Objectives To describe and elucidate skilled practices by which physiotherapists communicate with patients about problems of ongoing or recent performance of physical treatment activities; to offer a sociological perspective on this area of practice; to examine relations between actual communication practice and official (Chartered Society of Physiotherapy) recommendations; to explore problems associated with formulating standards pertaining to communication and suggest how these might be addressed. Design Video recordings of physiotherapy treatment sessions (n = 74) were analysed using conversation analysis-an observational, inductive, social science methodology. Setting Inpatient rehabilitation units in four English hospitals. Participants Twenty-one stroke patients aged 52-86 years and 10 senior physiotherapists with 3-23 years of postqualification experience. Results and conclusions A variety of practices were identified. Managing shortcomings of performance often involves identifying and/or correcting the problem in a manner that deals sensitively with the negative connotations of physical non-competence. Characteristics of these practices include indirectness and ambiguity. As such, they do not conform to some official recommendations. However, good interactional reasons underlie the observed patterns. It is suggested that official guidance should acknowledge the complexity of communication and its measurement. Recommendations should be based upon a thorough understanding of the interactional tasks and practices entailed in physiotherapy. Recommendations should be explicitly tentative and refer to broad principles. By elucidating specific communication strategies, their consequences and the considerations that underlie them, conversation analytic research into physiotherapy communication has the potential to inform guidelines, and provide resources for developing and teaching communication skills. (c) 2005 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
