The use of focus of attention for instruction and feedback during telehealth physiotherapy: An observational study

Background Telehealth in pediatric physiotherapy presents both opportunities and challenges, particularly in lower-resource settings where health service access and equity remain concerns. Focus of attention (FOA) for instructions and feedback, which influences motor learning outcomes, may be crucial in this context. While earlier studies have relied mainly on self-reports, direct observation can identify physiotherapists’ actual use of FOA in practice.Objective This study used an exploratory observational design to examine pediatric physiotherapists’ use of FOA when delivering instructions and feedback during telehealth.Methods The study involved two therapy centers in the capital region. Six physiotherapists each selected two clients with neurodevelopmental disorders who received weekly telehealth physiotherapy. Three sessions per client were recorded via Zoom (n = 36). Physiotherapists completed the Developmental Profile–4th Edition forms assessing clients’ physical and cognitive development. Transcriptions were coded as instructions, feedback, or general chatter and classified by focus, modality, and recipient. Frequencies were calculated to derive relative focus scores, indicating physiotherapists’ FOA preference.Results Paired t tests revealed significant differences (p < .001) in physiotherapists’ relative focus scores for instructions (mean 42.62 SD 25.03) and feedback (mean 58.98 SD 23.8). Pearson’s correlations revealed that overall relative focus scores were significantly associated with clients’ age (r = 0.396, p = .017), cognitive development (r = 0.552, p < .001), and physical development (r = 0.552, p < .001).Conclusion Physiotherapists prefer an external FOA during instructions and an internal FOA during feedback. Relative focus scores were associated with clients’ age and development levels. Given the heightened reliance on verbal instructions during telehealth, these findings offer baseline evidence to inform knowledge translation and context-specific application of FOA principles in pediatric physiotherapy practice.