title: Use of information feedback and attentional focus of feedback in treating the person with a hemiplegic arm.
abstract: OBJECTIVE
  Feedback about motor performance can induce either an internal focus of attention (about body movement) or an external focus of attention (about the effects on the environment) in the learner. The main aim of this pilot study was to examine the attentional focus of feedback given by physiotherapists during treatment of the hemiplegic arm. A second aim was to examine the frequency of feedback about motor performance during treatment.
  
  
  METHODS
  A multi-methods design was used (quantitative and qualitative). Eight physiotherapists and eight patients with stroke were recruited from two hospitals. Data were collected by video recordings of treatment, interviews (both therapists and patients) and questionnaire (therapists). Information feedback, instructions and motivational statements were identified from the video recordings. Feedback and instructions were further grouped into internal focus, external focus or mixed focus of attention. Themes were drawn from the interview transcripts. Triangulation was used to provide corroborating information from the different data sets.
  
  
  RESULTS
  Two hundred and forty-six of the total 1914 statements identified in the videos were feedback, the rest comprising instructions and statements of motivation. Of the feedback statements, 236 of the total 247 identified had an internal focus. Therapist interviews and questionnaires revealed more external focus communication than actual treatment.
  
  
  CONCLUSIONS
  Physiotherapists used instructions and statements of motivation more than feedback and directed the patient's attention more to body movement than movement effects. The outcome of this study may prompt clinicians' to examine the amount and the attentional focus of the feedback they use in their clinical practice, and to consider whether it is a most effective approach in light of current evidence.
authors.affiliation: School of Health Sciences, The University of Birmingham, Edgbaston, Birmingham, UK. k.f.durham@bham.ac.uk
authors.forename: Katherine
authors.initials: K
authors.lastname: Durham
authors.forename: Paulette M
authors.initials: PM
authors.lastname: Van Vliet
authors.forename: Frances
authors.initials: F
authors.lastname: Badger
authors.forename: Catherine
authors.initials: C
authors.lastname: Sackley
mesh_terms: D000368:Aged; D001132:Arm / Q000503:physiopathology; D001288:Attention; D001676:Biofeedback, Psychology / Q000379:methods*; D005260:Female; D006306:Health Surveys; D006429:Hemiplegia / Q000209:etiology / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010353:Patient Education as Topic / Q000379:methods*; D010865:Pilot Projects; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D014743:Videotape Recording