Fysioterapeuten 9-2017

FYSIOTERAPEUTEN 9/17 43 Sammendrag n I denne artikkelen argumenterer vi for nødvendigheten av at fysioterapeuter en- drer sin praksis i møtet med barn og unge som behandles for overvekt/fedme. Vi tar utgangspunkt i Barbara Gibsons post-kritiske etikk der målet er å reformulere moralsk praksis – noe som innebærer fokus på åpenhet og tvil som en del av en etisk forsvarlig fysioterapipraksis. I våre analyser anvendes Gibsons tilnærming for å oppdage etiske øyeblikk i forbindelse med barn og unges deltakelse i behandlingsopplegg der endring av livsstil er sentralt. Med utgangspunkt i empiriske eksempler fra to gruppebaserte livsstilsprogram der vektkontroll vektlegges gjennom regelmessige tester, understrekes betydningen av Gibsons tilnærming for å utfordre rådende praksis og etablerte normer. Ved å være sensitiv for (egen) tvil analyseres muligheter for nye praksisformer frem. Vi konkluderer med at det å innta et kritisk, etisk perspektiv til egen praksis er nødvendig for å utfordre status quo, gjennom å åpne opp for nye spørsmål når det gjelder hvordan barn og unge med overvekt/fedme bør behandles. adolescents in a vulnerable situation. This is not to say that embracing such an ethical approach is easy. On the contrary, a commit- ment to post-critical ethics in physiotherapy requires a radical shift in habits of thought. Appreciating that everyday practices of as- sessment and treatment are imbued with ethical import requires physiotherapists to adopt a position of constant, ongoing do- ubt. «What are you doing when you are doing what you are doing? Why this way? How does it affect the people both positively and nega- tively? Does it need to change? How could it be done differently?» (17, p. 137). A critical ethics for physiotherapy involves ongoing doubt as to the boundaries of the familiar. It demands critical reflection on one’s own practice. It means questioning basic prin- ciples and modes of thought, whether of traditional bioethics or of evidence-based practice. And as Karin’s experiences reveal, engaging in an ethics of doubt also requires the involvement of patients and colleagues. Concluding remarks Our research suggests that Gibson’s post- critical ethics can help physiotherapists re- flect critically on their own practice, towards the development of new approaches to chal- lenges and dilemmas. We also argue that the ethical aspects involved in the practice of testing require urgent, ongoing exploration and discussion. In particular, the ability to identify ethical moments of doubt – mo- ments that raise questions about established practices or suggest they may no longer be the best way ahead – emerges as crucial for physiotherapists and the development of their future practice. Acknowledgements We are grateful to Barbara E. Gibson for her generosity so that we could draw on her article «post-critical physiotherapy ethics: a commitment to openness» (in press). We also acknowledge Groven’s co-authors, Jen- ny Setchell and Nicole Glenn so that we co- uld draw on their article «What’s in a num- ber» (in press). References 1. Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx B.W. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies . Arch Gen Psychiatry, 2010; 67: 220-229. 2. Mannucci E, Petroni ML, Villanova N, Rotella CM, Apolone G, Marchesini G. Clinical and psychological corre- lates of health-related quality of life in obese patient s . Health Qual Life Outcomes, 2010; 8: 90. 3. Engström A, Abildsnes E, Mildestvedt T. It’s not like a fat camp. A focus group study of adolescents’ experi- ences on group-based obesity treatment . International Journal of Qualitative Studies on Health and Well-being, 2016; Doi: 10.3402/qhw.v11.32744. 4. Unick JL, Beavers D, Jakicic JM, Kitabchi AE, Knowler WC, Wadden. A Effectiveness of lifestyle interventions for individuals with severe obesity and type 2 diabetes: results from the Look AHEAD trial . Diabetes Care, 2011; 34: 2152-2157. 5. Blackburn GL, Wollner S, Heynsfield SB. Lifestyle interventions for the treatment of class 111 obesity: a primary target for nutrition medicine in the obesity epidemic . American Journal of Clinical Nutrition, 2010, 91: 289s-292s. 6. Benestad B, Lekhal S, Småstuen M, Hertel JK, Halsteinli V, Ødegård RA, Hjelmesæth J. Camp-based family tre- atment of childhood obesity: randomized controlled tria l . Arch Dis Child, 2016: 1-8, doi: 10.1136/archdis- child-2015-309813. 7. Danielsen KK, Sundgot-Borgen J, Rugseth G. Severe obesity and the ambivalence of attending physical activity: Exploring lived experiences, 2016 , Qualitative Health Research, 26 (5): 685-696. 8. Danielsen KK. Inpatient intensive lifestyle interven- tion for the treatment of severe obesity: Beyond the weight reduction and experience with physical activit y . Dissertation, 2015, Norwegian School of Sport Sciences. 9. Holm JC, Nowicka P, Farpour-Lambert NJ, Baker JL. The ethics of childhood obesity treatment . Obesity Facts, 2014, 7, 274-281. 10. Puder JJ, Munsch S. Psychological correlates of childhood obesity . International Journal of Obesity, 2010; 34, 37-43. 11. Russel-Mayhew S, McVey G, Bardick A. Mental health, wellness and childhood overweight/obesity . Journal of Obesity, 2012, http://dx.doi.org/10.1155/2012/281801 . 12. Doherty RF, Purtilo RB. Ethical dimensions in the health professions , 2015, Elsevier Health Sciences. 13. Hofmann B. Etiske aspekt ved fedmebehandling av barn og unge. [Ethical aspects and obesity treatment involving children and adolescents]. Tilleggsrapport til rapporten «effekt av tiltak for barn og unge med overvekt og fedme». Folkehelseinstituttet, 2016. Etisk vurdering av behandlingstiltak, 1-25. 14. Partridge CJ. Does ethical practice in physiotherapy matter? P hysiotherapy Research International. 2010; 15(2): 65-8. 15. Scott R. Supporting professional development: Understanding the interplay between health law and professional ethics . Journal of Physical Therapy Educa- tion; 2000, 14 (3): 17-24. 16. Swisher LL. A retrospective analysis of ethics knowledge in physical therapy (1970-2000 ) . Physical Therapy, 2002; 82 (7): 692-706. 17. Gibson BE. Rehabilitation: A post-critical approach, 2016 , New York: CRC Press, Taylor and Fransis Group. 18. Gibson BE. Post-Critical physiotherapy: A commitment to openness. In Gibson, Nicholls, Setchell & Groven, Ma- nipulating practices – a critical pysiotherapy reader, Oslo: Cappelen Damm Akademisk (in press). 19. Bjorbækmo WS, Engelsrud GH. Experiences of being tested: a critical discussion of the knowledge involved and produced in the practice of testing in children’s rehabilita- tion. Medicine, Health Care and Philosophy, 2011, 14 (2), 123-131. 20. Schriver N, Engelsrud GH. Rehabilitation of a knee injury: tensions between standardized exercises and lived experiences . Journal of Sports and Social Issues, 2011, 35, 22-33. 21. Rugseth G, Engelsrud GH. Overvåking av vekt . I G. Engelsrud, & K. Heggen (red.), Humanistisk sykdomslære: tanker om diagnoser og sykdom, helse og velvære. 2007. Oslo: Universitetsforlaget, ss. 128-147. 22. Bjorbækmo WS. «My own way of moving»: The mo- vement experiences of children with disabilities. (Doctoral dissertation). University of Oslo, 2010, Oslo, Norway. 23. Nicholls DA., & Gibson BE. The body and physiothe- rapy . Physiotherapy Theory and Practice, 26(8), 2010, 497-509. 24. Nicholls DA. (2017). The end of physiotherapy . London: Routledge. 25. Rugseth G. & Standal Ø. «My body can do magical things». The movement experiences of a man categorized as obese – a phenomenological study. Phenomenology & Practice, 2015, 9(1), 5-15. 26. Setchell J, Watson BM, Gard M & Jones L. Physical Therapists’ ways of talking about overweight and obesity: Clinical implications . Physical Therapy, 2016, 96 (6), 865-875. 27. Groven KS, Setchell J, Glenn NM. What’s in a number? Progress and body shame in lifestyle programs for adolescents . In Gibson, Nicholls, Setchell & Groven, Manipulating practices – a critical physiotherapy reader (in press). Oslo: Cappelen Damm Akademisk. 28. Groven KS & Heggen KM. (2016). Evidence and/or experience-based knowledge in lifestyle treatment of patients diagnosed as obese ? Indo-pacific journal of phenomenology, 1-2, 181-194.

RkJQdWJsaXNoZXIy MTQ3Mzgy