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Pasha S, Shepley MM. A Structured Literature Review on the Research and Design of Rehabilitation Environments. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024:19375867241248604. [PMID: 38742748 DOI: 10.1177/19375867241248604] [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: 05/16/2024]
Abstract
AIM This literature review is conducted to identify knowledge gaps and shape a framework for the development of guidelines and future research on programming and design of rehabilitation environments. BACKGROUND Patients suffering from trauma, stroke, neurological or cardiopulmonary conditions, or recovering from surgery or cancer treatment require rehabilitation services. A comprehensive rehabilitation program can support continuum of care for inpatient and outpatient groups. However, within most facilities, rehabilitation environments are found to be outdated and undersized compared to other programs or lack the correct adjacencies within the facility. Unfortunately, this deficiency is echoed by limited guidelines on programming, planning, and design of these environments. General guidelines derived from healthcare environments research is not adaptable to rehabilitation environments, because the paradigm used in most healthcare environment research does not address specific needs of rehabilitation patients in regaining confidence or relearning daily life skills. METHOD We conducted a structured literature review, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses as a basis for reporting the available body of work on evidence-based research in rehabilitation environments. RESULT AND CONCLUSION Through analysis of the limited literature, specific mediators such as patient confidence and motivation were identified. An environment that creates a balance between privacy and social interaction can promote these mediators. Creating enriched environments through elements that engage the senses and encourage more social and physical interaction is essential for recovery. Finally, accessibility and wayfinding are of great importance in these environments due to potential limited mobility or cognitive impairments of patients.
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2
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Bozkurt S, Lannin NA, Mychasiuk R, Semple BD. Environmental modifications to rehabilitate social behavior deficits after acquired brain injury: What is the evidence? Neurosci Biobehav Rev 2023; 152:105278. [PMID: 37295762 DOI: 10.1016/j.neubiorev.2023.105278] [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: 01/18/2023] [Revised: 04/22/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023]
Abstract
Social behavior deficits are a common, debilitating consequence of traumatic brain injury and stroke, particularly when sustained during childhood. Numerous factors influence the manifestation of social problems after acquired brain injuries, raising the question of whether environmental manipulations can minimize or prevent such deficits. Here, we examine both clinical and preclinical evidence addressing this question, with a particular focus on environmental enrichment paradigms and differing housing conditions. We aimed to understand whether environmental manipulations can ameliorate injury-induced social behavior deficits. In summary, promising data from experimental models supports a beneficial role of environmental enrichment on social behavior. However, limited studies have considered social outcomes in the chronic setting, and few studies have addressed the social context specifically as an important component of the post-injury environment. Clinically, limited high-caliber evidence supports the use of specific interventions for social deficits after acquired brain injuries. An improved understanding of how the post-injury environment interacts with the injured brain, particularly during development, is needed to validate the implementation of rehabilitative interventions that involve manipulating an individuals' environment.
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Affiliation(s)
- Salome Bozkurt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia; Alfred Health, Melbourne, VIC, Australia; School of Allied Health (Occupational Therapy), La Trobe University, Melbourne, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia; Alfred Health, Melbourne, VIC, Australia
| | - Bridgette D Semple
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia; Alfred Health, Melbourne, VIC, Australia; Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, VIC, Australia.
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3
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Annemans M, Van Dyck D, Heylighen A. What affects physical activity in a rehabilitation centre? Voices of patients, nurses, therapists, and activity trackers. Disabil Rehabil 2023; 45:3108-3117. [PMID: 36083025 DOI: 10.1080/09638288.2022.2118873] [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: 11/29/2021] [Revised: 08/16/2022] [Accepted: 08/21/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE In the context of rehabilitation, research shows a close connection between patients' physical activity, care culture, and the built environment. As these three impact on patients' rehabilitation process, we aim to understand what affects physical activity in a particular rehabilitation centre. MATERIALS AND METHODS We combine insights from literature with a qualitative study informed by quantitative data. Semi-structured and walking interviews with 16 patients were informed by output from activity trackers. Two focus-group interviews with respectively four nurses and two therapists provided extra perspectives. RESULTS We found that patients interpret physical activity rather narrowly, equating it with therapy. Yet, the data of the activity trackers show that daily activities are often as active as therapy, as confirmed by nurses and therapists. Motivation to be physically active was found in setting clear goals, social interaction, allowing choice and control to achieve a sense of normality, and the built environment. How patients act in and interact with the built environment are closely related to how staff approaches and communicates care. CONCLUSIONS The focus on what affects - defines, hampers, or supports - physical activity in a rehabilitation centre allowed developing a better understanding of how care culture and the built environment interrelate.Implications for rehabilitationHow physical activity is perceived by patients reflects the goals they like to achieve through rehabilitation.The built environment is a third factor in the relation between care culture and patients' physical activity.Fully supporting patients to be physically active with respect to their personality and capabilities requires differentiating between patients both in how they are approached (patient- or person-centred) and in how they are spatially facilitated.
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Affiliation(s)
- Margo Annemans
- Research[x]Design, Department of Architecture, KU Leuven, Leuven, Belgium
| | - Delfien Van Dyck
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Ann Heylighen
- Research[x]Design, Department of Architecture, KU Leuven, Leuven, Belgium
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4
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Lipson-Smith R, Zeeman H, Muns L, Jeddi F, Simondson J, Bernhardt J. The role of the physical environment in stroke recovery: Evidence-based design principles from a mixed-methods multiple case study. PLoS One 2023; 18:e0280690. [PMID: 37294748 PMCID: PMC10256226 DOI: 10.1371/journal.pone.0280690] [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: 10/26/2022] [Accepted: 01/05/2023] [Indexed: 06/11/2023] Open
Abstract
Hospital design can impact patient outcomes, but there is very little healthcare design evidence specific to stroke rehabilitation facilities. Our aim was to explore, from the patient perspective, the role of the physical environment in factors crucial to stroke recovery, namely, stroke survivor activity (physical, cognitive, social), sleep, emotional well-being, and safety. We conducted a mixed-methods multiple-case study at two inpatient rehabilitation facilities in Victoria, Australia, (n = 20 at Case 1, n = 16 at Case 2) using "walk-through" semi-structured interviews, behavioural mapping, questionnaires, and retrospective audit. Four interrelated themes emerged: 1) entrapment and escape; 2) power, dependency, and identity in an institutional environment; 3) the rehabilitation facility is a shared space; and 4) the environment should be legible and patient-centred. Quantitative data revealed patterns in patient activity; stroke survivors spent over 75% of their time in bedrooms and were often inactive. Convergent mixed methods analysis was used to generate a new conceptual model of the role of the physical environment in stroke survivors' behaviour and well-being, highlighting the importance of variety and interest, privacy without isolation, and patient-centred design. This model can be used by designers, healthcare providers, and policy makers to inform the design of rehabilitation environments.
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Affiliation(s)
- Ruby Lipson-Smith
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Heidi Zeeman
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Leanne Muns
- Bendigo Health, Clinical Operations, Bendigo, Victoria, Australia
| | - Faraz Jeddi
- Bendigo Health, Department of Integrated Medicine, Bendigo, Victoria, Australia
| | - Janine Simondson
- St Vincent’s Hospital Melbourne, Physiotherapy and Rehabilitation Unit, St George’s Hospital, Kew, Victoria, Australia
| | - Julie Bernhardt
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
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Bernhardt J, Lipson-Smith R, Davis A, White M, Zeeman H, Pitt N, Shannon M, Crotty M, Churilov L, Elf M. Why hospital design matters: A narrative review of built environments research relevant to stroke care. Int J Stroke 2021; 17:370-377. [PMID: 34427477 PMCID: PMC8969212 DOI: 10.1177/17474930211042485] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Healthcare facilities are among the most expensive buildings to construct, maintain, and operate. How building design can best support healthcare services, staff, and patients is important to consider. In this narrative review, we outline why the healthcare environment matters and describe areas of research focus and current built environment evidence that supports healthcare in general and stroke care in particular. Ward configuration, corridor design, and staff station placements can all impact care provision, staff and patient behavior. Contrary to many new ward design approaches, single-bed rooms are neither uniformly favored, nor strongly evidence-based, for people with stroke. Green spaces are important both for staff (helping to reduce stress and errors), patients and relatives, although access to, and awareness of, these and other communal spaces is often poor. Built environment research specific to stroke is limited but increasing, and we highlight emerging collaborative multistakeholder partnerships (Living Labs) contributing to this evidence base. We believe that involving engaged and informed clinicians in design and research will help shape better hospitals of the future.
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Affiliation(s)
- Julie Bernhardt
- Stroke, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Ruby Lipson-Smith
- Stroke, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Aaron Davis
- Stroke, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Marcus White
- Centre for Design Innovation, Swinburne University of Technology, Hawthorne, Australia
| | - Heidi Zeeman
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Natalie Pitt
- Silver Thomas Hanley (STH) Health Architecture, Australia
| | - Michelle Shannon
- Stroke, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Maria Crotty
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Leonid Churilov
- Melbourne Medical School, University of Melbourne, Parkville, Australia
| | - Marie Elf
- School of Education, Health and Social Studies, University of Dalarna, Falun, Sweden
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Kvæl LAH. Helhetlige pasientforløp: brukernes erfaringer med pasientdeltakelse og personsentrert omsorg i kommunal korttidsrehabilitering i overgangen mellom sykehus og hjem. TIDSSKRIFT FOR OMSORGSFORSKNING 2021. [DOI: 10.18261/issn.2387-5984-2021-02-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Hills D, Ekegren C, Plummer V, Freene N, Kunstler B, Robinson T, Healy E, Vo J, Gasevic D, Crabtree A. Nursing perspectives on reducing sedentary behaviour in sub-acute hospital settings: A mixed methods study. J Clin Nurs 2021; 31:1348-1361. [PMID: 34363267 DOI: 10.1111/jocn.15994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/05/2021] [Accepted: 07/26/2021] [Indexed: 11/27/2022]
Abstract
AIM AND OBJECTIVES To determine the factors influencing nurses' decisions and capacity to reduce sedentary behaviour in hospital inpatients in sub-acute hospital settings. BACKGROUND Sedentary behaviour in hospital inpatients is a complex issue that can be resistant to resolution. There is little research investigating factors influencing nurses' promotion of reduced levels of sedentary behaviour in sub-acute hospital settings. DESIGN An explanatory sequential design was employed, comprising quantitative and qualitative phases. METHODS An online survey was conducted with a convenience sample of 138 nurses from five Australian states. Logistic regression modelling identified demographic and behavioural characteristics of nurses who often encouraged patients to reduce their sedentary behaviour. In-depth interviews were conducted with 11 ward nurses and nurse managers, with the content subjected to thematic analysis. STROBE and GRAMMS checklists were employed. RESULTS Nurses recognised their role in promoting reduced sedentary behaviour but faced a range of personal and organisational barriers in achieving this outcome for patients. Few nurses were aware of national physical activity and sedentary behaviour guidelines. Five themes emerged from interviews (nursing role, care challenges, expectations of advocates, teamwork and improving the experience). Overall, many nurses experienced a lack of agency in promoting reduced sedentary behaviour and cognitive dissonance in feeling unable to undertake this role. CONCLUSIONS The results of this study are significant in confirming that reducing sedentary behaviour in hospital inpatients is influenced by a range of complex and multi-level factors. There is a fundamental need for organisational and clinical leadership in building a culture and climate in which staff feel empowered to promote reduced sedentary behaviour in their patients. RELEVANCE TO CLINICAL PRACTICE The results of this study highlight the importance of taking action to reduce sedentary behaviour in sub-acute hospital settings. A co-design approach to developing interventions in local health services is warranted.
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Affiliation(s)
- Danny Hills
- School of Health, Federation University, Ballarat, Vic., Australia.,Health Innovation and Transformation Centre, Federation University, Ballarat, Vic., Australia
| | - Christina Ekegren
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Frankston, Vic., Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Virginia Plummer
- School of Health, Federation University, Ballarat, Vic., Australia.,Peninsula Health, Frankston, Vic., Australia
| | - Nicole Freene
- Physiotherapy, University of Canberra, Bruce, ACT, Australia.,Health Research Institute, University of Canberra, Bruce, ACT, Australia
| | - Breanne Kunstler
- BehaviourWorks Australia, Monash University, Clayton, Vic., Australia
| | - Tracy Robinson
- Faculty of Nursing, Midwifery and Indigenous Health, Charles Sturt University, Bathurst, NSW, Australia
| | - Ellen Healy
- Physiotherapy Department, Monash University, Frankston, Vic., Australia
| | - Jennifer Vo
- Physiotherapy Department, Monash University, Frankston, Vic., Australia
| | - Danijela Gasevic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia.,Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Amelia Crabtree
- Department of Home, Acute and Community, Alfred Health, Melbourne, Vic., Australia
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Lipson-Smith R, Pflaumer L, Elf M, Blaschke SM, Davis A, White M, Zeeman H, Bernhardt J. Built environments for inpatient stroke rehabilitation services and care: a systematic literature review. BMJ Open 2021; 11:e050247. [PMID: 34353805 PMCID: PMC8344318 DOI: 10.1136/bmjopen-2021-050247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To identify, appraise and synthesise existing design evidence for inpatient stroke rehabilitation facilities; to identify impacts of these built environments on the outcomes and experiences of people recovering from stroke, their family/caregivers and staff. DESIGN A convergent segregated review design was used to conduct a systematic review. DATA SOURCES Ovid MEDLINE, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature were searched for articles published between January 2000 and November 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Qualitative, quantitative and mixed-methods studies investigating the impact of the built environment of inpatient rehabilitation facilities on stroke survivors, their family/caregivers and/or staff. DATA EXTRACTION AND SYNTHESIS Two authors separately completed the title, abstract, full-text screening, data extraction and quality assessment. Extracted data were categorised according to the aspect of the built environment explored and the outcomes reported. These categories were used to structure a narrative synthesis of the results from all included studies. RESULTS Twenty-four articles were included, most qualitative and exploratory. Half of the included articles investigated a particular aspect of the built environment, including environmental enrichment and communal areas (n=8), bedroom design (n=3) and therapy spaces (n=1), while the other half considered the environment in general. Findings related to one or more of the following outcome categories: (1) clinical outcomes, (2) patient activity, (3) patient well-being, (4) patient and/or staff safety and (5) clinical practice. Heterogeneous designs and variables of interest meant results could not be compared, but some repeated findings suggest that attractive and accessible communal areas are important for patient activity and well-being. CONCLUSIONS Stroke rehabilitation is a unique healthcare context where patient activity, practice and motivation are paramount. We found many evidence gaps that with more targeted research could better inform the design of rehabilitation spaces to optimise care. PROSPERO REGISTRATION NUMBER CRD42020158006.
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Affiliation(s)
- Ruby Lipson-Smith
- Stroke, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Luis Pflaumer
- Stroke, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Marie Elf
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Sarah-May Blaschke
- Stroke, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Aaron Davis
- Stroke, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Marcus White
- Centre for Design Innovation, The Swinburne University of Technology, Hawthorne, Melbourne, Australia
| | - Heidi Zeeman
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
| | - Julie Bernhardt
- Stroke, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
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9
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Kvæl LAH, Bergland A. The practice environment's influence on patient participation in intermediate healthcare services - the perspectives of patients, relatives and healthcare professionals. BMC Health Serv Res 2021; 21:180. [PMID: 33632241 PMCID: PMC7908719 DOI: 10.1186/s12913-021-06175-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intermediate care (IC) bridges the clinical pathway of older patients transitioning from the hospital to home. Currently, there is a strong consensus that the practice environment is an important factor in helping older people overcome their limitations and regain function after illness or injury. Regardless of the arising attention related to person-centred care, the practice environment is yet to be recognised as a vital part of care, and a small extent of focus has been given the environmental dimensions of IC services. Thus, more research is required regarding the complex relationships between older people and the practice environment. This study explores the perspectives of older patients, their relatives and healthcare professionals related to the practice environment's influence on patient participation among older people in the context of intermediate healthcare services. METHODS Using purposive sampling and theoretical approaches, including frameworks of patient participation, the practices environment and person-centred care, semi-structured interviews were conducted with 15 older patients, 12 relatives and 18 healthcare professionals from three different IC institutions in Norway to discuss their experiences and preferences regarding patient participation. A thematic analysis was used to explore patterns across the interviews. RESULTS Three main themes were identified: 'location and access to physical facilities', 'symbolic expression of patients' and professionals' possibilities' and 'participating in meaningful activities'. The findings show that both the physical and the psychosocial environments influenced older patients' various types of participation in IC services. CONCLUSIONS To optimise rehabilitation care for older people, the ward configuration should focus on supportive environments that facilitate patient participation and provide options for the patients and relatives to independently access the facilities, balancing the personal capabilities with the environmental demands. To foster patient participation, the practice environment should thus align with the model of person-centred rehabilitation.
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Affiliation(s)
- Linda Aimée Hartford Kvæl
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway. .,Norwegian Social Research (NOVA), OsloMet - Oslo Metropolitan University, Oslo, Norway.
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
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10
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Simpson DB, Jose K, English C, Gall SL, Breslin M, Callisaya ML. "Factors influencing sedentary time and physical activity early after stroke: a qualitative study". Disabil Rehabil 2021; 44:3501-3509. [PMID: 33399023 DOI: 10.1080/09638288.2020.1867656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE We aimed to understand from the perspective of stroke survivors and their carers (1) factors contributing to sedentary time and physical activity during inpatient rehabilitation and the transition home, and (2) actual and perceived opportunities to reduce sedentary time and increase physical activity. MATERIAL AND METHODS Qualitative study with 7 stroke survivor/carer dyads and 8 stroke survivors. Semi-structured interviews were conducted 2-4 weeks after hospital discharge, audio recorded and transcribed prior to thematic analysis. RESULTS Stroke survivors were mean age 69 [SD15] years (53% male). Carers were mean age 62 [SD15] years (86% were female). Five themes were identified: (1) Education and guidance about physical activity and sedentary behaviour after stroke is important to build understanding of recovery and secondary prevention, (2) Stroke survivors need clear communication about safety and risk, (3) Return to life participation supports motivation for and engagement in physical activity, 4) Social and professional influences and 5) Opportunities to be physically active. CONCLUSION Stroke survivors and their carers need a clearer understanding of the role of physical activity and risks of sedentary time during stroke recovery. Physical activity enablers included consistent communication, building confidence and skills to self-manage activity before discharge.Implications for RehabilitationInpatient rehabilitation and early after discharge may be an important time-point to support stroke survivors to establish long term physical activity behaviours before contact with healthcare professionals reduces.To reduce sedentary behaviour, people need to understand the health benefits of breaking up sedentary time and people who need physical support to stand up will need greater support from health professionals.Being able to imagine a future post-stroke self is important motivation to get up and move. Rehabilitation should help develop a person's vision of their post-stroke self.Managing potential risks in hospital without overly restricting physical activity is important and requires consistent communication from the multi-disciplinary team.Building a person's confidence and skills to self-manage physical activity in the community prior to discharge home may be another key enabler for activity.
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Affiliation(s)
- Dawn B Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Kim Jose
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Institute for the Study of Social Change, University of Tasmania, Hobart, Australia
| | - Coralie English
- School of Health Sciences, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, University of Newcastle Priority Research Centre for Stroke and Brain Injury, Newcastle, Australia
| | - Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Michele L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
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11
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Marín J, Blanco T, Marín JJ, Moreno A, Martitegui E, Aragüés JC. Integrating a gait analysis test in hospital rehabilitation: A service design approach. PLoS One 2019; 14:e0224409. [PMID: 31665158 PMCID: PMC6821402 DOI: 10.1371/journal.pone.0224409] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/11/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Gait analysis with motion capture (MoCap) during rehabilitation can provide objective information to facilitate treatment decision making. However, designing a test to be integrated into healthcare services requires considering multiple design factors. The difficulty of integrating a 'micro-service' (gait test) within a 'macro-service' (healthcare service) has received little attention in the gait analysis literature. It is a challenge that goes beyond the gait analysis case study because service design methods commonly focus on the entire service design (macro-level). OBJECTIVE This study aims to extract design considerations and generate guidelines to integrate MoCap technology for gait analysis in the hospital rehabilitation setting. Specifically, the aim is to design a gait test to assess the response of the applied treatments through pre- and post-measurement sessions. METHODS We focused on patients with spasticity who received botulinum toxin treatment. A qualitative research design was used to investigate the integration of a gait analysis system based on inertial measurement units in a rehabilitation service at a reference hospital. The methodological approach was based on contrasted methodologies from the service design field, which materialise through observation techniques (during system use), semi-structured interviews, and workshops with healthcare professionals (13 patients, 10 'proxies', and 6 doctors). RESULTS The analysis resulted in six themes: (1) patients' understanding, (2) guiding the gait tests, (3) which professionals guide the gait tests, (4) gait test reports, (5) requesting gait tests (doctors and test guide communication), and the (6) conceptual design of the service with the gait test. CONCLUSIONS The extracted design considerations and guidelines increase the applicability and usefulness of the gait analysis technology, improving the link between technologists and healthcare professionals. The proposed methodological approach can also be useful for service design teams that deal with the integration of one service into another.
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Affiliation(s)
- Javier Marín
- IDERGO (Research and Development in Ergonomics) Research Group, I3A (Aragon Institute of Engineering Research), University of Zaragoza, Zaragoza, Spain
- Department of Design and Manufacturing Engineering, University of Zaragoza, Zaragoza, Spain
| | - Teresa Blanco
- HOWLab (Human Openware Research Lab) Research Group, I3A, University of Zaragoza, Zaragoza, Spain
- GeoSpatiumLab, S.L. Zaragoza, Spain
| | - José J. Marín
- IDERGO (Research and Development in Ergonomics) Research Group, I3A (Aragon Institute of Engineering Research), University of Zaragoza, Zaragoza, Spain
- Department of Design and Manufacturing Engineering, University of Zaragoza, Zaragoza, Spain
| | - Alejandro Moreno
- IDERGO (Research and Development in Ergonomics) Research Group, I3A (Aragon Institute of Engineering Research), University of Zaragoza, Zaragoza, Spain
- Department of Health and Sports Sciences, University of Zaragoza, Zaragoza, Spain
| | - Elena Martitegui
- Rehabilitation and Physical Medicine Service, HUMS (Miguel Servet University Hospital), Zaragoza, Spain
| | - Juan C. Aragüés
- Rehabilitation and Physical Medicine Service, HUMS (Miguel Servet University Hospital), Zaragoza, Spain
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12
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Killington M, Fyfe D, Patching A, Habib P, McNamara A, Kay R, Kochiyil V, Crotty M. Rehabilitation environments: Service users' perspective. Health Expect 2019; 22:396-404. [PMID: 30632258 PMCID: PMC6543154 DOI: 10.1111/hex.12859] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/31/2018] [Accepted: 12/01/2018] [Indexed: 11/30/2022] Open
Abstract
Background Design of rehabilitation environments is usually “expert” driven with little consideration given to the perceptions of service users, especially patients and informal carers. There is a need to engage with consumers of services to gain their insights into what design aspects are required to facilitate optimum physical activity, social interaction and psychological responses when they are attempting to overcome their limitations and regain function. Research design Qualitative exploratory study. Method Interviews were conducted with patients (n = 54) and informal carers (n = 23), and focus groups with rehabilitation staff (n = 90), from the three metropolitan South Australia rehabilitation health services, comprising different building and environmental configurations. Thematic analysis was assisted by the use of NVivo 11 qualitative software, with pooled data from all interviews and focus groups undergoing open, axial and finally selective coding. Results Four major themes were identified as follows: (a) choice can be an Illusion in a rehabilitation ward; (b) access to outside areas is a priority and affects well‐being; (c) socialization can be facilitated by the environment; and (d) ward configuration should align with the model of care. Discussion and Conclusion Participants who encountered the most restrictive environments accepted their situation until probed to consider alternatives; those who enjoyed the most choice and access to facilities showed the greatest enthusiasm for these affordances. Future architectural designers should therefore consider the perceptions of a wide range of consumers with varying experiences to ensure they understand the complex requirements of patients and that the ward design facilitates the optimum rehabilitation model of care.
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Affiliation(s)
- Maggie Killington
- Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia.,Flinders University, Bedford Park, South Australia, Australia
| | - Dean Fyfe
- Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Allan Patching
- Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Paul Habib
- Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | - Annabel McNamara
- Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia.,Flinders University, Bedford Park, South Australia, Australia
| | - Rachael Kay
- Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Venugopal Kochiyil
- Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Maria Crotty
- Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia.,Flinders University, Bedford Park, South Australia, Australia
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