Graham Stew | University of Brighton (original) (raw)
Papers by Graham Stew
Journal of Psychiatric and Mental Health Nursing, Aug 15, 2010
Journal of Occupational Science, Aug 16, 2012
This article introduces reversal theory in relation to flow theory and occupational science. The ... more This article introduces reversal theory in relation to flow theory and occupational science. The reasons why reversal theory might be compatible with research into the flow process are explored. Reversal theory itself is described and the methods by which people are thought to move between domains and metamotivational states are explained. The variety of research underpinning reversal theory is examined
Otjr-occupation Participation and Health, 2009
Occupational balance is a prominent concept in occupational therapy and in society at large, and ... more Occupational balance is a prominent concept in occupational therapy and in society at large, and could be a key concept in that it may enhance understanding of the link between occupation and health. Because there is a lack of empirical evidence, the aim of this study was to critically examine the existing assumptions regarding occupational balance. An open narrative approach was applied to include the life context of the participants and to deliberately exclude predefinitions of the concept. From 10 reconstructed life stories, which were analyzed individually, three new dimensions of occupational balance related to health and grounded in the data were developed: a balance between challenging versus relaxing occupations and activities, activities meaningful for the individual and activities meaningful in a sociocultural context, and activities intended to care for oneself and activities intended to care for others. These three dimensions of occupational balance may be key concepts for future research.
Qualitative Health Research, Mar 12, 2008
Our aim with this study was to explore the narrative life story of individuals diagnosed with rhe... more Our aim with this study was to explore the narrative life story of individuals diagnosed with rheumatoid arthritis. An open qualitative approach, namely narrative biographic methodology, was applied to include the life context of the participants and to deliberately exclude predefinitions of concepts. Ten people with rheumatoid arthritis who retired early because of the disease participated and were interviewed three times according to a narrative biographic interview style. The biographical data and the interview texts were analyzed both individually and in comparison to each other. Some participants regarded rheumatoid arthritis as a challenge for mastery in their lives, whereas others adapted to the disease and "made the best out of a bad situation." Especially in countries where the medical model predominates in health care, our findings can be used to broaden the current view that some health professionals have toward patients, and stress the importance of patients being self-responsible.
Occupational Therapy in Health Care, May 15, 2023
British Food Journal, May 1, 2001
The notion of consumer sovereignty is not a new concept. However to effectively use it as a tool ... more The notion of consumer sovereignty is not a new concept. However to effectively use it as a tool to improve food hygiene standards, proprietors of eating‐places must know what customers look for to assess those standards. It is also important that customers demonstrate their unwillingness to buy from unhygienic premises. This article summarises research, using the “Delphi Technique”, backed up by semi‐structured interviews which has established a body of new knowledge about the subject. Conclusions are drawn about the relevance of food hygiene standards to running an effective business and the need for a public education campaign. The results also challenge current views about the importance of food hygiene standards to customers.
Journal of Advanced Nursing, Mar 1, 1996
New meanings: a qualitative study of change in nursing education This paper reports on the experi... more New meanings: a qualitative study of change in nursing education This paper reports on the experiences of teachers m one college of nursmg and midwifery in South East England during a period of profound and complex change Personal perceptions and reactions are studied in the context of professional and organizational influences A phenomenological approach was used to identify and portray the personal perspectives and meanings of the respondents Fifty semi-structured interviews with a purposeful sample of the college staff were supplemented with participant observation and documentary analysis The data were analysed inductively, and emergent categones were confirmed and clarified through respondent validation Findings relating to organizational, professional and personal perceptions are presented alongside the major themes of belonging, knowing and controlling The conclusions and implications of this exploratory study are discussed, together with aspects of the researcher's role and areas for future research
Journal of Interprofessional Care, Jun 1, 2005
This article describes the outcomes of a two-year project, commissioned by the Department of Heal... more This article describes the outcomes of a two-year project, commissioned by the Department of Health, to investigate the development of pre-registration education for the allied health professions in Kent, Surrey and Sussex. A range of data collection methods were adopted in order to identify where and how interprofessional education (IPE) was occurring in clinical settings. It was found that IPE is highly contextualized, and develops according to a variety of situational factors. The types of IPE encountered are described and their respective features, strengths and limitations are discussed.
Springer eBooks, Jun 14, 2018
International Nursing Review, Jun 1, 2006
Background: Institutionalized international nurse training organized by national educational inst... more Background: Institutionalized international nurse training organized by national educational institutions is a relatively new phenomenon. This, descriptive case study examines an early example of an American-Italian initiative of such training, in order to stimulate future international education of nurses. Aim: To find out what factors have to be taken into account to improve training and what its potential effects are in exchange and also in the context of nurse migration. Method: A questionnaire was sent to the 85 nurses who all participated in this particular international programme (response rate: 30.6%). Findings: The collected data indicate that personalized and well-aimed training, preparatory language courses, predeparture exposure of nurses to the culture of the host country and well-prepared welcomes are among the most important ways to improve this programme. Implications for practice: While the specific circumstances and cultures involved in this particular case study should not be ignored, these factors might also be applied to maximize the positive effects of nurse-migration. Twoway learning is among the positive effects of such an international training experience. Motivational and teambuilding effects can result in enhanced quality of care and a more efficient allocation of resources. However, the mind-opening effect seems to be the most important learning experience. Therefore, regardless of whether one system is considered better or worse than another, experiencing a different way of nursing/education is considered the most important, enriching element of an international learning experience. The effects of this experience could include avoiding cultural imposition in the increased cultural diversity of nursing in the country of origin.
Reflective Practice, Aug 1, 2007
A number of health professional groups have been looking at alternative models to the traditional... more A number of health professional groups have been looking at alternative models to the traditional 1:1 model of practice education in order to meet the increasing shortage of practice placements for pre-registration students. One such model that has been explored recently is the 2:1 or ...
Journal of Occupational Science, Oct 1, 2007
Abstract This study builds on previous research that has aimed to clarify uncertainties regarding... more Abstract This study builds on previous research that has aimed to clarify uncertainties regarding what happens before, during and after a 'flow' experience, a psychological state that appears to arise during optimal human experience. A phenomenological approach was taken to ...
Qualitative Research in Psychology, 2006
Boredom remains a poorly understood phenomenon despite its evident association with dysfunctional... more Boredom remains a poorly understood phenomenon despite its evident association with dysfunctional behavior and mental health problems. However, little research has been devoted to the topic, and the bulk of studies have almost exclusively been quantitative in design. For this reason, a qualitative, interpretive phenomenological study was carried out, during which ten participants were asked for their accounts of the experience of boredom. These people were sampled from the general population. The aims of the study were to find out more about the antecedents to boredom, the experience itself, any stages in its development, and methods used to deal with it. Findings indicated that boredom is an extremely unpleasant and distressing experience. Situations giving rise to the sensation varied between specific external factors, to a general propensity to boredom proneness, although, according to the participants of the study, these could change throughout their lifetime. Feelings comprising the experience of boredom were almost consistently those of restlessness combined with lethargy. No stages in the development of the experience were identified. Strategies used to overcome the problem varied greatly, but generally involved trying to find interesting things to do. These strategies tended to be unsuccessful. Traditional methods of dealing with boredom have focused on increasing stimulation and choice in the environment. The authors propose that a more effective strategy might be to focus more on internal causes of boredom, such as an inability to sustain attention, although further research is required to support this interpretation of the data.
Journal of Occupational Science, Aug 16, 2012
This article follows on from a previous discussion paper Exploring optimal experiences: A reversa... more This article follows on from a previous discussion paper Exploring optimal experiences: A reversal theory perspective of flow and occupational science, which argued the utility of reversal theory for increasing understanding of optimal experiences of engagement in occupation. Flow has been argued to be an optimal experience that occurs when people get so absorbed in what they are doing that
British Journal of Occupational Therapy, Jun 1, 2011
Introduction: This article describes the experiences of occupational therapy students over the co... more Introduction: This article describes the experiences of occupational therapy students over the course of three mindfulness programmes, designed to support them in managing stress in their personal and professional lives. Method: Hermeneutic phenomenology was used to explore the experiences and perceptions of 20 students undertaking these introductory programmes of mindfulness. Data were collected through interviews, questionnaires and emails. Findings: Five themes are presented to demonstrate the effects of mindfulness on students' personal lives, academic work and practice placements. Obstacles to mindfulness practice were found, alongside evidence of benefits in enhanced self-awareness and insight into habitual thought patterns. Techniques for managing stressful situations were used successfully. Conclusion: Implications arising from the study are discussed, including the potential for the future inclusion of mindfulness training within the occupational therapy curriculum.
International journal of therapy and rehabilitation, Apr 1, 2011
Background: The Neater Uni-wheelchair was designed as an alternative to powered wheelchairs, leve... more Background: The Neater Uni-wheelchair was designed as an alternative to powered wheelchairs, lever drive and dual handrim wheelchairs for hemiplegic users. It is a standard Action 3 chair to which a kit has been attached which enables users to self-propel and steer independently of attendants. The aim of this pilot study was to explore users' experiences of the Neater Uni-wheelchair in the home environment. Methods: Six users from a previous study, carried out in 2009, agreed to evaluate the Neater Uniwheelchair in their home environments. The methodological approach was micro-ethnography (Holloway and Wheeler, 2010) and data were transcribed and analysed using Framework Analysis (Ritchie and Spencer, 1994). Findings: Key themes identified were independence and freedom, ease of use and manoeuvrability, usefulness and change in activity. This pilot study would support the notion that the Neater Uniwheelchair is a viable alternative to those that are currently available to hemiplegic users. Conclusions: The results from this exploratory study would support the need for a larger study. There are no storage issues, it is a cheaper option than a powered wheelchair and it would appear to increase independence, activity and participation in the short term.
Neuropsychological Rehabilitation, 2013
Many persons with traumatic brain injury (TBI) are young adults who, prior to their TBI, were in ... more Many persons with traumatic brain injury (TBI) are young adults who, prior to their TBI, were in paid employment. Psychosocial outcome after TBI, for many, remains poor. This includes low rates of return to pre-injury work or education, among others. This qualitative study explored the experience of return to work (RTW) rehabilitation with 10 individuals who sustained TBI. Data were collected from semi-structured interviews. Transcripts were analysed using interpretative phenomenological analysis (IPA). Some of the main findings from this study included the following: Individuals find the RTW experience difficult and painful. They experience a distinct grief reaction in the process of exploring re-engagement in occupation following TBI. In view of these and other findings, changes to RTW rehabilitation should be considered to facilitate the optimal support for patients with TBI engaging in the RTW rehabilitation process.
Journal of Occupational Science, Aug 2, 2022
PURPOSE: According to the literature, expert physiotherapists possess a superior organization of ... more PURPOSE: According to the literature, expert physiotherapists possess a superior organization of knowledge, organized around working hypothesis, that includes specific patterns, which can be explicitly and intuitively recognized and more general abstract sets of semantic relations, which reflect meaningful links between aspects of the problem (Mayer 1992; Jones and Higgs 1995; Higgs and Jones 1995). This organization of knowledge allows for the solution of a typical problem almost automatically through recognition of clinical patterns. In these conditions, knowledge base becomes highly structured in the forms of semantic networks (referred as “schemas”). The purpose of this qualitative study was to describe the knowledge structure of expert physiotherapists when managing low back pain patients. Relevance: Elicitation and description of expert physiotherapists’ working hypothesis, both diagnostic and non- diagnostic will contribute to clarify the types of knowledge used in physiotherapy practice. Subjects: A sample of four expert physiotherapists was selected from a pool of registered physiotherapists of the Portuguese Manual Therapy Group, according to the following criteria: more than 10 years of experience in acute and recurrent low back pain, post- graduate education in areas related with management of low back pain problems and participation as lecturers or clinical supervisors in undergraduate and postgraduate courses related to neuromusculoskeletal dysfunctions. Methods and Material: This investigation uses a qualitative case study design. Data was collected through non- participant observation, semi- structured interview, memos and field notes, during the episode of care. The interviews were audio taped, transcribed and analysed. Data analysis process was organized according to Morse’s Model of qualitative data analysis (1994). After transcription of each interview, information received was coded. The coding process searches for working hypothesis according to Rivett and Higgs (1997) framework. Analysis: Coding categories were developed and revised while data analysis continues. Analysis of the data collected from video- observation and interview were reviewed by the sample that has been involved in the study. Both criterioa used in observation, and coding schema will be analysed by two external persons, who were not involved within the study. Results: The analysis of data showed evidence of working hypothesis generation in some specific themes. The majority of hypothesis formulated on the first session were related with areas or structures that could be responsible for patient’s symptoms and the mechanism by which a patient’s symptoms are being initiated and/ or maintained. In the following sessions the working hypothesis moved progressively to management and reassessment. Conclusions: This study provides some support for the view that understanding patient’s symptoms and its relationship with movement dysfunction seems to be the major concepts that organized expert’s reasoning in the management of low back pain patients.
Journal of Psychiatric and Mental Health Nursing, Aug 15, 2010
Journal of Occupational Science, Aug 16, 2012
This article introduces reversal theory in relation to flow theory and occupational science. The ... more This article introduces reversal theory in relation to flow theory and occupational science. The reasons why reversal theory might be compatible with research into the flow process are explored. Reversal theory itself is described and the methods by which people are thought to move between domains and metamotivational states are explained. The variety of research underpinning reversal theory is examined
Otjr-occupation Participation and Health, 2009
Occupational balance is a prominent concept in occupational therapy and in society at large, and ... more Occupational balance is a prominent concept in occupational therapy and in society at large, and could be a key concept in that it may enhance understanding of the link between occupation and health. Because there is a lack of empirical evidence, the aim of this study was to critically examine the existing assumptions regarding occupational balance. An open narrative approach was applied to include the life context of the participants and to deliberately exclude predefinitions of the concept. From 10 reconstructed life stories, which were analyzed individually, three new dimensions of occupational balance related to health and grounded in the data were developed: a balance between challenging versus relaxing occupations and activities, activities meaningful for the individual and activities meaningful in a sociocultural context, and activities intended to care for oneself and activities intended to care for others. These three dimensions of occupational balance may be key concepts for future research.
Qualitative Health Research, Mar 12, 2008
Our aim with this study was to explore the narrative life story of individuals diagnosed with rhe... more Our aim with this study was to explore the narrative life story of individuals diagnosed with rheumatoid arthritis. An open qualitative approach, namely narrative biographic methodology, was applied to include the life context of the participants and to deliberately exclude predefinitions of concepts. Ten people with rheumatoid arthritis who retired early because of the disease participated and were interviewed three times according to a narrative biographic interview style. The biographical data and the interview texts were analyzed both individually and in comparison to each other. Some participants regarded rheumatoid arthritis as a challenge for mastery in their lives, whereas others adapted to the disease and "made the best out of a bad situation." Especially in countries where the medical model predominates in health care, our findings can be used to broaden the current view that some health professionals have toward patients, and stress the importance of patients being self-responsible.
Occupational Therapy in Health Care, May 15, 2023
British Food Journal, May 1, 2001
The notion of consumer sovereignty is not a new concept. However to effectively use it as a tool ... more The notion of consumer sovereignty is not a new concept. However to effectively use it as a tool to improve food hygiene standards, proprietors of eating‐places must know what customers look for to assess those standards. It is also important that customers demonstrate their unwillingness to buy from unhygienic premises. This article summarises research, using the “Delphi Technique”, backed up by semi‐structured interviews which has established a body of new knowledge about the subject. Conclusions are drawn about the relevance of food hygiene standards to running an effective business and the need for a public education campaign. The results also challenge current views about the importance of food hygiene standards to customers.
Journal of Advanced Nursing, Mar 1, 1996
New meanings: a qualitative study of change in nursing education This paper reports on the experi... more New meanings: a qualitative study of change in nursing education This paper reports on the experiences of teachers m one college of nursmg and midwifery in South East England during a period of profound and complex change Personal perceptions and reactions are studied in the context of professional and organizational influences A phenomenological approach was used to identify and portray the personal perspectives and meanings of the respondents Fifty semi-structured interviews with a purposeful sample of the college staff were supplemented with participant observation and documentary analysis The data were analysed inductively, and emergent categones were confirmed and clarified through respondent validation Findings relating to organizational, professional and personal perceptions are presented alongside the major themes of belonging, knowing and controlling The conclusions and implications of this exploratory study are discussed, together with aspects of the researcher's role and areas for future research
Journal of Interprofessional Care, Jun 1, 2005
This article describes the outcomes of a two-year project, commissioned by the Department of Heal... more This article describes the outcomes of a two-year project, commissioned by the Department of Health, to investigate the development of pre-registration education for the allied health professions in Kent, Surrey and Sussex. A range of data collection methods were adopted in order to identify where and how interprofessional education (IPE) was occurring in clinical settings. It was found that IPE is highly contextualized, and develops according to a variety of situational factors. The types of IPE encountered are described and their respective features, strengths and limitations are discussed.
Springer eBooks, Jun 14, 2018
International Nursing Review, Jun 1, 2006
Background: Institutionalized international nurse training organized by national educational inst... more Background: Institutionalized international nurse training organized by national educational institutions is a relatively new phenomenon. This, descriptive case study examines an early example of an American-Italian initiative of such training, in order to stimulate future international education of nurses. Aim: To find out what factors have to be taken into account to improve training and what its potential effects are in exchange and also in the context of nurse migration. Method: A questionnaire was sent to the 85 nurses who all participated in this particular international programme (response rate: 30.6%). Findings: The collected data indicate that personalized and well-aimed training, preparatory language courses, predeparture exposure of nurses to the culture of the host country and well-prepared welcomes are among the most important ways to improve this programme. Implications for practice: While the specific circumstances and cultures involved in this particular case study should not be ignored, these factors might also be applied to maximize the positive effects of nurse-migration. Twoway learning is among the positive effects of such an international training experience. Motivational and teambuilding effects can result in enhanced quality of care and a more efficient allocation of resources. However, the mind-opening effect seems to be the most important learning experience. Therefore, regardless of whether one system is considered better or worse than another, experiencing a different way of nursing/education is considered the most important, enriching element of an international learning experience. The effects of this experience could include avoiding cultural imposition in the increased cultural diversity of nursing in the country of origin.
Reflective Practice, Aug 1, 2007
A number of health professional groups have been looking at alternative models to the traditional... more A number of health professional groups have been looking at alternative models to the traditional 1:1 model of practice education in order to meet the increasing shortage of practice placements for pre-registration students. One such model that has been explored recently is the 2:1 or ...
Journal of Occupational Science, Oct 1, 2007
Abstract This study builds on previous research that has aimed to clarify uncertainties regarding... more Abstract This study builds on previous research that has aimed to clarify uncertainties regarding what happens before, during and after a 'flow' experience, a psychological state that appears to arise during optimal human experience. A phenomenological approach was taken to ...
Qualitative Research in Psychology, 2006
Boredom remains a poorly understood phenomenon despite its evident association with dysfunctional... more Boredom remains a poorly understood phenomenon despite its evident association with dysfunctional behavior and mental health problems. However, little research has been devoted to the topic, and the bulk of studies have almost exclusively been quantitative in design. For this reason, a qualitative, interpretive phenomenological study was carried out, during which ten participants were asked for their accounts of the experience of boredom. These people were sampled from the general population. The aims of the study were to find out more about the antecedents to boredom, the experience itself, any stages in its development, and methods used to deal with it. Findings indicated that boredom is an extremely unpleasant and distressing experience. Situations giving rise to the sensation varied between specific external factors, to a general propensity to boredom proneness, although, according to the participants of the study, these could change throughout their lifetime. Feelings comprising the experience of boredom were almost consistently those of restlessness combined with lethargy. No stages in the development of the experience were identified. Strategies used to overcome the problem varied greatly, but generally involved trying to find interesting things to do. These strategies tended to be unsuccessful. Traditional methods of dealing with boredom have focused on increasing stimulation and choice in the environment. The authors propose that a more effective strategy might be to focus more on internal causes of boredom, such as an inability to sustain attention, although further research is required to support this interpretation of the data.
Journal of Occupational Science, Aug 16, 2012
This article follows on from a previous discussion paper Exploring optimal experiences: A reversa... more This article follows on from a previous discussion paper Exploring optimal experiences: A reversal theory perspective of flow and occupational science, which argued the utility of reversal theory for increasing understanding of optimal experiences of engagement in occupation. Flow has been argued to be an optimal experience that occurs when people get so absorbed in what they are doing that
British Journal of Occupational Therapy, Jun 1, 2011
Introduction: This article describes the experiences of occupational therapy students over the co... more Introduction: This article describes the experiences of occupational therapy students over the course of three mindfulness programmes, designed to support them in managing stress in their personal and professional lives. Method: Hermeneutic phenomenology was used to explore the experiences and perceptions of 20 students undertaking these introductory programmes of mindfulness. Data were collected through interviews, questionnaires and emails. Findings: Five themes are presented to demonstrate the effects of mindfulness on students' personal lives, academic work and practice placements. Obstacles to mindfulness practice were found, alongside evidence of benefits in enhanced self-awareness and insight into habitual thought patterns. Techniques for managing stressful situations were used successfully. Conclusion: Implications arising from the study are discussed, including the potential for the future inclusion of mindfulness training within the occupational therapy curriculum.
International journal of therapy and rehabilitation, Apr 1, 2011
Background: The Neater Uni-wheelchair was designed as an alternative to powered wheelchairs, leve... more Background: The Neater Uni-wheelchair was designed as an alternative to powered wheelchairs, lever drive and dual handrim wheelchairs for hemiplegic users. It is a standard Action 3 chair to which a kit has been attached which enables users to self-propel and steer independently of attendants. The aim of this pilot study was to explore users' experiences of the Neater Uni-wheelchair in the home environment. Methods: Six users from a previous study, carried out in 2009, agreed to evaluate the Neater Uniwheelchair in their home environments. The methodological approach was micro-ethnography (Holloway and Wheeler, 2010) and data were transcribed and analysed using Framework Analysis (Ritchie and Spencer, 1994). Findings: Key themes identified were independence and freedom, ease of use and manoeuvrability, usefulness and change in activity. This pilot study would support the notion that the Neater Uniwheelchair is a viable alternative to those that are currently available to hemiplegic users. Conclusions: The results from this exploratory study would support the need for a larger study. There are no storage issues, it is a cheaper option than a powered wheelchair and it would appear to increase independence, activity and participation in the short term.
Neuropsychological Rehabilitation, 2013
Many persons with traumatic brain injury (TBI) are young adults who, prior to their TBI, were in ... more Many persons with traumatic brain injury (TBI) are young adults who, prior to their TBI, were in paid employment. Psychosocial outcome after TBI, for many, remains poor. This includes low rates of return to pre-injury work or education, among others. This qualitative study explored the experience of return to work (RTW) rehabilitation with 10 individuals who sustained TBI. Data were collected from semi-structured interviews. Transcripts were analysed using interpretative phenomenological analysis (IPA). Some of the main findings from this study included the following: Individuals find the RTW experience difficult and painful. They experience a distinct grief reaction in the process of exploring re-engagement in occupation following TBI. In view of these and other findings, changes to RTW rehabilitation should be considered to facilitate the optimal support for patients with TBI engaging in the RTW rehabilitation process.
Journal of Occupational Science, Aug 2, 2022
PURPOSE: According to the literature, expert physiotherapists possess a superior organization of ... more PURPOSE: According to the literature, expert physiotherapists possess a superior organization of knowledge, organized around working hypothesis, that includes specific patterns, which can be explicitly and intuitively recognized and more general abstract sets of semantic relations, which reflect meaningful links between aspects of the problem (Mayer 1992; Jones and Higgs 1995; Higgs and Jones 1995). This organization of knowledge allows for the solution of a typical problem almost automatically through recognition of clinical patterns. In these conditions, knowledge base becomes highly structured in the forms of semantic networks (referred as “schemas”). The purpose of this qualitative study was to describe the knowledge structure of expert physiotherapists when managing low back pain patients. Relevance: Elicitation and description of expert physiotherapists’ working hypothesis, both diagnostic and non- diagnostic will contribute to clarify the types of knowledge used in physiotherapy practice. Subjects: A sample of four expert physiotherapists was selected from a pool of registered physiotherapists of the Portuguese Manual Therapy Group, according to the following criteria: more than 10 years of experience in acute and recurrent low back pain, post- graduate education in areas related with management of low back pain problems and participation as lecturers or clinical supervisors in undergraduate and postgraduate courses related to neuromusculoskeletal dysfunctions. Methods and Material: This investigation uses a qualitative case study design. Data was collected through non- participant observation, semi- structured interview, memos and field notes, during the episode of care. The interviews were audio taped, transcribed and analysed. Data analysis process was organized according to Morse’s Model of qualitative data analysis (1994). After transcription of each interview, information received was coded. The coding process searches for working hypothesis according to Rivett and Higgs (1997) framework. Analysis: Coding categories were developed and revised while data analysis continues. Analysis of the data collected from video- observation and interview were reviewed by the sample that has been involved in the study. Both criterioa used in observation, and coding schema will be analysed by two external persons, who were not involved within the study. Results: The analysis of data showed evidence of working hypothesis generation in some specific themes. The majority of hypothesis formulated on the first session were related with areas or structures that could be responsible for patient’s symptoms and the mechanism by which a patient’s symptoms are being initiated and/ or maintained. In the following sessions the working hypothesis moved progressively to management and reassessment. Conclusions: This study provides some support for the view that understanding patient’s symptoms and its relationship with movement dysfunction seems to be the major concepts that organized expert’s reasoning in the management of low back pain patients.