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Marwaa MN, Guidetti S, Ytterberg C, Kristensen HK. Acceptability of two mobile applications to support cross-sectoral, person-centred and empowering stroke rehabilitation - a process evaluation. Ann Med 2024; 56:2302979. [PMID: 38466794 DOI: 10.1080/07853890.2024.2302979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/04/2023] [Indexed: 03/13/2024] Open
Abstract
AIM To evaluate the acceptability of two co-designed mobile applications Mit Sygehus [a knowledge-based solution] and Genoptræn.dk [a self-training solution] to support a cross-sectoral, person-centred and empowering stroke rehabilitation. SETTING The applications were implemented and tested throughout two stroke rehabilitation trajectories in Southern Denmark, comprising two acute, two sub-acute and two municipal stroke rehabilitation settings. METHODS, PARTICIPANTS AND ANALYSIS A process evaluation focusing on acceptability was conducted. Individual and dyadic interviews were performed with ten stroke survivors (three women and seven men, aged 50-84) with moderate stroke and seven significant others (five women and two men, aged 50-78) post-rehabilitation. A constructivist Grounded Theory analysis was used to explore what, why, when, and how the apps worked or did not work throughout the stroke rehabilitation trajectory and if adaptions were needed. RESULTS Participants found that Mit Sygehus provided adequate and sufficient knowledge and was easy to use, however, acceptability of Mit Sygehus declined throughout the rehabilitation process. Also, knowledge on 'return-to-work' and 're-gaining driver's license/permission to drive' needed to be developed. The content in Genoptræn.dk was perceived as acceptable, through content being person-centred, motivating and meaningful. Genoptræn.dk furthermore, supported the transfer between rehabilitation settings, provided a sense of progress throughout the rehabilitation process, facilitated positive habits regarding self-training, and relieved the burden on significant others. Genoptræn.dk was perceived most acceptable in the sub-acute rehabilitation setting and declined when rehabilitation continued in the municipal setting. CONCLUSION Stroke survivors and their significant others found Mit Sygehus and Genoptræn.dk acceptable to support cross-sectoral, person-centred and empowering stroke rehabilitation, however acceptability declined throughout the rehabilitation process. Further investigations are required to determine how cognitive rehabilitation can play a greater role in app-supported stroke rehabilitation and how the need for more long-term follow-up can be supported.
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Affiliation(s)
- Mille Nabsen Marwaa
- Department of Physiotherapy Education, University College Southern Denmark, Esbjerg, Denmark
- Department of Clinical Research, Center for Innovative Medical Technologies, University of Southern Denmark, Odense, Denmark
| | - Susanne Guidetti
- Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
- Geriatric Research Unit, Department of Clinical Research, University Hospital Odense, University of Southern Denmark, Odense, Denmark
| | - Hanne Kaae Kristensen
- Department of Clinical Research, Center for Innovative Medical Technologies, University of Southern Denmark, Odense, Denmark
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Wade DT. Does a service provide safe, effective rehabilitation? An evaluation method for providers and purchasers. Clin Rehabil 2024:2692155241259644. [PMID: 39053145 DOI: 10.1177/02692155241259644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
BACKGROUND Independent organisations monitor the safety and governance of clinical services but do not assess specialist expertise. Peer review can assess service capability but is resource-intense and infeasible. THE PROBLEM How can you ensure a service provides safe, effective rehabilitation? You ask them to provide data as evidence that they can be trusted to do so. This article suggests a structured approach to providing data on entrustability. AN ANALOGY How is the specialist skill of a doctor in training established? They provide evidence about high-level outcomes (capabilities in practice) related to their speciality. An educational supervisor assesses whether they can be trusted to perform safely and effectively without supervision. The capabilities in practice define their expertise. THE SOLUTION A service can use seven high-level rehabilitation service capabilities, based on the clinical capabilities associated with medical training, with observable indicative descriptors, to collect evidence of their rehabilitation approach. A service must also select four to eight high-level competencies indicating they can rehabilitate their patient caseload safely and effectively. These competencies also need indicative descriptors as evidence of their performance in the service; 11 examples are given. CAPABILITIES. The seven rehabilitation capabilities are: using the biopsychosocial model, having a multi-professional team, making a person-centred rehabilitation plan, working collaboratively across all boundaries, tailoring treatments to the patient's needs, ensuring staff have specific competencies required for their caseload, and acknowledging and managing uncertainty and complexity. CONCLUSION. Service providers could use this structured approach to develop and provide users with evidence of their rehabilitation expertise.
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Affiliation(s)
- Derick T Wade
- Centre for Movement, Occupation and Rehabilitation Sciences (MOReS), Faculty of Health Sciences, Oxford Brookes University, Headington Campus, Oxford OX3 0BP, UK
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3
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Naylor J, Killingback C, Green A. The experiences of patients attending the emergency department who were managed by physiotherapists: a person-centred perspective. Disabil Rehabil 2024:1-13. [PMID: 39041363 DOI: 10.1080/09638288.2024.2382311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 07/13/2024] [Indexed: 07/24/2024]
Abstract
PURPOSE The expectation for all clinicians to deliver person-centred practices extends to the growing number of primary contact physiotherapists based in United Kingdom emergency departments (ED). Research on ED patients' experience of this physiotherapy role has yet to consider this through the lens of person-centredness. A qualitative exploration of person-centredness among ED physiotherapists through the experiences of attending patients targeted this knowledge gap to inform future clinical practice. METHODS Semi-structured interviews with thematic analysis. RESULTS 13 interviews were completed with four overarching themes generated: (1) patient experience of the ED; (2) the importance of connection, competence, and time; (3) recognising the benefits of being seen by a physiotherapist in ED; and (4) patient experience of the ED physical environment. CONCLUSION Novel contributions from the patient perspective, here, reflected a cognisance of certain environment limitations to PCP, as well as institutional challenges to their personhood, with a suggestion that ED patients anticipated a validation of their visit and valued the educational aspects that the physiotherapists provided. Considering this new knowledge can help ED physiotherapists to be more person-centred.
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Affiliation(s)
- John Naylor
- Department of Physiotherapy, Hull University Teaching Hospitals NHS Trust, UK
- Faculty of Health Sciences, University of Hull, UK
| | | | - Angela Green
- Department of Physiotherapy, Hull University Teaching Hospitals NHS Trust, UK
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Skoumal M, Lindner-Rabl S, Honegger M, Pertinatsch C, Kadane C, Neubacher B, Herzog C, Roller-Wirnsberger R. Goal Setting for Participatory Person-Centered Geriatric Rehabilitation-From Function-Centered Rehabilitation towards Digitally Supported Personalized and Integrated Care for Older People. J Clin Med 2024; 13:4134. [PMID: 39064173 PMCID: PMC11277607 DOI: 10.3390/jcm13144134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/08/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
As chronic illness is common among older people, self-care practices for older people are needed to control health status, to prevent possible complications and to ensure optimal quality of life. The literature has demonstrated that integrated care approaches are one key success factor for delivering person-centered and sustainable care for older people, with rehabilitation being a cornerstone in tertiary care prevention for older citizens. The current paper addresses the state of the literature for person-centered geriatric rehabilitation (GR) and the importance of personalized and participatory goal setting. In accordance with the bio-psycho-social model of the International Classification of Functioning, Disability and Health (ICF), social participation and the related goals are of particular importance for the entire rehabilitation process. The social participation of individuals enrolled into GR is therefore one of the milestones to be achieved during GR. Personalized goal setting during the entire rehabilitation process, Comprehensive Geriatric Assessment (CGA) and shared decision making allow a comprehensive care approach separate from solely function-based rehabilitation. The review also focusses on recent developments in digitalization in healthcare and delivers insights into how healthcare professionals' collaborative practice supports sustainable rehabilitation results in patients of advanced chronological age.
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Affiliation(s)
- Martin Skoumal
- Department of Internal Medicine, Research Unit for Aging and Life Long Health, Medical University of Graz, 8036 Graz, Austria; (M.S.); (M.H.); (C.P.); (C.K.); (B.N.); (C.H.)
- Department for Scientific Research in Rehabilitation, Pension Insurance Austria, 1021 Vienna, Austria
| | - Sonja Lindner-Rabl
- Department of Internal Medicine, Research Unit for Aging and Life Long Health, Medical University of Graz, 8036 Graz, Austria; (M.S.); (M.H.); (C.P.); (C.K.); (B.N.); (C.H.)
| | - Martina Honegger
- Department of Internal Medicine, Research Unit for Aging and Life Long Health, Medical University of Graz, 8036 Graz, Austria; (M.S.); (M.H.); (C.P.); (C.K.); (B.N.); (C.H.)
- Department for Scientific Research in Rehabilitation, Pension Insurance Austria, 1021 Vienna, Austria
| | - Christoph Pertinatsch
- Department of Internal Medicine, Research Unit for Aging and Life Long Health, Medical University of Graz, 8036 Graz, Austria; (M.S.); (M.H.); (C.P.); (C.K.); (B.N.); (C.H.)
- Department for Scientific Research in Rehabilitation, Pension Insurance Austria, 1021 Vienna, Austria
| | - Christof Kadane
- Department of Internal Medicine, Research Unit for Aging and Life Long Health, Medical University of Graz, 8036 Graz, Austria; (M.S.); (M.H.); (C.P.); (C.K.); (B.N.); (C.H.)
- Department for Scientific Research in Rehabilitation, Pension Insurance Austria, 1021 Vienna, Austria
| | - Britta Neubacher
- Department of Internal Medicine, Research Unit for Aging and Life Long Health, Medical University of Graz, 8036 Graz, Austria; (M.S.); (M.H.); (C.P.); (C.K.); (B.N.); (C.H.)
- Department for Scientific Research in Rehabilitation, Pension Insurance Austria, 1021 Vienna, Austria
| | - Carolin Herzog
- Department of Internal Medicine, Research Unit for Aging and Life Long Health, Medical University of Graz, 8036 Graz, Austria; (M.S.); (M.H.); (C.P.); (C.K.); (B.N.); (C.H.)
| | - Regina Roller-Wirnsberger
- Department of Internal Medicine, Research Unit for Aging and Life Long Health, Medical University of Graz, 8036 Graz, Austria; (M.S.); (M.H.); (C.P.); (C.K.); (B.N.); (C.H.)
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Sheehy B, Wepa D, Collis JM. Māori experiences of physical rehabilitation in Aotearoa New Zealand: a scoping review. Disabil Rehabil 2024:1-11. [PMID: 38989895 DOI: 10.1080/09638288.2024.2374494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/24/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE The purpose of this review was to explore what is currently known about Māori experiences of physical rehabilitation services in Aotearoa New Zealand. METHODS A scoping review was undertaken following steps described by the Joanna Briggs Institute. Databases and grey literature were searched for qualitative studies that included descriptions of Māori consumer experiences in their encounters with physical rehabilitation. Data relating to study characteristics were synthesised. Qualitative data were extracted and analysed using reflexive thematic analysis. RESULTS Fourteen studies were included in this review. Four themes were generated that describe Māori experiences of rehabilitation. The first theme captures the expectations of receiving culturally unsafe care that become a reality for Māori during rehabilitation. The second theme describes whānau as crucial for navigating the culturally alien world of rehabilitation. The third theme offers solutions for the incorporation of culturally appropriate Māori practices. The final theme encompasses solutions for the provision of rehabilitation that empowers Māori. CONCLUSIONS This scoping review highlights ongoing inequities experienced by Māori when engaging with rehabilitation services. Strategies for facilitating culturally safe rehabilitation for Māori have been proposed. It is essential that rehabilitation clinicians and policymakers implement culturally safe approaches to rehabilitation with a view to eliminating inequities in care provision and outcomes for Māori.
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Affiliation(s)
- Becky Sheehy
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Dianne Wepa
- School of Public Health and Interdisciplinary Studies, Auckland University of Technology, Auckland, New Zealand
- Faculty of Health, Charles Darwin University, Casuarina, Australia
- University of Bradford, Bradford, UK
| | - Julie M Collis
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
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Jesus TS, Struhar J, Zhang M, Lee D, Stern BZ, Heinemann AW, Jordan N, Deutsch A. Near real-time patient experience feedback with data relay to providers: a systematic review of its effectiveness. Int J Qual Health Care 2024; 36:mzae053. [PMID: 38907579 DOI: 10.1093/intqhc/mzae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/14/2024] [Accepted: 06/10/2024] [Indexed: 06/24/2024] Open
Abstract
Near Real-Time Feedback (NRTF) on the patient's experience with care, coupled with data relay to providers, can inform quality-of-care improvements, including at the point of care. The objective is to systematically review contemporary literature on the impact of the use of NRTF and data relay to providers on standardized patient experience measures. Six scientific databases and five specialty journals were searched supplemented by snowballing search strategies, according to the registered study protocol. Eligibility included studies in English (2015-2023) assessing the impact of NRTF and data relay on standardized patient-reported experience measures as a primary outcome. Eligibility and quality appraisals were performed by two independent reviewers. An expert former patient (Patient and Family Advisory Council and communication sciences background) helped interpret the results. Eight papers met review eligibility criteria, including three randomized controlled trials (RCTs) and one non-randomized study. Three of these studies involved in-person NRTF prior to data relay (patient-level data for immediate corrective action or aggregated and peer-compared) and led to significantly better results in all or some of the experience measures. In turn, a kiosk-based NRTF achieved no better experience results. The remaining studies were pre-post designs with mixed or neutral results and greater risks of bias. In-person NRTF on the patient experience followed by rapid data relay to their providers, either patient-level or provider-level as peer-compared, can improve the patient experience of care. Reviewed kiosk-based or self-reported approaches combined with data relay were not effective. Further research should determine which approach (e.g. who conducts the in-person NRTF) will provide better, more efficient improvements and under which circumstances.
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Affiliation(s)
- Tiago S Jesus
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W 10th Ave, Columbus, OH 43210, United States
- Center for Education in Health Sciences, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, United States
| | - Jan Struhar
- Nerve, Muscle and Bone Innovation Center & Oncology Innovation Center, Shirley Ryan AbilityLab, 355 E Erie St, Chicago, IL 60611, United States
| | - Manrui Zhang
- Center for Education in Health Sciences, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, United States
| | - Dongwook Lee
- Center for Child Development & Research, Sensory EL, ROK; Dept. of Physical Medicine and Rehabilitation Medicine, Korehab Clinic, Building 64 - Ground Floor, F Block - Dubai Healthcare City, Dubai, UAE
| | - Brocha Z Stern
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Allen W Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, 355 E Erie St, Chicago, IL 60611, United States
- Department of Physical Medicine and Rehabilitation Medicine, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, United States
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Department of Preventive Medicine, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, United States
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, 5000 5th Ave, Hines, IL 60141, United States
| | - Anne Deutsch
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, 355 E Erie St, Chicago, IL 60611, United States
- Department of Physical Medicine and Rehabilitation Medicine, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, United States
- Center for Health Care Outcomes, RTI International, 10 S. Riverside Plaza #875, Chicago, IL 60606, United States
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Rasmussen B, Maribo T, Skovsby Toft B. The content and characteristics of face-to-face interventions to encourage patients' enrollment in cardiac rehabilitation; a scoping review. Disabil Rehabil 2024; 46:2734-2746. [PMID: 37480155 DOI: 10.1080/09638288.2023.2236014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/07/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE To provide an overview of the content and characteristics of face-to-face interventions to encourage enrollment in exercise-based cardiac rehabilitation (CR). METHODS Following a published protocol describing the methods, six databases were searched. The search was limited to studies published from January 2000 to December 2021. Two reviewers independently performed study selection and data extraction. RESULTS 5583 studies were identified and 20 studies with a variety of study designs met the inclusion criteria. Eight studies specified important content in face-to-face interventions to be: Education, problem-solving, support of autonomy, exploring reasons for change, emotional and cognitive support while showing understanding. Studies targeting patients' experiences used motivational interviewing and addressed worries and anticipated difficulties. Intention to attend, CR barriers, practical barriers, exercise self-efficacy, and patients asking questions supported enrollment. Reassurance could lead to nonattendance if patients had a high degree of worry and distress. CONCLUSION Face-to-face interventions are important to support patients' enrollment in CR and should integrate a person-centered dialogue exploring reasons for change and providing support to overcome barriers. Focus on the patients' perspectives, the mechanisms of change, and the evaluation of the intervention to inform implementation should be further explored.Implications for RehabilitationIn-hospital face-to-face interventions support enrollment in cardiac rehabilitation (CR) in patients with ischemic heart disease.This study suggests that individual worries and barriers toward CR should be jointly explored while considering patients' capacity for making choices as well as their vulnerability.Patients should be encouraged to ask questions.A too strong focus on reassurance and problem-solving can impede enrollment.
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Affiliation(s)
- Birgit Rasmussen
- Department of Physio- and Occupational Therapy, Horsens Regional Hospital, Horsens, Denmark
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM - Social & Health Services and Labour Market, Corporate Quality, Aarhus, Denmark
| | - Bente Skovsby Toft
- Research Centre for Patient Involvement, Aarhus University Hospital, Aarhus, Denmark
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Jesus TS, Stern BZ, Lee D, Zhang M, Struhar J, Heinemann AW, Jordan N, Deutsch A. Systematic review of contemporary interventions for improving discharge support and transitions of care from the patient experience perspective. PLoS One 2024; 19:e0299176. [PMID: 38771768 PMCID: PMC11108181 DOI: 10.1371/journal.pone.0299176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/03/2024] [Indexed: 05/23/2024] Open
Abstract
AIM To synthesize the impact of improvement interventions related to care coordination, discharge support and care transitions on patient experience measures. METHOD Systematic review. Searches were completed in six scientific databases, five specialty journals, and through snowballing. Eligibility included studies published in English (2015-2023) focused on improving care coordination, discharge support, or transitional care assessed by standardized patient experience measures as a primary outcome. Two independent reviewers made eligibility decisions and performed quality appraisals. RESULTS Of 1240 papers initially screened, 16 were included. Seven studies focused on care coordination activities, including three randomized controlled trials [RCTs]. These studies used enhanced supports such as improvement coaching or tailoring for vulnerable populations within Patient-Centered Medical Homes or other primary care sites. Intervention effectiveness was mixed or neutral relative to standard or models of care or simpler supports (e.g., improvement tool). Eight studies, including three RCTs, focused on enhanced discharge support, including patient education (e.g., teach back) and telephone follow-up; mixed or neutral results on the patient experience were also found and with more substantive risks of bias. One pragmatic trial on a transitional care intervention, using a navigator support, found significant changes only for the subset of uninsured patients and in one patient experience outcome, and had challenges with implementation fidelity. CONCLUSION Enhanced supports for improving care coordination, discharge education, and post-discharge follow-up had mixed or neutral effectiveness for improving the patient experience with care, compared to standard care or simpler improvement approaches. There is a need to advance the body of evidence on how to improve the patient experience with discharge support and transitional approaches.
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Affiliation(s)
- Tiago S. Jesus
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
- Center for Education in Health Science, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Brocha Z. Stern
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Dongwook Lee
- Center for Child Development & Research, Sensory EL, ROK, Dept. of Physical Medicine and Rehabilitation Medicine, Korehab Clinic, Dubai, UAE
| | - Manrui Zhang
- Center for Education in Health Science, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Jan Struhar
- Nerve, Muscle and Bone Innovation Center & Oncology Innovation Center, Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | - Allen W. Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Physical Medicine and Rehabilitation Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Dept. of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois, United States of America
| | - Anne Deutsch
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Physical Medicine and Rehabilitation Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Center for Health Care Outcomes, RTI International, Chicago, Illinois, United States of America
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Li J, Aulakh N, Culum I, Roberts AC. Adherence to Non-Pharmacological Interventions in Parkinson's Disease: A Rapid Evidence Assessment of the Literature. JOURNAL OF PARKINSON'S DISEASE 2024:JPD230266. [PMID: 38640167 DOI: 10.3233/jpd-230266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Background Low adherence to non-pharmacological interventions can impact treatment effectiveness. Yet, there is limited information on adherence barriers and facilitators to non-pharmacological interventions in Parkinson's disease (PD). Objective 1) To examine the quality of adherence reporting and 2) to identify key determinants of adherence to PD non-pharmacological interventions. Methods A rapid evidence assessment was conducted, following PRISMA guidelines, that included controlled studies of exercise, physiotherapy, occupational therapy, speech-language therapy with explicit reporting of 'adherence' OR 'compliance', published in the last 15 years. Data extracted included: adherence rates, adherence outcomes, and factors associated with adherence. A collaborative thematic analysis was conducted to identify determinants of adherence. Results The search yielded 2,445 articles of which 114 met criteria for full screening with 45 studies meeting all inclusion criteria. High quality adherence data that aligned with the intervention goals were reported by 22.22%(N = 10) of studies, with the majority reporting attendance/attrition rates only 51.11%(N = 23). Four major themes (34 subthemes) emerged: disease and health, personal, program design, and system and environmental. Conclusions There has been limited progress in the quality of adherence reporting in PD non-pharmacological interventions over the last decade. Acknowledging this limitation, key determinants of adherence included: alignment with personal beliefs, attitudes, and expectations; the demands of the intervention and worsening disease symptoms and personal/time obligations; and accessibility and safety concerns. Program design elements found to facilitate adherence included: opportunities for social engagement and in-person offerings linked to higher levels of interventionist support, performative feedback, and social reinforcement.
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Affiliation(s)
- John Li
- Faculty of Health Sciences, Western University, School of Communication Sciences and Disorders, London, Ontario Canada
| | - Nimrit Aulakh
- Faculty of Health Sciences, Western University, School of Communication Sciences and Disorders, London, Ontario Canada
| | - Ivan Culum
- Faculty of Health Sciences, Western University, School of Communication Sciences and Disorders, London, Ontario Canada
- Canadian Centre for Activity and Aging, London, Ontario Canada
| | - Angela C Roberts
- Faculty of Health Sciences, Western University, School of Communication Sciences and Disorders, London, Ontario Canada
- Faculty of Science, Western University, Department of Computer Science, London, Ontario Canada
- Canadian Centre for Activity and Aging, London, Ontario Canada
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10
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Wade DT. A general theory of rehabilitation: Rehabilitation catalyses and assists adaptation to illness. Clin Rehabil 2024; 38:429-442. [PMID: 37885405 PMCID: PMC10898207 DOI: 10.1177/02692155231210151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND There is no general theory of rehabilitation, only definitions and descriptions, with the biopsychosocial model of illness as a structure. OBJECTIVE To develop a general theory of rehabilitation that explains how healthcare rehabilitation changes outcomes and to evaluate its validity. NEED A general rehabilitation theory would help research, improve services, increase understanding, modify resource allocation and explain some anomalies, such as how rehabilitation helps when no natural recovery occurs. BUILDING BLOCKS People adapt to change throughout their lives. Illness is a change, and people adapt to their illness. Adaptation's purpose is to maintain an equilibrium in a person's life. The balanced components are related to Maslow's five needs: basic, safety, affiliation, status and self-fulfilment. The general theory of behaviour suggests that a person's behaviours change to maintain balance, regulated by a central homeostatic mechanism. THE THEORY Rehabilitation aids adaptation to changes associated with illness through accurate diagnosis and formulation, catalysing adaptation, optimising the environment and assisting the person in making necessary changes by safely practising activities and teaching self-management. IMPLICATIONS The theory makes the person the central active agent, emphasises the importance of the environment in facilitating adaptation, explains why all conditions may benefit, including progressive and static conditions, suggests that health can be equated to someone maintaining their equilibrium and explains why a small dose may be very effective. CONCLUSION The general theory of rehabilitation emphasises the catalytic effects of rehabilitation in facilitating and guiding adaptation and suggests areas for research and improvement.
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Affiliation(s)
- Derick T Wade
- Centre for Movement, Occupation and Rehabilitation Sciences (MOReS), Oxford Brookes University, Oxford, UK
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11
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Elvén M, Prenkert M, Holmström IK, Edelbring S. Reasoning about reasoning - using recall to unveil clinical reasoning in stroke rehabilitation teams. Disabil Rehabil 2024:1-10. [PMID: 38392962 DOI: 10.1080/09638288.2024.2320263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/14/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE The study objective was to investigate how health care providers in stroke teams reason about their clinical reasoning process in collaboration with the patient and next of kin. MATERIALS AND METHODS An explorative qualitative design using stimulated recall was employed. Audio-recordings from three rehabilitation dialogs were used as prompts in interviews with the involved staff about their clinical reasoning. A thematic analysis approach was employed. RESULTS A main finding was the apparent friction between profession-centered and person-centered clinical reasoning, which was salient in the data. Five themes were identified: the importance of different perspectives for a rich picture and well-informed decisions; shared understanding in analysis and decision-making - good intentions but difficult to achieve; the health care providers' expertise directs the dialog; the context's impact on the rehabilitation dialog; and insights about missed opportunities to grasp the patient perspective and arrive at decisions. CONCLUSIONS Interprofessional stroke teams consider clinical reasoning as a process valuing patient and next of kin perspectives; however, their professional expertise risks preventing individual needs from surfacing. There is a discrepancy between professionals' intentions for person-centeredness and how clinical reasoning plays out. Stimulated recall can unveil person-centered practice and enhance professionals' awareness of their clinical reasoning.
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Affiliation(s)
- Maria Elvén
- School of Health, Care, and Social Welfare, Mälardalen University, Västerås, Sweden
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Malin Prenkert
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Inger K Holmström
- School of Health, Care, and Social Welfare, Mälardalen University, Västerås, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Samuel Edelbring
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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12
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Truong LK, Mosewich AD, Miciak M, Losciale JM, Li LC, Whittaker JL. Social support and therapeutic relationships intertwine to influence exercise behavior in people with sport-related knee injuries. Physiother Theory Pract 2024:1-14. [PMID: 38374585 DOI: 10.1080/09593985.2024.2315520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/03/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE Explore how social support influences exercise therapy participation and adherence before and after enrolling in an education and exercise therapy intervention (Stop OsteoARthritis, SOAR). METHODS Study design: Interpretative description. We sampled participants with sport-related knee injuries from the SOAR randomized controlled trial. SOAR is a virtual, physiotherapist-guided, education and exercise therapy-based knee health program that targets individuals at risk of early osteoarthritis. One-on-one semi-structured interviews were completed, and an inductive approach was guided by Braun & Clarke's reflexive thematic analysis. RESULTS Fifteen participants (67% female, median age 26 [19-35] years) were interviewed. Three themes were generated that encapsulated participants' social support experiences that fostered exercise participation: 1) Treat me as a whole person represented the value of social support that went beyond participants' physical needs, 2) Work with me highlighted the working partnership between the clinician and the participant, and 3) Journey with me indicated a need for on-going support is necessary for the long-term management of participants' knee health. A theme of the therapeutic relationship was evident across the findings. CONCLUSIONS Insight was gained into how and why perceived support may be linked to exercise behavior, with the therapeutic relationship being potentially linked to perceived support. Social support strategies embedded within an education and exercise therapy program may boost exercise adherence after sport-related knee injuries.
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Affiliation(s)
- Linda K Truong
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Amber D Mosewich
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
| | - Maxi Miciak
- College of Health Sciences, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Justin M Losciale
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Linda C Li
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
- College of Health Sciences, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
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13
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Naylor J, Killingback C, Green A. An exploration of person-centredness among emergency department physiotherapists: a mixed methods study. Disabil Rehabil 2024:1-14. [PMID: 38329070 DOI: 10.1080/09638288.2024.2310179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 01/20/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE There is a growing number of primary contact physiotherapists based in United Kingdom emergency departments (ED) who are expected to deliver person-centred practices. Perceptions of physiotherapists working in these high-pressure environments on person-centredness are currently unknown. A mixed methods exploration of person-centredness among ED physiotherapists targeted this knowledge gap to inform future clinical practice. METHODS Online survey and semi-structured interviews followed a convergent mixed methods design with sequential explanatory features. Data sets were analysed separately using descriptive statistics and thematic analysis, respectively, before merged analysis using joint display. RESULTS Twenty-six surveys and 11 in-depth interviews were completed. The three overarching themes of ED patients, ED physiotherapists, and ED environment were generated. Themes were integrated and analysed alongside quantitative survey findings. This produced three novel contributions that further our understanding of person-centred practices among ED physiotherapists. CONCLUSION ED physiotherapists were mindful of an apparent, yet unspoken struggle between the competing philosophies of biomedicine and person-centredness. The results here support entering a patient's world as a person-centred approach to help navigate the line between what an ED attender wants and the clinical need of their visit.
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Affiliation(s)
- John Naylor
- Department of Physiotherapy, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
- Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Clare Killingback
- Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Angela Green
- Department of Physiotherapy, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
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14
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Verdugo MÁ, Schalock RL, Gómez LE, Navas P. A Systematic Approach to Implementing, Evaluating, and Sustaining the Shared Citizenship Paradigm in the Disability Field. Behav Sci (Basel) 2023; 13:970. [PMID: 38131825 PMCID: PMC10740522 DOI: 10.3390/bs13120970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/01/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
The disability field continues to face challenges in transforming and implementing meaningful and effective changes in person-centered services and supports aligned with the principles of the Convention on the Rights of Persons with Disabilities. To guide this transformative process effectively, a paradigm must be operationalized through a systematic approach. This article outlines such a systematic approach, consisting of two components: (a) aligning the paradigm's foundational pillars to the elements of an explanatory/implementation model (the Quality of Life and Supports Model) to facilitate the paradigm's operationalization, acceptance, and application and (b) aligning implementation, evaluation, and sustainability strategies with ecological systems, implementation targets, and the paradigm's foundational pillars to drive change across systems. The synergy and alignment between these components underscore the importance of linking public policies with professional and organizational practices to promote social inclusion and enhance the quality of life for people with disabilities. We provide practical examples highlighting the collaborative potential of this synergy and emphasize the significance of evidence-based and person-centered practices in promoting equal rights and social inclusion for people with disabilities.
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Affiliation(s)
| | | | - Laura E. Gómez
- Department of Psychology, Universidad de Oviedo, 33003 Oviedo, Spain
| | - Patricia Navas
- INICO, Universidad de Salamanca, 37005 Salamanca, Spain; (M.Á.V.); (P.N.)
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15
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Kang E, Chen J, Foster ER. Feasibility and Implementation Determinants of a Structured Goal Setting and Goal Management System. Am J Occup Ther 2023; 77:7706205150. [PMID: 38060338 PMCID: PMC10846417 DOI: 10.5014/ajot.2023.050296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
IMPORTANCE There is no evidence-based system to guide occupational therapists in implementing theory-based, client-engaged goal setting and goal management. A new system is needed to support high-quality goal setting and goal management. OBJECTIVE To determine the acceptability, appropriateness, feasibility, credibility, and expectancy of a new structured theory-based, client-engaged goal setting and goal management system, called MyGoals, for occupational therapists. We explored MyGoals' implementation determinants, potential positive outcomes, and comparative advantages. DESIGN This was a mixed-methods feasibility study. SETTING Community. PARTICIPANTS Occupational therapists (N = 7). OUTCOMES AND MEASURES Acceptability, appropriateness, and feasibility were assessed using the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM). Credibility and expectancy were assessed with the Credibility and Expectancy Questionnaire (CEQ). Semistructured 1:1 interviews were conducted to explore occupational therapy perspectives on MyGoals and its implementation-related factors. RESULTS MyGoals had high AIM (M = 18.1, SD = 1.9), IAM (M = 17.9, SD = 2.2), FIM (M = 17.3, SD = 2.1) scores and high CEQ Credibility (M = 22.1, SD = 5.0) and Expectancy (M = 20.6, SD = 4.3) scores. Interview data revealed suggestions to improve MyGoals, implementation determinants across the individuals involved, inner setting, and intervention characteristic domains, client- and clinician-related potential positive outcomes, and comparative advantages. CONCLUSIONS AND RELEVANCE MyGoals is an acceptable, appropriate, feasible, credible, and promising system to guide occupational therapists in implementing theory-based, client-engaged goal setting and goal management for adults with chronic conditions in community-based rehabilitation. What This Article Adds: MyGoals is an easy-to-use, appealing, and helpful system to support occupational therapists in delivering theory-based goal setting and goal management components and to enable adults with chronic conditions to actively engage in their rehabilitation. This study supports the usefulness of MyGoals in community-based rehabilitation to improve goal setting and goal management quality and personally meaningful rehabilitation goal achievement in this population.
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Affiliation(s)
- Eunyoung Kang
- Eunyoung Kang, PhD, is Postdoctoral Research Fellow, Institute for Implementation Science, School of Public Health, University of Texas, Houston; . At the time this research was completed, Kang was Doctoral Student, Program in Occupational Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Julie Chen
- Julie Chen, BS, is Occupational Therapy Student, Program in Occupational Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Erin R Foster
- Erin R. Foster, PhD, OTD, OTR/L, is Associate Professor, Program in Occupational Therapy, Department of Neurology and Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO
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16
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Grilo AM, Vinagre G, dos Santos MC, Martinho JF, Gomes AI. Attitudes toward Patient-Centred Care, Empathy, and Assertiveness among Students in Rehabilitation Areas: A Longitudinal Study. Healthcare (Basel) 2023; 11:2803. [PMID: 37893877 PMCID: PMC10606137 DOI: 10.3390/healthcare11202803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
This study assessed attitudes toward patient-centred care, empathy, assertiveness, and subjective perception of communication skills and technical knowledge among Portuguese undergraduate students in healthcare. These students may develop rehabilitation activities with patients in their person-oriented or technique-oriented professions. Portuguese nursing and allied health students from two public higher education schools completed questionnaires in the first and third academic years: Patient-Practitioner Orientation Scale, Jefferson Scale of Physician Empathy, Scale for Interpersonal Behaviour, and a subjective perception of technical knowledge and communication skills. A total of 183 students completed the surveys. In the first year, students showed moderate to high scores on patient-centredness attitudes, empathy, and assertiveness and perceived themselves as having good communication skills. Students from person-oriented programmes significantly improved their Total and shared patient-centred attitudes in the third year compared with students attending technique-oriented professions. Significant differences in empathy were found between groups in the third year. Distress associated with assertive behaviours increased significantly across time in students from technique-oriented programmes compared with their peers in person-oriented programmes. The results suggest that the health profession's orientation and the programmes' specific curriculum might have a role in how some dimensions evolved in the two groups of students. The increasing assertiveness-related discomfort highlighted the importance of assessing and monitoring students' emotional wellbeing during their initial interactions with patients.
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Affiliation(s)
- Ana Monteiro Grilo
- H&TRC—Health & Technology Research Center, Escola Superior de Tecnologia da Saúde, Av. D. João II, Lote 4.69.01, 1990-096 Lisboa, Portugal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal;
| | - Graça Vinagre
- Escola Superior de Enfermagem de Lisboa, Av. Prof. Egas Moniz, 1990-096 Lisboa, Portugal;
| | - Margarida Custódio dos Santos
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal;
- Escola Superior de Tecnologia da Saúde, Av. D. João II, Lote 4.69.01, 1990-096 Lisboa, Portugal
| | - Joana Ferreira Martinho
- Câmara Municipal de Oliveira do Bairro, Ed. Paços do Concelho, Praça do Município, 3770-851 Oliveira do Bairro, Portugal;
| | - Ana Isabel Gomes
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal;
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Carruthers H, Derry D, Astin F. Becoming partners in rehabilitation with patients in intensive care: physiotherapists' perspectives. Disabil Rehabil 2023:1-11. [PMID: 37818631 DOI: 10.1080/09638288.2023.2266993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/30/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE Person-centred care is widely accepted as being central to high quality care, but little is known about how physiotherapists implement person centred rehabilitation in Intensive Care. This study explores the self-reported experiences and interpretations of physiotherapists delivering person-centred rehabilitation in this setting. METHODS A qualitative study using Interpretative Phenomenological Analysis explored the lived experiences of physiotherapists and students who have worked in Intensive Care. Three focus groups, with four participants in each, were conducted. Data were fully transcribed, analysed and managed using NVivo software. RESULTS Participants shared similar interpretations about the principles of person-centred care. Operationalising person-centred rehabilitation during early recovery was not easily achievable. As the person's clinical condition improved, participants moved away from routine physiotherapy and their practice became more person-centred through the development of a partnership. Participants connected as humans to understand the person and respond to their needs within a culture that valued person-centred care. CONCLUSIONS Physiotherapists aspire to develop a partnership with their patients by connecting on a human level with them and addressing their biopsychosocial needs. Physiotherapists with experience of developing patient partnerships influence the culture of the Intensive Care team and are role-models to facilitate collaborative person-centred activity in others.
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Affiliation(s)
- Helen Carruthers
- School of Health and Society, University of Salford, Salford, UK
| | - David Derry
- Long-Term Ventilation Unit, Wythenshawe Hospital, Manchester Foundation NHS Trust, Manchester, UK
| | - Felicity Astin
- School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, UK
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18
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Kim DJ. Analyzing the trends in intervention studies of rehabilitation nursing: a literature review. J Exerc Rehabil 2023; 19:247-251. [PMID: 37928826 PMCID: PMC10622935 DOI: 10.12965/jer.2346342.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/29/2023] [Indexed: 11/07/2023] Open
Abstract
The present study reviewed the literature to determine the trends in rehabilitation nursing intervention programs by systematically analyzing previous studies including rehabilitation nursing interventions, seeking insight to reconstruct future rehabilitation programs, and exploring research directions for future rehabilitation nursing intervention studies. About 94 intervention studies published from the inaugural issue of the Journal of the Korean Society of Rehabilitation Nursing to 2022 were analyzed. Among them, 33 studies were published between 2001 and 2005, followed by 25 studies between 2011 and 2015. All studies were authored by nurses. Concerning the types of rehabilitation nursing intervention programs, exercise interventions were more common than educational interventions. The exercise intervention programs improved performance in daily activities and decreased pain. The education intervention programs improved knowledge and increased the implementation of health behaviors. Based on these findings, we intend to ascertain the roles and functions of rehabilitation nurses in the mid-to-long-term and develop a specialized rehabilitation nurse system with expertise and science that meets the current trends of an increasing demand for rehabilitation nursing in various institutions such as rehabilitation hospitals, homes, welfare rehabilitation centers, and long-term care facilities, taking the field of rehabilitation nursing to another level.
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Affiliation(s)
- Da-Jung Kim
- Department of Nursing, Cheju Halla University, Jeju,
Korea
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19
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Farre A, Morris JH, Irvine L, Dombrowski SU, Breckenridge JP, Ozakinci G, Lebedis T, Jones C. Exploring the views and experiences of people recovering from a stroke about a new text message intervention to promote physical activity after rehabilitation-Keeping Active with Texting After Stroke: A qualitative study. Health Expect 2023; 26:2013-2022. [PMID: 37409460 PMCID: PMC10485328 DOI: 10.1111/hex.13809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/30/2023] [Accepted: 06/13/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Participating in exercise following a stroke is essential for recovery. When community-based rehabilitation services end, some people struggle to remain active. We codesigned Keeping Active with Texting After Stroke (KATS), a text message intervention to support home-based, self-directed plans to continue exercising. KATS delivers a series of automated text messages over a 12-week period from the point of discharge from National Health Service-funded therapy. The aim of this study was to explore the views and experiences of the first cohort of participants to complete the KATS intervention about the meaning, engagement, workability and worth of the intervention. METHODS We undertook a qualitative study, theoretically informed by Normalisation Process Theory. We conducted semi-structured telephone interviews with people with stroke from two Health Boards in Scotland. Data collection took place over two phases, with each participant being interviewed twice: first, halfway through intervention delivery (Week 6) and then again at the end of the intervention (Week 12). All interviews were audio-recorded, transcribed and analysed thematically. RESULTS A total of 24 interviews were conducted with 12 participants. Our findings were organised around four overarching analytical themes: (1) making sense of KATS: timing and complementarity in the rehabilitation journey; (2) engaging with KATS: connection and identification with others; (3) making KATS work: flexibility and tailorable guidance; (4) appraising the worth of KATS: encouragement and friendliness. Participants differentiated KATS from current rehabilitation practice, finding it relevant, fitting and worthwhile. Variations were reported in engagement with behaviour change techniques, but participants were able to tailor KATS use, making it work for them in different ways. CONCLUSIONS Perceived benefits went beyond promoting physical activity, including feeling supported and connected. Future research will test the effectiveness of KATS in promoting physical activity and explore any associations with relevant social and emotional secondary outcomes. PATIENT OR PUBLIC CONTRIBUTION A research funding proposal was developed in collaboration with five people with stroke and three spouses. After securing funding, six people with stroke were invited to join the project's Collaborative Working Group, alongside health professionals and stroke rehabilitation experts, to codevelop the intervention and support the feasibility study.
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Affiliation(s)
- Albert Farre
- School of Health SciencesUniversity of DundeeDundeeUK
| | | | - Linda Irvine
- School of Health SciencesUniversity of DundeeDundeeUK
| | | | | | - Gozde Ozakinci
- Division of Psychology, Faculty of Natural SciencesUniversity of StirlingStirlingUK
| | | | - Claire Jones
- Health Informatics CentreSchool of MedicineUniversity of DundeeDundeeUK
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20
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Olufson HT, Ottrey E, Young AM, Green TL. An ethnographic study exploring person-centred nutrition care in rehabilitation units. Disabil Rehabil 2023:1-9. [PMID: 37776895 DOI: 10.1080/09638288.2023.2254230] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 08/25/2023] [Indexed: 10/02/2023]
Abstract
PURPOSE Person-centred care (PCC) is an essential component of high-quality healthcare across professions and care settings. While research is emerging in subacute nutrition services more broadly, there is limited literature exploring the person-centredness of nutrition care in rehabilitation. This study aimed to explore person-centred nutrition care (PCNC) in rehabilitation units, as described and actioned by patients, support persons and staff. Key factors influencing PCNC were also explored. MATERIALS AND METHODS An ethnographic study was undertaken across three rehabilitation units. Fifty-eight hours of field work were completed with 165 unique participants to explore PCNC. Field work consisted of observations and interviews with patients, support persons and staff. Data were analysed through the approach of reflexive thematic analysis, informed by PCC theory. RESULTS Themes generated were: (1) tensions between patient and staff goals; (2) disconnected moments of PCNC; (3) the necessity of interprofessional communication for PCNC; and (4) the opportunity for PCNC to enable the achievement of rehabilitation goals. CONCLUSIONS PCNC was deemed important to different stakeholders but was at times hindered by a focus on profession-specific objectives. Opportunities exist to enhance interprofessional practice to support PCNC in rehabilitation. Future research should consider the system-level factors influencing PCNC in rehabilitation settings.
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Affiliation(s)
- Hannah T Olufson
- School of Nursing, Midwifery & Social Work, Faculty of Health & Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia
- Dietetics & Food Services, Surgical, Treatment & Rehabilitation Service (STARS), Metro North Health, Herston, QLD, Australia
- STARS Education & Research Alliance, STARS, University of Queensland & Metro North Health, Herston, QLD, Australia
| | - Ella Ottrey
- Monash Centre for Scholarship in Health Education, Monash University, Clayton, VIC, Australia
| | - Adrienne M Young
- Dietetics & Food Services, Royal Brisbane & Women's Hospital, Metro North Health, Herston, QLD, Australia
- Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
| | - Theresa L Green
- School of Nursing, Midwifery & Social Work, Faculty of Health & Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia
- STARS Education & Research Alliance, STARS, University of Queensland & Metro North Health, Herston, QLD, Australia
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21
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Forslund L, Arntzen C, Nikolaisen M, Gramstad A, Eliassen M. Physiotherapy as part of collaborative and person-centered rehabilitation services: the social systems constraining an innovative practice. Physiother Theory Pract 2023:1-16. [PMID: 37676077 DOI: 10.1080/09593985.2023.2255893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND A person-centered and collaborative practice is considered crucial in contemporary physiotherapy. These ideals are often embraced in theory but are difficult to put into practice. As problems and solutions are related, understanding and refining theory on practical problems can close the knowing-doing gap and link the problem to the development of possible solutions. OBJECTIVE To explore the challenges with providing physiotherapy as part of collaborative and person-centered rehabilitation services. METHODS This article reports on an all-day interactive workshop with eight focus group discussions where physiotherapists from six different professional settings participated. We draw on theories of institutional logics to interpret the results. RESULTS Challenges were linked to: 1) Professional level: Services being based on what the profession can offer - not on users' needs; 2) Organizational level: Rewarding efficiency instead of user outcomes; and 3) System level: Not knowing the other service providers involved or what they are doing. CONCLUSION An innovative practice was constrained by multilevel social systems: the professional logic shaping the perceived professional scope, the organizational logic shaping the understanding of what was expected in the organizational context, and a system logic within a biomedical paradigm. Transforming and transcending these social systems is needed to realize collaborative and person-centered practice.
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Affiliation(s)
- Lina Forslund
- Department of Health and Care Sciences, University of Tromsø, Artic University of Norway, Tromsø, Norway
| | - Cathrine Arntzen
- Department of Health and Care Sciences, University of Tromsø, Artic University of Norway, Tromsø, Norway
- Center for Care Sciences, North, University of Tromsø, Artic University of Norway, Tromsø, Norway
| | - Morten Nikolaisen
- Department of Health and Care Sciences, University of Tromsø, Artic University of Norway, Tromsø, Norway
- Center for Care Sciences, North, University of Tromsø, Artic University of Norway, Tromsø, Norway
| | - Astrid Gramstad
- Department of Health and Care Sciences, University of Tromsø, Artic University of Norway, Tromsø, Norway
| | - Marianne Eliassen
- Department of Health and Care Sciences, University of Tromsø, Artic University of Norway, Tromsø, Norway
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22
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Dornonville de la Cour FL, Norup A, Andersen TE, Schow T. Defining a Treatment Model for Self-Management of Fatigue in Rehabilitation of Acquired Brain Injury Using the Rehabilitation Treatment Specification System. J Clin Med 2023; 12:jcm12093192. [PMID: 37176631 PMCID: PMC10179474 DOI: 10.3390/jcm12093192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Systematic treatment descriptions to standardize and evaluate management of fatigue after acquired brain injury (ABI) are lacking. The purpose of this multi-phase qualitative study was to formulate a treatment model for promoting self-management of fatigue in rehabilitation of ABI based on practice-based understandings and routines. The study was conducted in a community-based rehabilitation center in Denmark. The model was defined using the Rehabilitation Treatment Specification System. Phase 1 comprised co-production workshops with five service providers (occupational therapists, physiotherapists, and a neuropsychologist) to elicit preliminary treatment theories. In Phase 2, four case studies were conducted on management of fatigue in vocational rehabilitation. Interviews (n = 8) and treatment log entries (n = 76) were analyzed thematically to specify treatment targets and active ingredients. The treatment model comprised five main components: (i) Knowledge and understanding of fatigue, (ii) Interoceptive attention of fatigue, (iii) Acceptance of fatigue, (iv) Activity management, and (v) Self-management of fatigue. For each component, lists of targets and active ingredients are outlined. In conclusion, management of fatigue includes multiple treatment components addressing skills, habits, and mental representations such as knowledge and attitudes. The model articulates treatment theories, which may guide clinical reasoning and facilitate future theory-driven evaluation research.
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Affiliation(s)
| | - Anne Norup
- Neurorehabilitation Research and Knowledge Centre, Rigshospitalet, 2600 Glostrup, Denmark
| | | | - Trine Schow
- Cervello, 2800 Kongens Lyngby, Denmark
- Neurorehabilitation Research and Knowledge Centre, Rigshospitalet, 2600 Glostrup, Denmark
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23
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Kayes NM, Papadimitriou C. Reflecting on challenges and opportunities for the practice of person-centred rehabilitation. Clin Rehabil 2023:2692155231152970. [PMID: 36726297 DOI: 10.1177/02692155231152970] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To (1) reflect on challenges to the practice of person-centred rehabilitation; and (2) propose opportunities for the development of person-centred rehabilitation. CHALLENGES Person-centred practice has received widespread endorsement across healthcare settings and is understood to be an important, positive approach in rehabilitation. However, the rhetoric of this approach does not always translate meaningfully into practice. Emphasis on patient choice, patient involvement in decision making, and increasing patient capacity for self-management have become a proxy for person-centred rehabilitation in lieu of a more fundamental shift in practice and healthcare structures. System (e.g. biomedical orientation), organisational (e.g. key performance indicators) and professional (e.g. identity as expert) factors compete with person-centred rehabilitation. OPPORTUNITIES Four key recommendations for the development of person-centred rehabilitation are proposed including to: (1) develop a principles-based approach to person-centred rehabilitation; (2) move away from the dichotomy of person-centred (or not) rehabilitation; (3) build person-centred cultures of care in rehabilitation; and (4) learn from diverse perspectives of person-centred rehabilitation. CONCLUSION Fixed assumptions about what constitutes person-centred rehabilitation may limit our ability to respond to the needs of persons and families. Embedding person-centred ways of working is challenging due to the competing drivers and interests of healthcare systems and organisations. A principles-based approach, enabled by person-centred cultures of care, may achieve the aspirations of person-centred rehabilitation.
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Affiliation(s)
- Nicola M Kayes
- Faculty of Health and Environmental Sciences, Centre for Person Centred Research, School of Clinical Sciences, 1410Auckland University of Technology, Auckland, New Zealand
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Harvey AR. Injury, illness, and emotion: A review of the motivational continuum from trauma through recovery from an ecological perspective. Brain Behav Immun Health 2023; 27:100586. [PMID: 36655055 PMCID: PMC9841046 DOI: 10.1016/j.bbih.2022.100586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/15/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
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Wallace TD, McCauley KL, Hodge AT, Moran TP, Porter ST, Whaley MC, Gore RK. Use of person-centered goals to direct interdisciplinary care for military service members and Veterans with chronic mTBI and co-occurring psychological conditions. Front Neurol 2022; 13:1015591. [PMID: 36523344 PMCID: PMC9746344 DOI: 10.3389/fneur.2022.1015591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/26/2022] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVE To explore the use of person-centered goals (PCGs) to direct interdisciplinary care to support PCG attainment in military service members and Veterans (SM/Vs) with chronic mild traumatic brain injury (mTBI) and co-occurring psychological conditions. METHODS A retrospective chart review was completed for 146 United States military SM/Vs reporting chronic symptoms following mTBI and co-occurring psychological conditions who received care in the SHARE Military Initiative intensive outpatient program, a donor-funded program administered by a not-for-profit hospital, between April 1, 2015 and March 31, 2019. PCGs were used to direct care consisting of individual and group-based interventions and therapies delivered by an interdisciplinary, co-located team including behavioral health, case management, neurology or physiatry, nursing, occupational therapy, physical therapy, recreation therapy, speech-language pathology, and transition support. The primary outcome measure was PCG attainment measured via goal attainment scaling. RESULTS Increased PCG attainment was demonstrated at program discharge and throughout the first year following program discharge. Predictors of goal attainment at discharge included longer participation in treatment, greater reduction in depressive symptoms and greater improvement in adjustment at discharge, male gender, and higher cognitive and physical abilities on admission. CONCLUSIONS This sample of military SM/Vs with mTBI and co-occurring psychological conditions who received intensive, interdisciplinary, PCG directed care demonstrated increased PCG attainment at program discharge which further increased with transition support over the year post-discharge. Results suggest PGC goal directed care is a feasible, promising methodology of individualizing treatment in this population. This exploratory study lays a foundation for future prospective, controlled, comparative effectiveness research that will further understanding of the effectiveness of intensive, interdisciplinary, PCG directed care.
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Affiliation(s)
- Tracey D. Wallace
- SHARE Military Initiative, Shepherd Center, Atlanta, GA, United States
| | | | - April T. Hodge
- SHARE Military Initiative, Shepherd Center, Atlanta, GA, United States
| | - Tim P. Moran
- School of Medicine, Department of Emergency Medicine, Emory University, Atlanta, GA, United States
| | - Stephen T. Porter
- School of Medicine, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
| | - Maya C. Whaley
- SHARE Military Initiative, Shepherd Center, Atlanta, GA, United States
| | - Russell K. Gore
- SHARE Military Initiative, Shepherd Center, Atlanta, GA, United States
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
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Eggen L, Thuesen J. Goals and Action Plans Across Time and Place-A Qualitative Study Exploring the Importance of "Context" in Person-Centered Rehabilitation. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:788080. [PMID: 36189011 PMCID: PMC9397753 DOI: 10.3389/fresc.2022.788080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/10/2022] [Indexed: 11/23/2022]
Abstract
Background Person-centeredness is increasingly addressed in relation to rehabilitation interventions. Collaborative goal setting and action plans are key measures in person-centered rehabilitation. There is a lack of knowledge about how person-centered goals and action plans developed away from the patient's everyday life are experienced by patients after discharge. Purpose This aim of the study is to explore how patients with rheumatic diseases experience the relevance of goals and action plans after discharge from inpatient rehabilitation hospital stay. Methods Individual narrative interviews were conducted with eight patients with rheumatic diseases, aged between 40 and 60. A convenience sampling strategy was applied. Data collection, analysis and interpretation of data were performed within a phenomenological-hermeneutic framework inspired by Paul Ricoeur's interpretative philosophy. Results The analysis derived one core theme, “The relevance of goals and action plans is contextual” and three subthemes: “Admission—a protected bubble,” “Back home—a harsh reality,” and “Need for post-discharge support.” Conclusion This study indicates that the relevance of goals and action plans to patients with rheumatic diseases is context specific. On the basis of the study, it is suggested that the context should be considered in rehabilitation practice, including the social network of the patients. This is in order to support patients in rehabilitation interventions to manage everyday life with disease after discharge to their own homes. Moreover, the concept of context in person-centered rehabilitation should be reconsidered. The study also concludes that there is a need for further development and research in follow up programs, as it is not clear what may constitute an optimal design of follow up support.
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Affiliation(s)
- Linda Eggen
- Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark
| | - Jette Thuesen
- Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
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Jesus TS, Stern BZ, Struhar J, Deutsch A, Heinemann AW. The use of patient experience feedback in rehabilitation quality improvement and codesign activities: Scoping review of the literature. Clin Rehabil 2022; 37:261-276. [DOI: 10.1177/02692155221126690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To characterize the literature, reported enablers, and gaps on the use of patient experience feedback for person-centered rehabilitation quality improvement and codesign activities. Design Scoping Review. Data sources Scientific databases (PubMed, CINAHL, Rehabdata, Scopus, Web of Science, ProQuest), website searches (e.g. Beryl Institute), snowballing, and key-informant recommendations. Methods Two independent reviewers performed title and abstract screenings and full-text reviews. Eligibility focused on English-language, peer-reviewed (all time) and gray literature (last five years) that used patient experience feedback in rehabilitation improvement activities. The aims, settings, methods, findings, implications, and reported limitations were extracted, followed by content analyses identifying reported enablers and gaps. Results Among the 901 unique references and 52 full texts reviewed, ten were included: four used patient experience surveys for improving patient experiences; six used codesign methodologies to engage patient feedback in service improvement activities. Implementation enablers included securing managerial support, having a structured methodology and facilitator, using efficient processes, engaging staff experiences, and using appreciative inquiry. Reported study gaps included limited follow-up, low sample sizes, analytical limitations, lack of reported limitations, or narrow range of perspectives (e.g. not from people with severe impairments). Conclusion Few examples of the use of patient experience feedback in quality improvement or codesign activities were found in the rehabilitation literature. Patient experience improvement activities relied exclusively on retrospective survey data, which were not combined with often more actionable forms (e.g. qualitative, real time) of patient experience feedback. Further research might consider design of activities that collect and use patient experience feedback for rehabilitation service improvements.
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Affiliation(s)
- TS Jesus
- Center for Education in Health Sciences, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - BZ Stern
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Struhar
- Nerve, Muscle + Bone Innovation Center & Oncology Innovation Center, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - A Deutsch
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- RTI International, Chicago, IL, USA
| | - AW Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Morris JH, Kayes N, McCormack B. Editorial: Person-Centred Rehabilitation – Theory, Practice, and Research. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:980314. [PMID: 36189058 PMCID: PMC9397690 DOI: 10.3389/fresc.2022.980314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Jacqui H. Morris
- School of Health Sciences, University of Dundee, Dundee, United Kingdom
- *Correspondence: Jacqui H. Morris
| | - Nicola Kayes
- Centre for Person Centered Research, Auckland University of Technology, Auckland, New Zealand
| | - Brendan McCormack
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
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Shiner CT, Bramah V, Wu J, Faux SG, Watanabe Y. Health care interpreter use in an inpatient rehabilitation setting: examining patterns of use and associated clinical outcomes. Disabil Rehabil 2022:1-11. [PMID: 35705483 DOI: 10.1080/09638288.2022.2086637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Professional interpreters can improve healthcare quality and outcomes when there is language discordance between patients and health care providers. Multidisciplinary rehabilitation relies on nuanced communication; however, the use of interpreters in rehabilitation is underexplored. This study aimed to examine patterns of health care interpreter use in an inpatient rehabilitation setting. METHODS A retrospective cohort study was conducted including patients admitted for subacute rehabilitation during 2019-2020 identified as having limited English proficiency. Patterns of interpreter use (professional and "ad hoc") and rehabilitation outcomes were evaluated via medical record review. RESULTS Eighty-five participants were included. During inpatient rehabilitation (median 17 [12-28] days), most clinical interactions (95%) occurred without an interpreter present. Patterns of interpreter use were variable; with greater use of ad hoc versus professional interpreters (received by 60% versus 49% of the cohort, respectively). Those who interacted with a professional interpreter had a longer length-of-stay, larger Functional Independence Measure (FIM) gain, and lower rate of hospital readmission six months post-discharge. The number of professional interpreter sessions correlated positively with FIM gain. CONCLUSIONS Access to professional interpreters in inpatient rehabilitation was variable, with some patients having no or minimal access. These findings provide preliminary evidence that professional interpreter use may be associated with clinical rehabilitation outcomes. Implications for rehabilitationProfessional health care interpreters can be used to overcome language barriers in rehabilitation.In an inpatient rehabilitation setting, professional interpreters appeared to be underutilized, with many patients having no or minimal access to interpreters.Use of ad hoc, untrained interpreters and informal communication strategies was common during rehabilitation.Use of professional interpreters appeared to be associated with favorable rehabilitation outcomes.
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Affiliation(s)
- Christine T Shiner
- Department of Rehabilitation, St Vincent's Hospital Sydney, Darlinghurst, Australia.,Faculty of Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Valerie Bramah
- Department of Rehabilitation, St Vincent's Hospital Sydney, Darlinghurst, Australia
| | - Jane Wu
- Department of Rehabilitation, St Vincent's Hospital Sydney, Darlinghurst, Australia
| | - Steven G Faux
- Department of Rehabilitation, St Vincent's Hospital Sydney, Darlinghurst, Australia.,Faculty of Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Yuriko Watanabe
- Department of Rehabilitation, St Vincent's Hospital Sydney, Darlinghurst, Australia
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Leeson R, Collins M, Douglas J. Finding Goal Focus With People With Severe Traumatic Brain Injury in a Person-Centered Multi-Component Community Connection Program (M-ComConnect). FRONTIERS IN REHABILITATION SCIENCES 2021; 2:786445. [PMID: 36188811 PMCID: PMC9397994 DOI: 10.3389/fresc.2021.786445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022]
Abstract
Background and Objectives: Loss of social connections in the community is a common consequence of severe traumatic brain injury (TBI), resulting in reduced well-being and quality of life. M-ComConnect is an individualized multi-component community connection intervention with the key objectives of increasing social activity, developing social relationships, and supporting community participation following severe TBI. As part of the M-ComConnect approach, semi-structured initial interviews were conducted to develop a holistic understanding of each participant and their goal focus for the project. In this paper we describe how clinicians worked with participants to identify a desired community-based social activity in which to participate. Method: Transcripts of initial interviews between participant and clinician were analyzed using the phases of reflexive thematic analysis developed by Braun and Clarke. Participants were ten individuals aged between 24 and 75 with severe TBI. All were living in the community and reported reduced social connections since their TBI. The aim of the analysis was to evaluate the skills and strategies used by clinicians in their interactions with participants to derive goal focus for the program. Results: Thematic analysis of initial interview data revealed three main categories and fourteen sub-categories of clinical strategies. These were: (1) Humanizing (curiosity; demonstrating respect and empathy; providing compliments and affirmations; simple reflections; revealing aspects of self; and humor and laughter), (2) Empowering (emphasizing choice and control; highlighting strengths; identifying roadblocks and reframing to reveal opportunities; and collaborative problem solving), and (3) Focusing (making suggestions; identifying preferences; working with ideas; and negotiating). These strategies aligned with the program's relational approach and supported the core processes of the goal-focussing framework, namely understanding and connecting with you, building a relationship, and working together with you to find focus. Conclusion: The goal-focusing framework and clinical strategies outlined provide guidance for clinicians working with people with TBI in the community and is a promising way to engage clients when focusing on individualized social activity-based goals.
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Affiliation(s)
- Rebecca Leeson
- Living With Disability Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Michelle Collins
- Living With Disability Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Jacinta Douglas
- Living With Disability Research Centre, La Trobe University, Melbourne, VIC, Australia
- The Summer Foundation, Melbourne, VIC, Australia
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