing populations of increasingly chronically ill people, a growing scepticism towards biomedicine and the changing economy of hea...

In recent decades, physiotherapists have become concerned with cultural, economic, philosophical, political, and social questions and have been exploring more flexible ways of speaking about and practicing physiotherapy. While recognizing the need to embrace a broader range of perspectives, physiotherapy educators and other medical educators have b...

Background: In the third and final article in this three part series, I look at sampling in qualitative studies, methods of data collection and analysis. Content: Building on the previous two articles, I highlight the importance of rigour and explore some of the different criteria used by researchers to demonstrate that their research is trustwort...

This is the final paper reporting on a historiographic study of physical therapies in 19th century Aotearoa/New Zealand. Here we focus on the development of the Rotorua Spa in the final decades of the 19th century and follow the methodological framework of the first two papers by exploring the physical therapies and practitioners that were associat...

Background: There are still many practitioners, academics and researchers who are bemused by the principles and practices of qualitative research. The second paper in this three part series on qualitative research explores the important question of research methodologies. Content: Focusing on four of the more common methodologies—phenomenology, gr...

This paper is the second of two reporting on a historiographic study of physical therapies in 19th century Aotearoa/New Zealand. This paper focuses on physical therapies practised by colonists, missionaries, pioneers, and other settlers to Aotearoa/New Zealand before 1900. The paper follows the methodological framework of the first paper and explor...

Drawing from Annemarie Mol's conceptulisation of multiplicity, we explore how health care practices enact their object(s), using physiotherapy as our example. Our concern is particularly to mobilise ways of practicing or doing physiotherapy that are largely under-theorised, unexamined or marginalised. This approach explores those actions that resid...

This paper is the second of two reporting on a historiographic study of physical therapies in 19th century Aotearoa/New Zealand. This paper focuses on physical therapies practised by colonists, missionaries, pioneers, and other settlers to Aotearoa/New Zealand before 1900. The paper follows the methodological framework of the first paper and explor...

This paper is the first of three reporting on a historiographic study of physical therapies in 19th century Aotearoa/New Zealand. This first paper focuses on traditional Māori healing practices. The paper begins by setting out the parameters for the study and outlining the role that massage and manipulation, electrotherapy, hydrotherapy and remedia...

In this chapter, I have used the historical figure of the artisan to develop a critique of the limits of present health care practice. Drawing on Michel Foucault’s later works on truth telling (parrhēsia) and Hannah Arendt’s writings on action, making, behaviour and fabrication, I offer the possibility that a revised notion of the artisan practitio...

Having spent their first century anchored to a biomedical model of practice, physiotherapists have been increasingly interested in exploring new models and concepts that will better equip them for serving the health-care needs of 21st century clients/patients. Connectivity offers one such model. With an extensive philosophical background in phenome...

Vocational rehabilitation for people experiencing work disability is a social practice often situated within health services, but the social and political drivers and effects of this practice are rarely critically analysed in health research or policy. In this study we used a Foucauldian theoretical perspective to analyse the ways in which current...

Rationale for this Report Changes in delivery and focus for UG education • Change from hospital or vocational based programmes to Institute / University based programmes • Change from diploma to degree status (Hunt, Adamson, Higgs & Harris, 1998; Ladyshewsky, 2000; McKenzie, 1999) • Altered health care delivery (often decentralized health servic...

Central to health practice is the aim to use professional knowledge and capabilities in the service of others (Higgs, 2012). The inherent humanness of health practice highlights the importance of health practice relationships in shaping individuals’ access, agency and abilities for the achievement of meaningful health outcomes. In this chapter we i...

Postmodernism is a notion that causes as much confusion as it does consternation, yet in recent years it has become one of the most widely debated philosophies in health care research. Based on skepticism of grand narratives and an opening towards diversity and inclusiveness, postmodern research provides a set of tools and some distinctive ways of...

FADYL JK and NICHOLLS DA. Nursing Inquiry 2013; 20: 23–29 Foucault, the subject and the research interview: a critique of methods Research interviews are a widely used method in qualitative health research and have been adapted to suit a range of methodologies. Just as it is valuable that new approaches are explored, it is also important to continu...

Discourse analysis following the work of Michel Foucault has become a valuable methodology in the critical analysis of a broad range of topics relating to health. However, it can be a daunting task, in that there seems to be both a huge number of possible approaches to carrying out this type of project, and an abundance of different, often conflict...

For nearly 40 years, researchers have been coming to terms with the impact of Michel Foucault's philosophical work. In fields as diverse as medical sociology, health policy, architecture, urban geography, history, and sport, scholars have made use of Foucault's notions of discourse, knowledge, truth, and power. With a few exceptions, however, Fouca...

Therapeutic touch has played an important part in human civilization and continues to contribute to our social relations and individual identities. Therapeutic touch has been a vital component in the development and definition of physiotherapy practice and continues to be one of the profession's principal distinguishing competencies. It is surprisi...

In recent years, physiotherapists have been increasingly interested in defining their professional identity. At the heart of this interest lies a fundamental question about the role that the body plays in defining physiotherapy practice. Given the importance of the body to physiotherapy, it is surprising how under-theorized the body is in existing...

This paper is a report of a secondary analysis of the experiences of employed breastfeeding mothers. Health promotion policies exhort mothers to feed their infants breastmilk exclusively for the first 6 months and partially until the age of 2 years. More mothers are returning to paid employment less than a year after having a baby. Combining breast...

Background There are still many practitioners, academics and researchers who are bemused by the principles and practices of qualitative research. In the third and final article in this three part series, I look at sampling in qualitative studies, methods of data collection and analysis. Content Building on the previous two articles, I highlight th...

Background There are still many practitioners, academics and researchers who are bemused by the principles and practices of qualitative research. The second paper in this three part series on qualitative research explores the important question of research methodologies. Content Focusing on four of the more common methodologies – phenomenology, gr...

Background Qualitative research has made great strides in recent years and it now makes an important contribution to our understanding of health and illness. But there are still many practitioners, academics and researchers who are totally bemused by its principles and practices. Content In the first of a series of three articles exploring qualita...

It is estimated that by 2050, one in five adults will be over 65 and four-fifths of them will have one or more chronic illness. Many chronic illnesses encompass subjective (i.e., social, spiritual, cultural, and personal) phenomena that can only be interpreted by the person experiencing them. Much of the current health care research oversimplifies...

Over the last 30 years there has been a gradual but nonetheless significant shift in the political economy of healthcare in developed countries. The health reforms that have accompanied this shift have had a significant impact upon medicine, nursing and a number of other orthodox health professions, but to date, little work has been done to explore...

This paper presents an overview of the methodological approach taken in a recently completed Foucauldian discourse analysis of physiotherapy practice. In keeping with other approaches common to postmodern research this paper resists the temptation to define a proper or ‘correct’ interpretation of Foucault’s methodological oeuvre; preferring instead...

In 1894 the Society of Trained Masseuses (STM) formed in response to massage scandals published by the British Medical Journal (BMJ). The Society's founders acted to legitimise massage, which had become sullied by its association with prostitution. This study analyses the discourses that influenced the founders of the Society and reflects upon the...

This paper discusses how physiotherapists might respond to the challenges of health care reform taking place in New Zealand. We begin by outlining the health policy initiatives that are challenging our understanding of physiotherapy practice. We then outline a socio-political history of physiotherapy, using the 'body-as-machine' as a metaphor. We t...

This paper considers the related concepts of breathlessness and self-image. It argues that quantitative methods are based on dogma rather than methodological awareness and illustrates an alternative model. Using life history narratives and a grounded theory framework, the author argues that qualitative methodologies are the only ones capable of obt...

Physiotherapists are clear about the meaning of objective and subjective information when assessing a patient. Objective data are considered to be a set of ‘facts’ representing the patients current status; the blood gas results, X-ray changes, goniometry measurements or lung function tests. Subjective information is used to embellish the objective...