The Path to Translating Focus of Attention Research Into Canadian Physiotherapy, Part 1: Physiotherapists’ Self-Reported Focus of Attention Use Via a Study-Specific Questionnaire

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Julia Hussien School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada

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https://orcid.org/0000-0001-7434-228X *
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Diane Ste-Marie School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada

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The focus of attention literature has shown robust findings for the benefits of providing statements that focus on the movement effect or outcome (external focus of attention [EFOA]) as opposed to focusing on the movement kinematics (internal focus of attention). Observational studies, however, have revealed that physiotherapists use fewer EFOA statements than internal focus of attention statements in their practice. Most evidence in this regard has been from non-Canadian physiotherapists working in stroke rehabilitation; consequently, we sought to examine whether Canadian physiotherapists working with various rehabilitation populations also use EFOA statements to a lesser extent than internal focus of attention statements. The “Therapists’ Perceptions of Motor Learning Principles Questionnaire (TPMLPQ)” was thus designed and data from 121 Canadian physiotherapists showed low relative frequencies of EFOA use (31.3% ± 14%) averaged across six hypothetical scenarios. A higher EFOA was reported, however, for two of the six scenarios: a functional reaching scenario (55.5% ± 37.0%) and pelvic floor task (65.6% ±32.9%). This data suggest that the findings of EFOA benefits have not been widely translated into Canadian physiotherapy settings; furthermore, the findings of the scenario-dependency warrant future investigation into factors, such as task characteristics, that may influence physiotherapists’ FOA use.

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  • Ahsanullah, M., Kibria, B.M.G., & Shakil, M. (2014). Normal distribution. In M. Ahsanullah, B.M.G. Kibria, & M. Shakil (Eds.), Normal and student’s t distributions and their applications (pp. 750). Atlantis Press. https://doi.org/10.2991/978-94-6239-061-4_2

    • Search Google Scholar
    • Export Citation
  • Atun-Einy, O., & Kafri, M. (2019). Implementation of motor learning principles in physical therapy practice: Survey of physical therapists’ perceptions and reported implementation. Physiotherapy Theory and Practice, 35(7), 633644. https://doi.org/10.1080/09593985.2018.1456585

    • Search Google Scholar
    • Export Citation
  • Bramley, A., Rodriguez, A.A., Chen, J., Desta, W., Weir, V., DePaul, V.G., & Patterson, K.K. (2018). Lessons about motor learning: How is motor learning taught in physical therapy programmes across Canada? Physiotherapy Canada, 70(4), 365372. https://doi.org/10.3138/ptc.2017-31.e

    • Search Google Scholar
    • Export Citation
  • Canadian Institute for Health Information. (2021). Physiotherapists. https://www.cihi.ca/en/how-many-physiotherapists-are-in-canada

  • Chiviacowsky, S., Wulf, G., & Wally, R. (2010). An external focus of attention enhances balance learning in older adults. Gait & Posture, 32(4), 572575. https://doi.org/10.1016/j.gaitpost.2010.08.004

    • Search Google Scholar
    • Export Citation
  • Chua, L.K., Jimenez-Diaz, J., Lewthwaite, R., Kim, T., & Wulf, G. (2021). Superiority of external attentional focus for motor performance and learning: Systematic reviews and meta-analyses. Psychological Bulletin, 147(6), 618645. https://doi.org/10.1037/bul0000335

    • Search Google Scholar
    • Export Citation
  • Diekfuss, J.A., Rhea, C.K., Schmitz, R.J., Grooms, D.R., Wilkins, R.W., Slutsky, A.B., & Raisbeck, L.D. (2019). The influence of attentional focus on balance control over seven days of training. Journal of Motor Behavior, 51(3), 281292. https://doi.org/10.1080/00222895.2018.1468312

    • Search Google Scholar
    • Export Citation
  • Durham, K., Van Vliet, P.M., Badger, F., & Sackley, C. (2009). Use of information feedback and attentional focus of feedback in treating the person with a hemiplegic arm. Physiotherapy Research International: The Journal for Researchers and Clinicians in Physical Therapy, 14(2), 7790. https://doi.org/10.1002/pri.431

    • Search Google Scholar
    • Export Citation
  • Gokeler, A., Benjaminse, A., Welling, W., Alferink, M., Eppinga, P., & Otten, B. (2015). The effects of attentional focus on jump performance and knee joint kinematics in patients after ACL reconstruction. Physical Therapy in Sport, 16(2), 114120. https://doi.org/10.1016/j.ptsp.2014.06.002

    • Search Google Scholar
    • Export Citation
  • Greenfield, B.H., Greene, B., & Johanson, M.A. (2007). The use of qualitative research techniques in orthopedic and sports physical therapy: Moving toward postpositivism. Physical Therapy in Sport, 8(1), 4454. https://doi.org/10.1016/j.ptsp.2006.11.002

    • Search Google Scholar
    • Export Citation
  • Halperin, I., Williams, K.J., Martin, D.T., & Chapman, D.W. (2016). The effects of attentional focusing instructions on force production during the isometric midthigh pull. The Journal of Strength & Conditioning Research, 30(4), 919923. https://doi.org/10.1519/JSC.0000000000001194

    • Search Google Scholar
    • Export Citation
  • Harris, J.E., Boushey, C., Bruemmer, B., & Archer, S.L. (2008). Publishing nutrition research: A review of nonparametric methods, part 3. Journal of the American Dietetic Association, 108(9), 14881496. https://doi.org/10.1016/j.jada.2008.06.426

    • Search Google Scholar
    • Export Citation
  • Hunt, C., Paez, A., & Folmar, E. (2017). The impact of attentional focus on the treatment of musculoskeletal and movement disorders. International Journal of Sports Physical Therapy, 12(6), 901907.

    • Search Google Scholar
    • Export Citation
  • Johnson, L., Burridge, J.H., & Demain, S.H. (2013). Internal and external focus of attention during gait re-education: An observational study of physical therapist practice in stroke rehabilitation. Physical Therapy, 93(7), 957966. https://doi.org/10.2522/ptj.20120300

    • Search Google Scholar
    • Export Citation
  • Kal, E., van den Brink, H., Houdijk, H., van der Kamp, J., Goossens, P.H., van Bennekom, C., & Scherder, E. (2018). How physical therapists instruct patients with stroke: An observational study on attentional focus during gait rehabilitation after stroke. Disability and Rehabilitation, 40(10), 11541165. https://doi.org/10.1080/09638288.2017.1290697

    • Search Google Scholar
    • Export Citation
  • Kim, T., Jiménez Díaz, J., & Chen, J. (2017). The effect of attentional focus in balancing tasks: A systematic review with meta-analysis. Journal of Human Sport and Exercise, 12(2), 463479. https://doi.org/10.14198/jhse.2017.122.22

    • Search Google Scholar
    • Export Citation
  • Laufer, Y., Rotem-Lehrer, N., Ronen, Z., Khayutin, G., & Rozenberg, I. (2007). Effect of attention focus on acquisition and retention of postural control following ankle sprain. Archives of Physical Medicine and Rehabilitation, 88(1), 105108. https://doi.org/10.1016/j.apmr.2006.10.028

    • Search Google Scholar
    • Export Citation
  • Lohse, K., & Sherwood, D.E. (2011). Defining the focus of attention: Effects of attention on perceived exertion and fatigue. Frontiers in Psychology, 2, Article 332. https://doi.org/10.3389/fpsyg.2011.00332

    • Search Google Scholar
    • Export Citation
  • Lohse, K.R., Sherwood, D.E., & Healy, A.F. (2010). How changing the focus of attention affects performance, kinematics, and electromyography in dart throwing. Human Movement Science, 29(4), 542555. https://doi.org/10.1016/j.humov.2010.05.001

    • Search Google Scholar
    • Export Citation
  • Marchant, D.C., Greig, M., Bullough, J., & Hitchen, D. (2011). Instructions to adopt an external focus enhance muscular endurance. Research Quarterly for Exercise and Sport, 82(3), 466473. https://doi.org/10.1080/02701367.2011.10599779

    • Search Google Scholar
    • Export Citation
  • McNevin, N.H., Wulf, G., & Carlson, C. (2000). Effects of attentional focus, self-control, and dyad training on motor learning: Implications for physical rehabilitation. Physical Therapy, 80(4), 373385. https://doi.org/10.1093/ptj/80.4.373

    • Search Google Scholar
    • Export Citation
  • Mückel, S., & Mehrholz, J. (2014). Immediate effects of two attention strategies on trunk control on patients after stroke. A randomized controlled pilot trial. Clinical Rehabilitation, 28(7), 632636. https://doi.org/10.1177/0269215513513963

    • Search Google Scholar
    • Export Citation
  • Neil-Sztramko, S.E., Ghayyur, A., Edwards, J., & Campbell, K.L. (2017). Physical activity levels of physiotherapists across practice settings: A cross-sectional comparison using self-report questionnaire and accelerometer measures. Physiotherapy Canada, 69(2), 152160. https://doi.org/10.3138/ptc.2015-64

    • Search Google Scholar
    • Export Citation
  • Neumann, D.L. (2019). A systematic review of attentional focus strategies in weightlifting. Frontiers in Sports and Active Living, 1, Article 7. https://doi.org/10.3389/fspor.2019.00007

    • Search Google Scholar
    • Export Citation
  • Piccoli, A., Rossettini, G., Cecchetto, S., Viceconti, A., Ristori, D., Turolla, A., Maselli, F., & Testa, M. (2018). Effect of attentional focus instructions on motor learning and performance of patients with central nervous system and musculoskeletal disorders: A systematic review. Journal of Functional Morphology and Kinesiology, 3(3), Article 40. https://doi.org/10.3390/jfmk3030040

    • Search Google Scholar
    • Export Citation
  • Raisbeck, L.D., Yamada, M., Diekfuss, J.A., & Kuznetsov, N.A. (2020). The effects of attentional focus instructions and task difficulty in a paced fine motor skill. Journal of Motor Behavior, 52(3), 262270. https://doi.org/10.1080/00222895.2019.1614900

    • Search Google Scholar
    • Export Citation
  • Redenbach, D., & Bainbridge, L. (2007). Canadian physiotherapy education: The University of British Columbia example. Physical Therapy Reviews, 12(2), 92104. https://doi.org/10.1179/108331907X175087

    • Search Google Scholar
    • Export Citation
  • Richer, N., Ly, K., Fortier, N., & Lajoie, Y. (2020). Absence of ankle stiffening while standing in focus and cognitive task conditions in older adults. Journal of Motor Behavior, 52(2), 167174. https://doi.org/10.1080/00222895.2019.1599808

    • Search Google Scholar
    • Export Citation
  • Simms, L.J., Zelazny, K., Williams, T.F., & Bernstein, L. (2019). Does the number of response options matter? Psychometric perspectives using personality questionnaire data. Psychological Assessment, 31(4), 557566. https://doi.org/10.1037/pas0000648

    • Search Google Scholar
    • Export Citation
  • Wulf, G. (2013). Attentional focus and motor learning: A review of 15 years. International Review of Sport and Exercise Psychology, 6(1), 77104. https://doi.org/10.1080/1750984X.2012.723728

    • Search Google Scholar
    • Export Citation
  • Wulf, G., & Dufek, J.S. (2009). Increased jump height with an external focus due to enhanced lower extremity joint kinetics. Journal of Motor Behavior, 41(5), 401409. https://doi.org/10.1080/00222890903228421

    • Search Google Scholar
    • Export Citation
  • Wulf, G., Höß, M., & Prinz, W. (1998). Instructions for motor learning: Differential effects of internal versus external focus of attention. Journal of Motor Behavior, 30(2), 169179. https://doi.org/10.1080/00222899809601334

    • Search Google Scholar
    • Export Citation
  • Wulf, G., Landers, M., Lewthwaite, R., & Toöllner, T. (2009). External focus instructions reduce postural instability in individuals with Parkinson disease. Physical Therapy, 89(2), 162168. https://doi.org/10.2522/ptj.20080045

    • Search Google Scholar
    • Export Citation
  • Wulf, G., & McNevin, N. (2003). Simply distracting learners is not enough: More evidence for the learning benefits of an external focus of attention. European Journal of Sport Science, 3(5), 113. https://doi.org/10.1080/17461390300073501

    • Search Google Scholar
    • Export Citation
  • Zachariah, N. (2013). Use of attentional focus in a rehabilitation setting: A comparison of theoretical frameworks and clinical practice. Electronic Theses and Dissertations. Article 4938. https://scholar.uwindsor.ca/etd/4938

    • Search Google Scholar
    • Export Citation
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