Physiotherapy December 2002/vol 88/no 12

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Rhoda AllisonAuckland University of Technology and South Devon Healthcare NHS TrustIntroduction Rehabilitation is an area of healthcare whereit is particularly important to develop a client-focusedapproach. This study examined the ways in whichassessments were conducted and goals of treatment wereagreed between physiotherapists and service users. AFoucaldian discourse analysis was chosen as the researchmethod. This was primarily due to the critical potential ofFoucalt’s approach, with particular reference to the role ofpower and knowledge in relationships between healthcareusers and professionals.

Method Detailed assessments between six service users andphysiotherapists were observed and recorded. The datacomprised transcripts of the assessments, and the text ofpublicised policies, guidelines and standards that were feltto impact on practice. The data also included the access toinformation for both parties before the assessment.

A Foucaldian discourse analysis was used to identify thepredominant discourses that were adopted byphysiotherapists and service users in the assessments. These

discourses were then analysed to identify the subject andpower positions they offered for service users andphysiotherapists, and the power strategies exercised duringthe assessments. This paper introduces Foucault’s conceptsof discourse and power, and demonstrates discourse analysisof several extracts from the assessments.

Findings Discourses of medicine and medicine-basedpractice tended to dominate the assessments. Thesediscourses frequently positioned the physiotherapist in arole of more authority and the service user in a morepassive role. Although discourses of empowerment and userinvolvement were present in the rhetoric of standards andpolicies, they were less apparent in clinical practice.

Discussion Through discussion of the competing discoursesoccurring in these assessments, this paper explores some ofthe difficulties that physiotherapists face with attempts todevelop empowering practices, alongside demands forevidence-based practice and some of the traditionalconstraints of service provision. It highlights the instancesof empowering practices that did occur and considers howthese can be developed.

Sustained Maximal Inspiratory Manoeuvres Can Be Used toPredict Extubation Outcome after Prolonged Periods ofMechanical Ventilation

CARDIO-RESPIRATORY CARE

A Foucaldian Discourse Analysis of the Ability of Physiotherapy Service Users to Participate in Goal Setting

PROFESSIONAL ISSUES

A BrutonUniversity of SouthamptonIntroduction Maximal inspiratory pressure is an acceptedeffort-dependent measure of global inspiratory musclestrength. Although numerous studies have examined itsability to predict weaning/extubation outcome aftermechanical ventilation, maximal inspiratory pressure hasgenerally been found to have lower specificity than isclinically acceptable. The Respiratory Trainer (RT2) is anew device originally conceived as a methodology fortraining the inspiratory muscles. It generates threemeasures of inspiratory muscle function including a newmeasure called sustained maximal inspiratory pressure.This is calculated as the area under the curve produced bysampling maximal inspiratory pressure at 16 Hz during asustained inspiratory manoeuvre.

Method Twenty-seven intubated adults who had requiredprolonged mechanical ventilation (48 hours or more) andwere deemed ready for extubation were measured using theRT2 before extubation. Differences in sustained maximalinspiratory pressure measures between extubation successand failure outcome groups were then sought usingindependent samples t-tests. The sensitivity and specificityof using different levels of sustained maximal inspiratorypressure measures to predict outcome were also calculatedusing receiver operating charactistic curves.

Results Significant differences in sustained maximalinspiratory pressuremeasures were found between theextubation success and failure groups (t = 7.371, p < 0.001).A sustained maximal inspiratory pressure cut-off point of