Exercise Prescription for Patients with Non-specific Chronic Low Back Pain: a Qualitative Study of Patients' Experiences in Decision Making

Background The culture of current clinical practice calls for collaboration between therapists and patients, sharing power and responsibility. This paper reports on the findings of a qualitative study of exercise prescription for patients with NSCLBP, taking into account issues such as decision making and how this accords with patient preferences and experiences. Objective To understand the treatment decision making experiences, information and decision support needs of patients with NSCLBP who have been offered exercise as part of their management plan. Design A qualitative study using a philosophical hermeneutic approach. Methods Semi-structured interviews with eight patients (including use of brief patient vignettes) was undertaken to explore their personal experiences of receiving exercise as part of the management of their NSCLBP, and their involvement in decisions regarding their care. Findings The findings provide a detailed insight into patients’ perceptions and experiences of receiving exercise-based management strategies. Four themes were formed from the texts: (1) patients’ expectations and patients’ needs are not synonymous, (2) information is necessary but often not sufficient, (3) not all decisions need to be shared, and (4) wanting to be treated as an individual. Conclusions Shared decision making did not appear to happen in physiotherapy clinical practice, but equally may not be what every patient wants. The overall feeling of the patients was that the therapist was dominant in structuring the interactions, leaving the patients feeling disempowered to question and contribute to the decision making.

Visualising Spaces: The Illustrated Map as a Mode of Communicating Fact, Fiction and Feeling

Communicating thoughts, facts and narratives through visual devices such as allegory or symbolism was fundamental to early map making and this remains the case with contemporary illustration. Drawing was employed then as a way of describing historic narratives (fact and folklore) through the convenience of a drawn symbol or character. The map creators were visionaries, depicting known discoveries and anticipating what existed beyond the agreed boundaries. As we now have photographic and virtual reality maps at our disposal, how can illustration develop the language of what a map is and can be? How can we break the rules of map design and yet still communicate the idea of a sense of place with the aim to inform, excite and/or educate the ‘traveller’? As Illustrators we need to question the purpose of creating a ‘map’: what do we want to communicate and is representational image making the only way to present information of a location? Is creating a more personal interpretation a form of cartouche, reminiscent of elements within the Hereford Mappa Mundi and maps of Blaeu, and can this improve/hinder the communicative aspect of the map? Looking at a variety of historical and contemporary illustrated maps and artists (such as Grayson Perry), who track their journeys through drawing, both conventional journeys and emotional, I will aim to prove that the illustrated map is not mere decoration but is a visual language providing an allegorical response to tangible places and personal feelings.