Electronic Thesis and Dissertation Repository

Degree

Doctor of Philosophy

Program

Health and Rehabilitation Sciences

Supervisor

Dr. Denise Connelly

Abstract

Research problem: The majority of older Canadians live with at least one chronic disease. Exercise has been shown to be an effective means to reducing symptoms, and to improving physical dysfunction in chronically ill populations; and self-management is a nationally advocated approach to dealing with the growing health care issue of chronic disease. Physiotherapists are experts in prescribing therapeutic exercise and promoting chronic disease self-management.

Methods: This two-study dissertation explored older adults’ perceptions of exercise as a self-care activity within a chronic disease self-management strategy using focused ethnography; and physiotherapists’ experiences in promoting exercise as a means to chronic disease self-management using hermeneutic phenomenology.

Findings: Older adults defined exercise generally, as movement, but did not demonstrate an understanding of the relevance or importance of exercise intensity or specificity to gain health benefits specific to their chronic disease(s). Older adults preferred to participate in exercise they enjoyed doing and was familiar to them. Older adults may not value exercise as a self-care activity in the same way that physiotherapists do. The client’s values with respect to exercise and the structure of the service model significantly impacted the physiotherapists’ ability to promote chronic disease self-management. Physiotherapists described facilitating chronic disease self-management as an important practice role, but physiotherapists were not referred to promote chronic disease self-management. This meant physiotherapists felt constrained by time, as they attempted to both promote chronic disease self-management and address the primary reason for referral. Physiotherapists took on a consultative role described as making connections with the client to build rapport, to help the client understand their chronic disease, and to connect the client with additional community programs, and/or health care practitioners to meet their goals or care needs.

Conclusions: Physiotherapists could improve efficiency of their practice by gaining skills to help them understand client’s perceptions about exercise as a means to self-care, and or tailoring interventions to include opportunities to participate in enjoyable and familiar activities. Changes to service model with respect to acknowledging the role of physiotherapists in promoting chronic disease self-management could also facilitate physiotherapists’ efforts to enact this role in community settings.

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