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Asada Y, Nishio K, Iitsuka K, Yaeda J. A qualitative study of stressors faced by older stroke patients in a convalescent rehabilitation hospital. PLoS One 2024; 19:e0309457. [PMID: 39186755 PMCID: PMC11346951 DOI: 10.1371/journal.pone.0309457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 08/13/2024] [Indexed: 08/28/2024] Open
Abstract
This study aimed to explore the stressors experienced by older patients with stroke in convalescent rehabilitation wards in Japan. Semi-structured interviews were conducted with four stroke patients aged > 65 years who experienced a stroke for the first time in their lives. The interviews were analyzed using the Steps for Coding and Theorization method for qualitative data analysis. The results of the qualitative analysis demonstrated that patients experienced specific stressors, such as, difficulty in movement of the paralyzed hand, fear of stroke recurrence, and dietary problems. Some stressors were manageable through healthcare professionals' active and sensitive communication strategies. These stressors were derived from the theoretical framework of "stressors related to hospitalization" and "stressors related to the illness". Additional stressors emerged from the interaction between these two types within the theoretical framework. The results of this study contribute to a deeper understanding of the specific stressors experienced by older stroke patients during the recovery process.
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Affiliation(s)
- Yuta Asada
- Department of Occupational Therapy, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan
| | - Kaori Nishio
- Department of Occupational Therapy, Teikyo Heisei University, Toshima, Tokyo, Japan
| | - Kohei Iitsuka
- Department of Occupational Therapy, Saitama Medical Center, Kawagoe, Saitama, Japan
| | - Jun Yaeda
- Faculty of Human Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
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Nielsen LS, Primdahl J, Clausen B, Bremander A. A joint venture: patients' experiences with goal setting in rheumatology rehabilitation - a qualitative study. Disabil Rehabil 2024:1-9. [PMID: 38375771 DOI: 10.1080/09638288.2024.2313122] [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: 07/06/2023] [Accepted: 01/27/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE To explore how patients with rheumatic musculoskeletal diseases (RMDs) perceive participation in the goal setting process prior to interdisciplinary rehabilitation. METHODS We conducted semi-structured interviews with 22 participants admitted to an interdisciplinary rehabilitation stay for patients with RMDs at two Danish rehabilitation centres. Qualitative content analysis was applied. RESULTS The participants perceived goal setting as a joint venture between two parties: the health professionals and the participant. Three categories were formed, which described both facilitators and barriers in the process. Responsibility for goal setting described the importance of shared responsibility, or health professionals as experts, taking full responsibility for goal setting. Equipped for goal setting included perceptions of being well prepared for the process, or considerations that goal setting was difficult because of a lack of information. An equal member of the team entailed both the feeling of being recognised as one in the team, or feeling like an outsider. CONCLUSION Goal setting is perceived as a challenge by some patients. Participation in goal setting depends on both the capacity and the opportunity to participate which are factors linked to patients' level of health literacy.
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Affiliation(s)
- Lisbeth Skovly Nielsen
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- The Danish Rheumatism Association's Rehabilitation Centre, Sano, Denmark
| | - Jette Primdahl
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Brian Clausen
- The Danish Rheumatism Association's Rehabilitation Centre, Sano, Denmark
| | - Ann Bremander
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Spenshult Research and Development Centre, Halmstad, Sweden
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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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Kang E, Foster ER. Development of a goal setting and goal management system: Intervention Mapping. FRONTIERS IN REHABILITATION SCIENCES 2024; 4:1274191. [PMID: 38259874 PMCID: PMC10801041 DOI: 10.3389/fresc.2023.1274191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/13/2023] [Indexed: 01/24/2024]
Abstract
Background Although goal setting and goal management (GSGM) is a key component of chronic disease management and rehabilitation practice, there is currently no widely used evidence-based intervention system available. This paper describes the theoretical underpinnings and development of a new intervention called MyGoals. MyGoals is designed to guide occupational therapy (OT) practitioners to implement theory-based, client-engaged GSGM for adults with chronic conditions in community-based OT rehabilitation settings. Methods We first developed a planning team with two adults with chronic conditions, two clinicians, and two researchers. As a collaborative team, we co-developed MyGoals by following Intervention Mapping (IM) steps 1-4 and incorporating community-based participatory research principles to ensure equitable, ecologically valid, and effective intervention development. In the first step, the planning team conducted a discussion-based needs assessment and a systematic review of current GSGM practice to develop a logic model of the problem. In the second step, the planning team identified performance objectives, intervention target personal determinants, and change objectives, and created a logic model of change and matrics of change objectives. In the third step, the planning team designed MyGoals. Lastly, in the fourth step, the planning team produced, pilot-tested, and refined MyGoals. Results The ultimate goal of the MyGoals intervention is to enable clients to achieve personally meaningful rehabilitation goals. The planning team identified four target determinants (e.g., self-efficacy), six intervention activities (e.g., Education, Reflection, Find My Goals, Make My Goals, Make My Plans, My Progress), eight performance objectives (e.g., List potential goals), and 26 change objectives (e.g., Understand the importance of GSGM). Two pilot tests indicated that MyGoals is feasible for clients and identified areas for improvement. Based on the feedback, minor refinements were made to the MyGoals intervention materials. Conclusions We completed rigorous and collaborative IM to develop MyGoals. Establishing the theoretical and developmental foundation for MyGoals sets the groundwork for high-quality, evidence-based GSGM. Future studies on effectiveness and implementation are necessary to refine, translate, and scale MyGoals in rehabilitation practice.
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Affiliation(s)
- Eunyoung Kang
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
| | - Erin R. Foster
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
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Kylén M, Sturge J, Lipson-Smith R, Schmidt SM, Pessah-Rasmussen H, Svensson T, de Vries L, Bernhardt J, Elf M. Built Environments to Support Rehabilitation for People With Stroke From the Hospital to the Home (B-Sure): Protocol for a Mixed Method Participatory Co-Design Study. JMIR Res Protoc 2023; 12:e52489. [PMID: 37943590 PMCID: PMC10667985 DOI: 10.2196/52489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND A global trend is to move rehabilitation closer to people's neighborhoods and homes. Still, little attention has been given to how the built environment outside the hospital setting might impact rehabilitation and recovery for stroke survivors. OBJECTIVE The overarching objective of this project is to develop conceptual models of built environments that support stroke rehabilitation and recovery outside the hospital setting. Specifically, the project will explore factors and characteristics of the built environment that support people with stroke and their families and identify innovative built environments that can be designed for local health care. The project will examine facilitators and obstacles for implementing built environmental solutions and evaluate the potential benefits, feasibility, and acceptability. METHODS The project uses a mixed methods design approach with 3 phases. In phase 1, factors and characteristics of the built environment for rehabilitation will be identified. Based on the results from phase 1, phase 2 will involve co-designing prototypes of environments to support the rehabilitation process for people with stroke. Finally, the prototypes will be evaluated in phase 3. Qualitative and quantitative methods will include a literature review, a concept mapping (CM) study, stakeholder interviews, prototype development, and testing. The project will use multidimensional scaling, hierarchical cluster analysis, descriptive statistics for quantitative data, and content analysis for qualitative data. Location analysis will rely on the location-allocation model for network problems, and the rule-based analysis will be based on geographic information systems data. RESULTS As of the submission of this protocol, ethical approval for the CM study and the interview study has been obtained. Data collection is planned to start in September 2023 and the workshops later in the same year. The scoping review is ongoing from January 2023. The CM study is ongoing and will be finalized in the spring of 2024. We expect to finish the data analysis in the second half of 2024. The project is a 3-year project and will continue until December 2025. CONCLUSIONS We aim to determine how new environments could better support a person's control over their day, environment, goals, and ultimately control over their recovery and rehabilitation activities. This "taking charge" approach would have the greatest chance of transferring the care closer to the patient's home. By co-designing with multiple stakeholders, we aim to create solutions with the potential for rapid implementation. The project's outcomes may target other people with frail health after a hospital stay or older persons in Sweden and anywhere else. The impact and social benefits include collaboration between important stakeholders to explore how new environments can support the transition to local health care, co-design, and test of new conceptual models of environments that can promote health and well-being for people post stroke. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52489.
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Affiliation(s)
- Maya Kylén
- Department of Health Sciences, Lund University, Lund, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Jodi Sturge
- Department of Design, Production and Management, Faculty of Engineering Technology, University of Twente, Twente, Netherlands
| | - Ruby Lipson-Smith
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, Australia
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | | | - Hélène Pessah-Rasmussen
- Department of Neurology, Rehabilitation Medicine, Memory Clinic and Geriatrics, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Tony Svensson
- School of Information and Engineering, Dalarna University, Borlänge, Sweden
| | - Laila de Vries
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Julie Bernhardt
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Marie Elf
- School of Health and Welfare, Dalarna University, Falun, Sweden
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Wattel EM, de Groot AJ, Deetman-van der Breggen S, Bonthuis R, Jongejan N, Tol-Schilder MMR, van der Wouden JC, Gobbens R. Development of a practical guideline for person centred goal setting in geriatric rehabilitation: a participatory action research. Eur Geriatr Med 2023; 14:1011-1019. [PMID: 37460835 PMCID: PMC10587279 DOI: 10.1007/s41999-023-00830-w] [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: 05/02/2023] [Accepted: 06/28/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE To improve goal setting in Geriatric Rehabilitation (GR), by developing an evidence-based practical guideline for patient-centred goal setting. METHODS Participatory action research (PAR) in a cyclical process, with GR professionals as co-researchers. Each cycle consisted of five phases: problem analysis, literature review, development, practical experience, feedback & evaluation. The evaluation was based on video recordings of goal setting conversations, and on oral and written feedback of the GR professionals who tested the guideline. RESULTS In two PAR-cycles the guideline was developed, consisting of eight recommendations for setting and using goals, and of practical advices elaborating three of the recommendations, concerning conversational skills specific for goal setting conversations. After the second cycle the research team concluded that the guideline was feasible in daily practice and effective when used consciously. CONCLUSION In this study, a practical guideline for setting and using goals in GR was developed. GR teams can improve their patient centred working with goals by discussing the recommendations in their team and choosing the recommendations to work on. This can be supported by the development of an interdisciplinary training. The effect on quality of care should be subject to further investigation.
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Affiliation(s)
- Elizabeth M. Wattel
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1109, OZW 8B-05, 1081 HV Amsterdam, The Netherlands
- Aging and Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Aafke J. de Groot
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1109, OZW 8B-05, 1081 HV Amsterdam, The Netherlands
- Aging and Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | | | - Robin Bonthuis
- Zonnehuisgroep IJssel-Vecht, Location Stadshagen, Geriatric Rehabilitation, Zwolle, The Netherlands
| | - Niels Jongejan
- Stichting QuaRijn, Geriatric Rehabilitation Care, Doorn, The Netherlands
| | | | - Johannes C. van der Wouden
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1109, OZW 8B-05, 1081 HV Amsterdam, The Netherlands
- Aging and Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Robbert Gobbens
- Zonnehuisgroep Amstelland, Amstelveen, The Netherlands
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Tranzo, Tilburg University, Tilburg, The Netherlands
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Vingerhoets C, Hay-Smith J, Graham F. Getting to know our patients and what matters: exploring the elicitation of patient values, preferences, and circumstances in neurological rehabilitation. Disabil Rehabil 2023; 45:1444-1452. [PMID: 35476588 DOI: 10.1080/09638288.2022.2063416] [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: 08/13/2021] [Revised: 03/25/2022] [Accepted: 04/04/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Patient values, preferences, and circumstances are critical to decision-making in both patient-centred and evidence-based practice models of healthcare. Despite the established importance of integrating these patient attributes, the ways they are elicited in rehabilitation remain unclear. This study aimed to explore how health professionals elicit and share patients' 'values', 'preferences', and 'circumstances', and what they understand by the terms. METHODS This exploratory qualitative descriptive study used interviews with 13 clinicians from interprofessional teams in inpatient neurological rehabilitation. Data were analysed using a general inductive approach. RESULTS Participants understood 'values' to mean what is important and meaningful; 'preferences' as likes/dislikes and choices; and 'circumstances' as the social, physical, and environmental context surrounding the person. Formal and informal strategies were used to gather information directly from patients or indirectly from other sources. The processes of eliciting and communicating this information were influenced by relationships and relied on contributions from many people. Elicitation involved a flexible approach tailored to the individual and considering each unique context. CONCLUSION The strategies used and the approach used to implement these strategies were both essential to eliciting patient values, preferences, and circumstances in neurological rehabilitation. These findings offer insights into the practices of interprofessional rehabilitation clinicians. Implications for rehabilitationEliciting patient values, preferences, and circumstances involves a combination of strategies and approaches that are applied gradually throughout the continuum of rehabilitation.These processes are flexible, and strategies should be tailored to individual patients/families and phases of rehabilitation.Clinicians should be attentive to informal opportunities to gather valuable information throughout rehabilitation.Establishing positive relationships and using effective communication is foundational to these processes.
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Affiliation(s)
| | - Jean Hay-Smith
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Fiona Graham
- Department of Medicine, University of Otago, Wellington, New Zealand
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8
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Goldwater D, Wenger NK. Patient-centered care in geriatric cardiology. Trends Cardiovasc Med 2023; 33:13-20. [PMID: 34758389 DOI: 10.1016/j.tcm.2021.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/21/2021] [Accepted: 11/03/2021] [Indexed: 02/01/2023]
Abstract
Geriatric cardiology involves providing cardiovascular care to older adults in relation to aging. Although cardiovascular diseases are the most common diseases faced by older adults, they often co-occur with numerous aging-related challenges, such as multimorbidity, frailty, polypharmacy, falls, functional and cognitive impairment, which present challenges to implementing standard disease-based treatment strategies. Faced with these complexities, patient-centered care in geriatric cardiology strives to direct all management toward the achievement of an individual's prioritized health and life goals by employing shared decision-making to align treatment with goals, utilizing stated goals to navigate situations of treatment uncertainty, and pro-actively mitigating aging-related risks. This fundamental change in cardiovascular medicine from disease-centered management to patient-centered goal-directed care is necessary to facilitate wellness, independence, and favorable quality of life outcomes in the older adult population.
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Affiliation(s)
| | - Nanette K Wenger
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Kang E, Foster ER. Use of Implementation Mapping With Community-Based Participatory Research: Development of Implementation Strategies of a New Goal Setting and Goal Management Intervention System. Front Public Health 2022; 10:834473. [PMID: 35619816 PMCID: PMC9127132 DOI: 10.3389/fpubh.2022.834473] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/09/2022] [Indexed: 11/30/2022] Open
Abstract
Aims This study aims to identify implementation determinants, mechanisms of action, implementation strategies, and implementation outcome evaluation plans for a new theory-based rehabilitation goal setting and goal management intervention system, called MyGoals, using Implementation Mapping with community-based participatory research principles. Methods We completed Implementation Mapping tasks 1 to 4 as a planning team consisting of MyGoals target implementers (occupational therapists (OTs), MyGoals intervention target clients (adults with chronic conditions), and the research team. We are currently conducting mapping task 5. These processes were guided by the Consolidated Framework for Implementation Research, social cognitive theory, the taxonomy of behavior change methods, and Proctor's implementation research framework. Results We identified intervention-level determinants (MyGoals' evidence strength & quality, relative advantages) and OT-level determinants (knowledge, awareness, skills, self-efficacy, outcome expectancy). We selected the MyGoals implementation outcome (OTs will deliver MyGoals completely and competently), outcome variables (acceptability, appropriateness, feasibility, fidelity), and process outcomes. We also determined three performance objectives (e.g., OTs will deliver all MyGoals intervention components) and 15 change objectives (e.g., OTs will demonstrate skills for delivering all MyGoals intervention components). Based on the identified outcomes, objectives, and determinants, we specified the mechanisms of change (e.g., active learning). To address these determinants and achieve the implementation outcomes, we produced two tailored MyGoals implementation strategies: MyGoals Clinician Education and MyGoals Clinician Audit & Feedback. We developed evaluation plans to explore and evaluate how these two MyGoals implementation strategies perform using a mixed-methods study of OT-client dyads. Conclusion We produced tailored implementation strategies for a rehabilitation goal setting and goal management intervention by using Implementation Mapping with community-based participatory research principles. The MyGoals implementation strategies may help OTs implement high-quality goal setting and goal management practice and thus contribute to bridging current research-practice gaps. Our findings can provide insight on how to apply implementation science in rehabilitation to improve the development and translation of evidence-based interventions to enhance health in adults with chronic conditions.
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Affiliation(s)
- Eunyoung Kang
- Program in Occupational Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Erin R Foster
- Program in Occupational Therapy, Department of Neurology and Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
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Knowing-in-action that centres humanising relationships on stroke units: an appreciative action research study. BRAIN IMPAIR 2022. [DOI: 10.1017/brimp.2021.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background:
Equal, collaborative and therapeutic relationships centred on the person affected by stroke are important for supporting recovery and adjustment. However, realising these relationships in hospital practice is challenging when there is increasing focus on biomedical needs and organisational pressures. Despite a body of evidence advocating for quality relationships, there remains limited research describing how to achieve this in clinical practice. This appreciative action research (AAR) study aimed to describe the processes involved in co-creating meaningful relationships on stroke units.
Design and methods:
An AAR approach was used to develop humanising relationship-centred care (RCC) within two hospital stroke units. Participants were staff (n = 65), patients (n = 17) and relatives (n = 7). Data generation comprised of interviews, observations and discussion groups. Data were analysed collaboratively with participants using sense-making as part of the AAR cyclical process. Further in-depth analysis using immersion crystallisation confirmed and broadened the original themes.
Findings:
All participants valued similar relational experiences around human connections to support existential well-being. The AAR process supported changes in self, and the culture on the stroke units, towards increased value being placed on human relationships. The processes supporting human connections in practice were: (i) sensitising to humanising relational knowing; (ii) valuing, reflecting and sharing relational experiences with others that co-created a relational discourse; and (iii) having the freedom to act, enabling human connections. The outcomes from this study build on existing lifeworld-led care theories through developing orientations for practice that support relational knowing and propose the development of RCC to include humanising values.
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Alanko T, Karhula M, Kröger T, Piirainen A, Nikander R, Vuoskoski P. Conceptions of healthcare professionals about rehabilitees' participation in goal setting in an acute hospital: A phenomenographic study. Physiother Theory Pract 2022:1-12. [PMID: 35180836 DOI: 10.1080/09593985.2022.2037796] [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: 10/19/2022]
Abstract
PURPOSE In acute care, effective goal-setting is an essential phase of a successful rehabilitation process. However, professionals' knowledge and skills in rehabilitee-centered practice may not always match the ways of implementing goal-setting. This study aimed to describe the variation in how acute hospital professionals perceive and comprehend rehabilitee participation in rehabilitation goal-setting. METHODS Data were collected by interviewing 27 multidisciplinary rehabilitation team members in small groups shortly after rehabilitation goal-setting sessions. A qualitative research design based on phenomenography was implemented. RESULTS We identified four conceptions of rehabilitee participation, based on four hierarchically constructed categories: 1) Professional-driven rehabilitee participation; 2) Awakening rehabilitee participation; 3) Coaching participation; and 4) Shared participation. These categories varied according to four themes: 1) Use of power; 2) Ability to involve; 3) Interaction process; and 4) Atmosphere. Three critical aspects between the categories were also identified: 1) Appreciative listening; 2) Trustful relationship; and 3) Collaborative partnership. CONCLUSION The study generated new insights into the meaning of rehabilitee participation, as conceptualized in relation to rehabilitation goal-setting and an acute hospital context. The identified critical aspects can be useful for planning and developing continuing professional education (CPE) in rehabilitation goal-setting for professionals.
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Affiliation(s)
| | - Maarit Karhula
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland.,South-Eastern Finland University of Applied Sciences, Patteristonkatu Finland; Social Insurance Institution of Finland, Helsinki, Finland
| | - Teppo Kröger
- University of Jyväskylä, Department of Social Sciences and Philosophy, Finland & Centre for Care Research West, Western Norway University of Applied Sciences, Norway; Department of Social Sciences and Philosophy, University of Jyväskylä, Jyvaskyla, Finland
| | - Arja Piirainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
| | - Riku Nikander
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
| | - Pirjo Vuoskoski
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
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12
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Catz A. Conceptual changes needed to improve outcomes in rehabilitation medicine: A clinical commentary. NeuroRehabilitation 2022; 51:341-345. [PMID: 35527581 PMCID: PMC9535547 DOI: 10.3233/nre-220069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/08/2022] [Indexed: 12/04/2022]
Abstract
Rehabilitation medicine has expanded the horizon of all medicine and brought about new human achievements. To facilitate continued advances in achievement, several changes are suggested in customary rehabilitation strategic goals, concepts, and practices. The main rehabilitation goals should focus on prolonged survival, contrary to the opinions of most authors on rehabilitation, and on achievement of maximum ability realization, rather than of independence or any given (including previous) level of functioning. Setting rehabilitation goals should benefit the patient, rather than the caregiver or the insurer. Training should focus on tasks that contribute to the patients' interests and desires, rather than on any task that reduces the burden of care. The main criterion for admission to a rehabilitation ward should be based on expected advantage in prolonging patient survival and maximizing ability realization.
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Affiliation(s)
- Amiram Catz
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel E-mail:
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Lafiatoglou P, Ellis-Hill C, Gouva M, Ploumis A, Mantzoukas S. A systematic review of the qualitative literature on older individuals' experiences of care and well-being during physical rehabilitation for acquired brain injury. J Adv Nurs 2021; 78:377-394. [PMID: 34397112 PMCID: PMC9291982 DOI: 10.1111/jan.15016] [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: 02/16/2021] [Revised: 06/24/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022]
Abstract
Aims To acquire an in‐depth understanding of how older individuals diagnosed with acquired brain injury (ABI) experience their well‐being and care when undergoing physical rehabilitation. Design Systematic literature review. Data sources The electronic databases of PubMed, CINAHL, APA PsycInfo, ASSIA and SCOPUS were searched from 2005 to 2020. Extensive reference checking was also conducted. Review methods A systematic review was conducted following PRISMA guidelines, including predominantly qualitative studies. Studies’ quality was appraised using the critical apraisal skills programme (CASP) tool. Results Seventeen studies met the inclusion criteria. Following methods of thematic synthesis, four overarching interpretive themes were identified: (a) Rehabilitation processes and their impact on older individuals’ well‐being; (b) Identity and embodiment concerns of older individuals during rehabilitation; (c) Institutional factors affecting older individuals’ care and well‐being experiences; and (d) Older individuals’ participation in creative activities as part of rehabilitation. Conclusion Organizational and structural care deficiencies as well as health disparities can adversely impact older individuals’ autonomous decision‐making and goal‐setting potentials. The discrepancy between older individuals’ expectations and the reality of returning home along with the illusionary wish to return to a perceived normality, can further negatively affect older individuals’ sense of well‐being. Constructive communication, emotional support, family involvement in rehabilitation and creating a stimulating, enriching social environment can humanize and facilitate older individuals’ adjustment to their new reality following ABI. Impact There is a lack of qualitative research on older individuals’ ABI rehabilitation experiences, especially traumatic brain injury incidents. Further study should consider patients’ concerns over their involvement in decision‐making and goal setting about their care. Overall, this review reveals the need to examine further the significance of humanizing care and the factors that affect older individuals’ sense of well‐being.
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Affiliation(s)
| | | | - Mary Gouva
- Department of Nursing, University of Ioannina, Ioannina, Greece
| | - Avraam Ploumis
- Department of Medicine, University of Ioannina, Ioannina, Greece
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Jesus TS, Papadimitriou C, Bright FA, Kayes NM, Pinho CS, Cott CA. The Person-Centered Rehabilitation Model: Framing the concept and practice of person-centered adult physical rehabilitation based on a scoping review and thematic analysis of the literature. Arch Phys Med Rehabil 2021; 103:106-120. [PMID: 34228955 DOI: 10.1016/j.apmr.2021.05.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/04/2021] [Accepted: 05/11/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To develop a cross-professional model framing the concept and practice of Person-Centered Rehabilitation (PCR) in adult populations, based on a scoping review and thematic analysis of the literature. DATA SOURCES Key databases (PubMed, Scopus, CINAHL), snowballing searches, and experts' consultation were the data sources for English-language empirical or conceptual papers, published from January 2007 to February 2020. STUDY SELECTION Two independent reviewers selected adult-based papers addressing at least one of the six categories of PCR-related content, a priori specified in the published review protocol. From 6527 unique references, 147 were finally included in the analysis. Of those, 26 were exclusively conceptual papers. DATA EXTRACTION Two independent reviewers extracted textual data on what PCR entails conceptually or as a practice. No quality appraisals were performed as is typical in scoping reviews. DATA SYNTHESIS A thematic analysis produced thematic categories that were combined into an emergent model (the PCR Model), which was reviewed by five external experts. PCR was framed as a way of thinking about and providing rehabilitation services "with" the person. PCR is embedded in rehabilitation structures and practice across three levels: 1) the person-professional dyad, 2) the micro-system level (typically an interprofessional team, involving significant others) and 3) a macro-system level (organization within which rehabilitation is delivered). Thematic categories are articulated within each level, detailing both the conceptual and practice attributes of PCR. CONCLUSION The PCR model can inform both clinical and service organization practices. The PCR Model may benefit from further developments including obtaining wider stakeholders' input, determining relevance in different cultural and linguistic groups, and further operationalization and testing in implementation projects.
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Affiliation(s)
- Tiago S Jesus
- Global Health and Tropical Medicine (GHTM) & WHO Collaborating Centre for Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine - NOVA University of Lisbon, Rua da Junqueira 100, Lisbon 1349-008, Portugal.
| | | | - Felicity A Bright
- Centre for Person Centred Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Nicola M Kayes
- Centre for Person Centred Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Cátia S Pinho
- ISVOUGA - Superior Institute of Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Cheryl A Cott
- Rehabilitation Sciences Institute, Faculty of Medicine; University of Toronto, Toronto, Canada
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Vaalburg AM, Wattel E, Boersma P, Hertogh C, Gobbens R. Goal-setting in geriatric rehabilitation: Can the nursing profession meet patients' needs? A narrative review. Nurs Forum 2021; 56:648-659. [PMID: 33625738 PMCID: PMC8451803 DOI: 10.1111/nuf.12562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To provide an overview of patients' needs concerning goal-setting, and indications of how those needs can be met by nurses. METHODS A narrative review. Pubmed and Cinahl were searched through March 1, 2020 for: patients' experiences concerning goal-setting and the role of nursing in rehabilitation. Additional articles were found through snowballing. A total of 22 articles were reviewed on patients' experiences, and 12 on the nursing role. RESULTS Patients need to be prepared for collaborating in goal-setting and to receive an explanation about their part in that process. The multiplicity of disciplines may cloud patients' understanding of the process. The nurse's planning of the rehabilitation process should be aimed at resolving this issue. Goals need to be meaningful, and patients need support in attaining them. The interpretive, integrative, and consoling functions of Kirkevold's nursing role are suitable to meet these needs. CONCLUSIONS Both the literature about patients' needs regarding goal-setting and the nursing role make clear that the way nurses work in rehabilitation can gain in clarity. Strengthening the role of nurses will improve the goal-setting process for patients. Interprofessional collaboration, clear work procedures, continuity of care, time and trust, and the physical environment all are important to reinforce this role.
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Affiliation(s)
- Anne Marie Vaalburg
- Faculty of Health, Sports and Social WorkInholland University of Applied SciencesAmsterdamThe Netherlands
- Department of Medicine for Older People, Amsterdam Public Health Research InstituteAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Elizabeth Wattel
- Department of Medicine for Older People, Amsterdam Public Health Research InstituteAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Petra Boersma
- Faculty of Health, Sports and Social WorkInholland University of Applied SciencesAmsterdamThe Netherlands
| | - Cees Hertogh
- Department of Medicine for Older People, Amsterdam Public Health Research InstituteAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Robbert Gobbens
- Faculty of Health, Sports and Social WorkInholland University of Applied SciencesAmsterdamThe Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
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Suddick KM, Cross V, Vuoskoski P, Stew G, Galvin KT. Holding space and transitional space: stroke survivors' lived experience of being on an acute stroke unit. A hermeneutic phenomenological study. Scand J Caring Sci 2021; 35:104-114. [PMID: 32065418 PMCID: PMC7984029 DOI: 10.1111/scs.12824] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/13/2019] [Accepted: 01/12/2020] [Indexed: 12/01/2022]
Abstract
Despite substantial reorganisation of stroke unit provision in the United Kingdom, limited qualitative research has explored how stroke survivors experience the acute stroke unit. This hermeneutic phenomenological study used accounts from four stroke survivors who experienced one of two acute stroke units. Through detailed analysis, the acute stroke unit emerged as a meaningful space, in two distinct but interconnected forms. As holding space, the unit was understood to offer protection and safe haven, as the stroke survivors looked to cope and respond to the temporal, bodily, biographical disruption and significant vulnerability brought about by stroke and by being in hospital. Holding was fulfilled by different people (including their fellow stroke survivors) and reflected a human response to human need and existential vulnerability. This space, and the practices within it, functioned to hold them intimately but also at a distance from their prestroke lifeworld. As such, the acute stroke unit holding space was intertwined with how it supported, encouraged or provoked transition. In the transitional space of the acute stroke unit, stroke survivors described how they survived the hospital-healthcare space, stroke unit and poststroke space. This paper articulates how transition was meaningfully signified through its absence or presence, as they transformed, relinquished or re-asserted their 'self', and in one case, recovered whilst 'in there'. The findings of this study provide phenomenological insight into stroke survivors' lived experience, the meaningful holding and transitional contribution of the unit, and how these spatial forms were intertwined. These insights are discussed in relation to the existing evidence base and stroke unit provision.
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Affiliation(s)
| | - Vinette Cross
- School of Health SciencesUniversity of BrightonEastbourneUK
- Centre for Health and Social Care ImprovementSchool of Health and WellbeingUniversity of WolverhamptonWolverhamptonUK
| | - Pirjo Vuoskoski
- School of Health SciencesUniversity of BrightonEastbourneUK
- Present address:
Faculty of Sport and Health SciencesUniversity of JyväskyläJyväskyläFinland
| | - Graham Stew
- School of Health SciencesUniversity of BrightonEastbourneUK
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17
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Odero A, Pongy M, Chauvel L, Voz B, Spitz E, Pétré B, Baumann M. Core Values that Influence the Patient-Healthcare Professional Power Dynamic: Steering Interaction towards Partnership. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228458. [PMID: 33203162 PMCID: PMC7696821 DOI: 10.3390/ijerph17228458] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 02/03/2023]
Abstract
Healthcare has long been marked by the authoritative-physician–passive-patient interaction, with patients seeking help and physicians seeking to restore patients back to health. However, globalisation, social movements, and technological advancements are transforming the nature of this relationship. We aim to identify core values that influence the power dynamic between patients and healthcare professionals, and determine how to steer these interactions towards partnership, a more suitable approach to current healthcare needs. Patients with chronic diseases (10 men, 18 women) and healthcare professionals (11 men, 12 women) were interviewed, sessions transcribed, and the framework method used to thematically analyse the data. Validation was done through analyst triangulation and member check recheck. Core values identified as influencing the patient-healthcare professional power dynamic include: (A) values that empower patients (acceptance of diagnosis and autonomy); (B) values unique to healthcare professionals (HCPs) (acknowledging patients experiential knowledge and including patients in the therapeutic process); and (C) shared capitals related to their interactions (communication, information sharing and exchange, collaboration, and mutual commitment). These interdependent core values can be considered prerequisites to the implementation of the patient-as-partner approach in healthcare. Partnership would imply a paradigm shift such that stakeholders systematically examine each other’s perspective, motivations, capabilities, and goals, and then adapt their interactions in this accord, for optimal outcome.
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Affiliation(s)
- Angela Odero
- Department of Social Sciences, Institute for Research on Sociology and Economic Inequalities (IRSEI), University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg
| | - Manon Pongy
- Department of Social Sciences, Institute for Research on Sociology and Economic Inequalities (IRSEI), University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg
- Department of Health Psychology, Metz Saulcy Campus, University of Lorraine, 54395 Grand Est, France
| | - Louis Chauvel
- Department of Social Sciences, Institute for Research on Sociology and Economic Inequalities (IRSEI), University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg
| | - Bernard Voz
- Department of Public Health, University of Liège, 4000 Liège, Belgium
| | - Elisabeth Spitz
- Department of Health Psychology, Metz Saulcy Campus, University of Lorraine, 54395 Grand Est, France
| | - Benoit Pétré
- Department of Public Health, University of Liège, 4000 Liège, Belgium
| | - Michèle Baumann
- Department of Social Sciences, Institute for Research on Sociology and Economic Inequalities (IRSEI), University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg
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18
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Kucheria P, Moore Sohlberg M, Machalicek W, Seeley J, DeGarmo D. A single-case experimental design investigation of collaborative goal setting practices in hospital-based speech-language pathologists when provided supports to use motivational interviewing and goal attainment scaling. Neuropsychol Rehabil 2020; 32:579-610. [PMID: 33153386 DOI: 10.1080/09602011.2020.1838301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The study investigated the impact of the electronic Goal Attainment Scaling (eGAS) process on medical speech-language pathologists' (SLPs) interviewing and goal setting. The process was trained via the eGAS app, designed to facilitate motivational interviewing and goal attainment scaling. The study utilized a single-case, nonconcurrent, multiple-baseline design replicated across three clinicians and their 27 respective clients. We observed client-clinician dyads engaged in setting rehabilitation goals pre and post eGAS training. The clients had neurogenic conditions and were being treated for cognitive, communication and/or swallowing challenges in an outpatient setting. Two measures were used to collect data on the clinician's interviewing and goal-setting behaviors: (1) Assessment of Client-Centeredness when Interviewing and Goal Setting (ACIG) scale, and (2) a task analysis, i.e., the Clinician Interview Behavior scale (CIB). Training with eGAS had a strong effect on clinicians' collaborative interviewing behaviors, an inconsistent effect on their ability to adhere to a three-phase interview structure, and a strong effect on their ability to generate valid goal attainment scales. This study provides preliminary support that the eGAS process provides a feasible framework for training hospital-based SLPs engaged in neurorehabilitation to use collaborative interviewing behaviors and produce valid person-centered rehabilitation goals.
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Affiliation(s)
- Priya Kucheria
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR, USA
| | - McKay Moore Sohlberg
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR, USA
| | - Wendy Machalicek
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR, USA
| | - John Seeley
- Department of Education Methodology, Policy and Leadership, University of Oregon, Eugene, OR, USA
| | - David DeGarmo
- Department of Education Methodology, Policy and Leadership, University of Oregon, Eugene, OR, USA
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Evans E, Kosar CM, Thomas KS. Positive Beliefs and the Likelihood of Successful Community Discharge From Skilled Nursing Facilities. Arch Phys Med Rehabil 2020; 102:480-487. [PMID: 32991871 DOI: 10.1016/j.apmr.2020.09.375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 08/07/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To examine the association of patient and direct-care staff beliefs about patients' capability to increase independence with activities of daily living (ADL) and the probability of successful discharge to the community after a skilled nursing facility (SNF) stay. DESIGN Retrospective cohort study of SNF patients using 100% Medicare inpatient claims and Minimum Data Set resident assessment data. Linear probability models were used to estimate the probability of successful discharge based on patient and staff beliefs about the patient's ability to improve in function, as well as patient and staff beliefs together. Estimates were adjusted for demographics, health status, functional characteristics, and SNF fixed effects. PARTICIPANTS Fee-for-service Medicare beneficiaries (N=526,432) aged 66 years or older who were discharged to an SNF after hospitalization for stroke, hip fracture, or traumatic brain injury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Successful community discharge (discharged alive within 90d of SNF admission and remaining in the community for ≥30d without dying or health care facility readmission). RESULTS Patients with positive beliefs about their capability to increase independence with ADLs had a higher adjusted probability of successful discharge than patients with negative beliefs (positive, 63.8%; negative, 57.8%; difference, 6.0%, 95% confidence interval [CI], 5.4-6.6). This remained true regardless of staff beliefs, but the difference in successful discharge probability between patients with positive and negative beliefs was larger when staff had positive beliefs. Conversely, the association between staff beliefs and successful discharge varied based on patient beliefs. If patients had positive beliefs, the difference in the probability of successful discharge between positive and negative staff beliefs was 2.5% (95% CI, 1.0-4.0). If patients had negative beliefs, the difference between positive and negative staff beliefs was -4.6% (95% CI, -6.0 to -3.2). CONCLUSIONS Patients' beliefs have a significant association with the probability of successful discharge. Understanding patients' beliefs is critical to appropriate goal-setting, discharge planning, and quality SNF care.
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Affiliation(s)
- Emily Evans
- Department of Health Services, Policy, and Practice, Center for Gerontology and Healthcare Research, Brown School of Public Health, Providence, RI.
| | - Cyrus M Kosar
- Department of Health Services, Policy, and Practice, Center for Gerontology and Healthcare Research, Brown School of Public Health, Providence, RI
| | - Kali S Thomas
- Department of Health Services, Policy, and Practice, Center for Gerontology and Healthcare Research, Brown School of Public Health, Providence, RI; Providence VA Medical Center, Providence, RI
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Mertz K, Shah RF, Eppler SL, Yao J, Safran M, Palanca A, Hu SS, Gardner M, Amanatullah DF, Kamal RN. A Simple Goal Elicitation Tool Improves Shared Decision Making in Outpatient Orthopedic Surgery: A Randomized Controlled Trial. Med Decis Making 2020; 40:766-773. [PMID: 32744134 DOI: 10.1177/0272989x20943520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction. Shared decision making involves educating the patient, eliciting their goals, and collaborating on a decision for treatment. Goal elicitation is challenging for physicians as previous research has shown that patients do not bring up their goals on their own. Failure to properly elicit patient goals leads to increased patient misconceptions and decisional conflict. We performed a randomized controlled trial to test the efficacy of a simple goal elicitation tool in improving patient involvement in decision making. Methods. We conducted a randomized, single-blind study of new patients presenting to a single, outpatient surgical center. Prior to their consultation, the intervention group received a demographics questionnaire and a goal elicitation worksheet. The control group received a demographics questionnaire only. After the consultation, both groups were asked to complete the Perceived Involvement in Care Scale (PICS) survey. We compared the mean PICS scores for the intervention and control groups using a nonparametric Mann-Whitney Wilcoxon test. Secondary analysis included a qualitative content analysis of the patient goals. Results. Our final cohort consisted of 96 patients (46 intervention, 50 control). Both groups were similar in terms of demographic composition. The intervention group had a significantly higher mean (SD) PICS score compared to the control group (9.04 [2.15] v. 7.54 [2.27], P < 0.01). Thirty-nine percent of patient goals were focused on receiving a diagnosis or treatment, while 21% of patients wanted to receive education regarding their illness or their treatment options. Discussion. A single-step goal elicitation tool was effective in improving patient-perceived involvement in their care. This tool can be efficiently implemented in both academic and nonacademic settings.
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Affiliation(s)
- Kevin Mertz
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Romil F Shah
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Sara L Eppler
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Jeffrey Yao
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Marc Safran
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Ariel Palanca
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Serena S Hu
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Michael Gardner
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Derek F Amanatullah
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Robin N Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
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Chen L, Xiao LD, Chamberlain D. An integrative review: Challenges and opportunities for stroke survivors and caregivers in hospital to home transition care. J Adv Nurs 2020; 76:2253-2265. [PMID: 32511778 DOI: 10.1111/jan.14446] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 04/18/2020] [Accepted: 05/04/2020] [Indexed: 11/28/2022]
Abstract
AIM To identify challenges and opportunities for stroke survivors and caregivers in hospital to home transition care. BACKGROUND Due to shortened hospital stays, stroke survivors and caregivers must take responsibility for complex care on discharge from hospital to home. Gaps exist in the literature that synthesizes studies on hospital to home transition care. DESIGN A systematic integrated review. DATA SOURCES Six databases were searched systematically between 18 June 2018 - 31 October 2018 including Medline, CINAHL, Web of Science, ProQuest, Scopus and Science Direct. The search did not have a date limit. REVIEW METHODS Studies that met the selection criteria were critically reviewed. Data were extracted from the studies for analyses. A convergent qualitative synthesis approach using inductive thematic synthesis was applied to the review. RESULTS The analysis of 23 studies identified three major findings. First, health and social care systems influence transition care by either enabling stroke survivors and caregivers to manage transition care via well-coordinated services or preventing them from accessing services. Second, health professionals' partnership with stroke survivors and caregivers largely decides tailored support for them. Successful partnerships and engagements with stroke survivors and caregivers depend on organizational resources. Third, survivors and caregivers are at different levels of readiness to cope with challenges. Individualized support for them to develop resilience is highly regarded. CONCLUSION Stroke survivors and caregivers encounter enormous challenges in self-management of hospital to home transition care. Further research is required to address their expectations of support during transition care. IMPACT There is a lack of synthesis of studies on factors affecting hospital to home transition care for stroke survivors. Health and social care system designs, health professionals' commitment to individualized care and the self-management capability of stroke survivors and their caregivers have a profound influence on the transition care experiences.
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Affiliation(s)
- Langduo Chen
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Lily D Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Diane Chamberlain
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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Berg K, Askim T, Rise MB. What do speech-language pathologists describe as most important when trying to achieve client participation during aphasia rehabilitation? A qualitative focus group interview study. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:493-503. [PMID: 29252012 DOI: 10.1080/17549507.2017.1413134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 10/30/2017] [Accepted: 11/30/2017] [Indexed: 06/07/2023]
Abstract
Purpose: The aim of this study was to investigate what speech-language pathologists describe as most important when trying to achieve client-oriented participation during aphasia rehabilitation. Method: A qualitative study including semi-structured focus group interviews with 11 speech-language pathologists. Interviews were analysed with the use of systematic text condensation. Result: Four main themes emerged from the analysis. (1) It is important to take the vulnerability of the client group into account. (2) It is important to address the client's process of realisation by navigating around unrealistic wishes and goals. (3) It is challenging to involve clients when the evidence-base for clinical practice is limited. (4) It is crucial to make therapy meaningful to the client. Conclusion: This study showed that speech-language pathologists perceived prediction of a clinical course in aphasia rehabilitation as challenging due to the vulnerable client group and the perceived need to guide the clients through the rehabilitation process. They talked about how unrealistic client goals, and the lack of a solid evidence-base to guide their clinical practice, made collaborative goal setting and treatment planning challenging. Due to these barriers, the speech-language pathologists struggled to achieve client participation, and thereby aphasia rehabilitation could not be described as fully client-oriented.
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Affiliation(s)
- Karianne Berg
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology , Trondheim , Norway and
| | - Torunn Askim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology , Trondheim , Norway and
| | - Marit By Rise
- Department of Mental Health, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology , Trondheim , Norway
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Jesus TS, Bright FA, Pinho CS, Papadimitriou C, Kayes NM, Cott CA. Scoping review of the person-centered literature in adult physical rehabilitation. Disabil Rehabil 2019; 43:1626-1636. [PMID: 31553633 DOI: 10.1080/09638288.2019.1668483] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To describe the amount, range, and key characteristics (e.g., publication years, methods, topics) of the person-centered rehabilitation literature in adults with physical impairments. METHOD Following the published scoping review protocol, papers were identified through: three major databases, snowball searches and expert consultation. Two independent reviewers have identified English-language papers on adult person-centered rehabilitation according to six pre-defined inclusion categories - theoretical, quantitative and qualitive research papers are included; and then have extracted their key characteristics (e.g., aims, methods, participants). Descriptive statistics, regression and content analyses were used to synthesize the results. RESULTS Of 5912 deduplicated records initially screened, 170 papers were included: 136 empirical, including 13 systematic reviews. Empirical papers had data from 15264 clients and 4098 providers, in total. Yearly publications grew significantly from 2009 to 2018 (r2 = 0.71; b = 1.98: p < 0.01). Publications were unevenly distributed by countries (e.g., United States' publications per population was 44 times lower than New Zealand's). Most papers focused in more than one profession, setting-type or health conditions. Finally, many empirical papers (n = 67) studied implementation of person-centered rehabilitation approaches, including its effect. CONCLUSION This scoping review synthesizes key characteristics and publication trends in the person-centered rehabilitation literature on adults with physical impairments, a growing but unchartered territory thus far. This large and diverse body of literature can ground further person-centered rehabilitation practices and research, including toward building a transdisciplinary, trans-service model of person-centered rehabilitation.Implications for rehabilitationThe person-centered rehabilitation literature on adults with physical impairments, especially the empirical one, has been growing significantly over time, despite inequitably distributed per countries.Rehabilitation stakeholders, including practitioners, have a growing amount of literature in which they can rely for the operationalization and implementation of person-centered rehabilitation approaches into routine practice.Based on our work, person-centered rehabilitation emerges as a practice requirement that cuts across professional and other rehabilitation silos.
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Affiliation(s)
- Tiago S Jesus
- Global Health and Tropical Medicine (GHTM) & WHO Collaborating Centre for Health Workforce Policy and Planning-Institute of Hygiene and Tropical Medicine: NOVA University of Lisbon, Lisbon, Portugal
| | - Felicity A Bright
- Centre for Person Centred Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Cátia S Pinho
- ISVOUGA - Superior Institute of Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | | | - Nicola M Kayes
- Centre for Person Centred Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Cheryl A Cott
- Rehabilitation Sciences Institute, Faculty of Medicine; University of Toronto, Toronto, Canada
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Dekker J, de Groot V, Ter Steeg AM, Vloothuis J, Holla J, Collette E, Satink T, Post L, Doodeman S, Littooij E. Setting meaningful goals in rehabilitation: rationale and practical tool. Clin Rehabil 2019; 34:3-12. [PMID: 31530186 DOI: 10.1177/0269215519876299] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT Goal-setting is a key characteristic of modern rehabilitation. However, goals need to be meaningful and of importance to the client. AXIOMS Both theories and empirical evidence support the importance of a hierarchy of goals: one or more overall goals that clients find personally meaningful and specific goals that are related to the overall goals. We posit that the client's fundamental beliefs, goals and attitudes ("global meaning") need to be explored before setting any rehabilitation goal. A chaplain or other person with similar skills can be involved in doing so in an open-ended way. The client's fundamental beliefs, goals and attitudes serve as a point of departure for setting rehabilitation goals. SETTING GOALS We set out a three-stage process to set goals: (1) exploring the client's global meaning (i.e. fundamental beliefs, goals and attitudes), (2) deriving a meaningful overall rehabilitation goal from the client's global meaning and (3) setting specific rehabilitation goals that serve to achieve the meaningful overall rehabilitation goal. CONCLUSION This is an extension of current practice in many rehabilitation teams, which may help counter the drive toward exclusively functional goals based around independence.
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Affiliation(s)
- Joost Dekker
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Vincent de Groot
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | | | - Jasmijn Holla
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
| | - Emma Collette
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ton Satink
- Department of Occupational Therapy and Research Group Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Lenneke Post
- Department of Spiritual Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Faculty of Religion and Theology, VU University, Amsterdam, The Netherlands
| | - Suzan Doodeman
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Elsbeth Littooij
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
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Dörfler E, Kulnik ST. Despite communication and cognitive impairment – person-centred goal-setting after stroke: a qualitative study. Disabil Rehabil 2019; 42:3628-3637. [DOI: 10.1080/09638288.2019.1604821] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Elisa Dörfler
- Department of Health Sciences, FH Campus Wien – University of Applied Sciences, Vienna, Austria
| | - Stefan Tino Kulnik
- Department of Health Sciences, FH Campus Wien – University of Applied Sciences, Vienna, Austria
- Faculty of Health, Social Care and Education, Kingston University and St George’s, University of London, London, UK
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26
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Suddick KM, Cross V, Vuoskoski P, Stew G, Galvin KT. The acute stroke unit as a meaningful space: The lived experience of healthcare practitioners. Health Place 2019; 57:12-21. [PMID: 30849691 DOI: 10.1016/j.healthplace.2019.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/08/2018] [Accepted: 02/07/2019] [Indexed: 11/17/2022]
Abstract
This hermeneutic phenomenological study was undertaken in response to the recent re-organization of stroke unit provision in the United Kingdom. Through the analysis of four acute stroke unit practitioners' subjective accounts, the acute stroke unit emerged as a dynamic, meaningful space, where they experienced authenticity and belonging. The findings showed how these practitioners navigated their way through the space, thriving, and/or surviving its' associated vulnerabilities. They offer a different gaze on which to attend to the complexity and challenge that is interwoven with health professionals' flourishing, the spatiality of healthcare practice, and perhaps other demanding places of work.
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Affiliation(s)
- Kitty Maria Suddick
- School of Health Sciences, University of Brighton, Robert Dodd Building, 49 Darley Road, Eastbourne, East Sussex, BN20 7UR, United Kingdom.
| | - Vinette Cross
- School of Health Sciences, University of Brighton, Robert Dodd Building, 49 Darley Road, Eastbourne, East Sussex, BN20 7UR, United Kingdom
| | - Pirjo Vuoskoski
- School of Health Sciences, University of Brighton, Robert Dodd Building, 49 Darley Road, Eastbourne, East Sussex, BN20 7UR, United Kingdom.
| | - Graham Stew
- School of Health Sciences, University of Brighton, Robert Dodd Building, 49 Darley Road, Eastbourne, East Sussex, BN20 7UR, United Kingdom.
| | - Kathleen T Galvin
- School of Health Sciences, University of Brighton, Robert Dodd Building, 49 Darley Road, Eastbourne, East Sussex, BN20 7UR, United Kingdom.
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27
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Lewthwaite R, Winstein CJ, Lane CJ, Blanton S, Wagenheim BR, Nelsen MA, Dromerick AW, Wolf SL. Accelerating Stroke Recovery: Body Structures and Functions, Activities, Participation, and Quality of Life Outcomes From a Large Rehabilitation Trial. Neurorehabil Neural Repair 2019; 32:150-165. [PMID: 29554849 DOI: 10.1177/1545968318760726] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Task-oriented therapies have been developed to address significant upper extremity disability that persists after stroke. Yet, the extent of and approach to rehabilitation and recovery remains unsatisfactory to many. OBJECTIVE To compare a skill-directed investigational intervention with usual care treatment for body functions and structures, activities, participation, and quality of life outcomes. METHODS On average, 46 days poststroke, 361 patients were randomized to 1 of 3 outpatient therapy groups: a patient-centered Accelerated Skill Acquisition Program (ASAP), dose-equivalent usual occupational therapy (DEUCC), or usual therapy (UCC). Outcomes were taken at baseline, posttreatment, 6 months, and 1 year after randomization. Longitudinal mixed effect models compared group differences in poststroke improvement during treatment and follow-up phases. RESULTS Across all groups, most improvement occurred during the treatment phase, followed by change more slowly during follow-up. Compared with DEUCC and UCC, ASAP group gains were greater during treatment for Stroke Impact Scale Hand, Strength, Mobility, Physical Function, and Participation scores, self-efficacy, perceived health, reintegration, patient-centeredness, and quality of life outcomes. ASAP participants reported higher Motor Activity Log-28 Quality of Movement than UCC posttreatment and perceived greater study-related improvements in quality of life. By end of study, all groups reached similar levels with only limited group differences. CONCLUSIONS Customized task-oriented training can be implemented to accelerate gains across a full spectrum of patient-reported outcomes. While group differences for most outcomes disappeared at 1 year, ASAP participants achieved these outcomes on average 8 months earlier (ClinicalTrials.gov: Interdisciplinary Comprehensive Arm Rehabilitation Evaluation [ICARE] Stroke Initiative, at www.ClinicalTrials.gov/ClinicalTrials.gov . Identifier: NCT00871715).
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Affiliation(s)
- Rebecca Lewthwaite
- 1 University of Southern California, Los Angeles, CA, USA.,2 Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | | | | | | | - Burl R Wagenheim
- 2 Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | | | - Alexander W Dromerick
- 4 Georgetown University, Washington, DC, USA.,5 MedStar National Rehabilitation Hospital, Washington, DC, USA.,6 VA Medical Center, Washington, DC, USA
| | - Steven L Wolf
- 3 Emory University, Atlanta, GA, USA.,7 VA Center on Visual and Neurocognitive Rehabilitation, Decatur, GA, USA
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van Seben R, Smorenburg SM, Buurman BM. A qualitative study of patient-centered goal-setting in geriatric rehabilitation: patient and professional perspectives. Clin Rehabil 2018; 33:128-140. [PMID: 30103621 PMCID: PMC6311617 DOI: 10.1177/0269215518791663] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE: To characterize how rehabilitation goals of older patients change over time and to explore professionals' attitudes toward patient-centered goal-setting and their perspectives on rehabilitation goals. DESIGN: Qualitative interview study. SETTING: Three geriatric rehabilitation centers. SUBJECTS: Ten patients (aged ⩾ 80), who had recently received inpatient geriatric rehabilitation, and seven professionals were purposively recruited. METHODS: Semi-structured interviews. Patients were interviewed in the third or fourth week after discharge from inpatient rehabilitation, to reflect on their inpatient goals and to investigate long-term goals now that they were at home. A thematic analysis was performed. RESULTS: During inpatient rehabilitation, participants' main goals were regaining independence in self-care activities and going home. Post-discharge, patients were not at their baseline functioning level. Rehabilitation goals appeared to shift over time, and once at home, patients formulated more ambitious rehabilitation goals that were related to regaining full independence and being able to perform activities. Although professionals thought goal-setting together with the patient is important, they also stated that older individuals often are either unable to formulate goals or they set unrealistic ones. In addition, professionals indicated that goals have to be related to discharge criteria, such as performing basic self-care activities, and rehabilitation revolves around getting patients ready for discharge. CONCLUSION: During inpatient rehabilitation, patient goals are related to going home. After discharge, patients have ambitious goals, related to their premorbid functioning level. Rehabilitation services should distinguish between goals that are important while patients are inpatient and goals that are important after discharge.
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Affiliation(s)
- Rosanne van Seben
- 1 Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Bianca M Buurman
- 1 Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, The Netherlands.,3 ACHIEVE-Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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29
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Enemark Larsen A, Rasmussen B, Christensen JR. Enhancing a Client-Centred Practice with the Canadian Occupational Performance Measure. Occup Ther Int 2018; 2018:5956301. [PMID: 30050391 PMCID: PMC6040242 DOI: 10.1155/2018/5956301] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/28/2018] [Accepted: 05/08/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The active participation of clients is an important aspect of rehabilitation quality as conceptualized in client-centred practice (CCP). A recommended outcome measure for enhancing CCP is the Canadian Occupational Performance Measure (COPM). However, the relationship between COPM use and CCP enhancement has not been documented. AIM The aim of this study was to examine whether the use of the COPM enhanced CCP. METHODS We performed a scoping review in five steps: (1) identifying a search strategy with inclusion and exclusion criteria; (2) screening relevant databases for published and unpublished studies by using selected keywords and by manually scrutinizing reference lists; (3) agreeing on eligible papers between authors in terms of inclusion and exclusion criteria; (4) charting included data; and (5) analysing data using qualitative content analysis. RESULTS Twelve studies were included in the review. The results indicated enhanced CCP in two themes when using the COPM. These themes appeared to influence each other; therefore, the first theme, Conditions for enhancing CCP when using the COPM, represented the circumstances needed for the second theme, Enhancing CCP when using the COPM, to be fulfilled. CONCLUSION The use of the COPM seems to enhance CCP if certain conditions are present.
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Affiliation(s)
- A. Enemark Larsen
- Department of Occupational Therapy, Institute of Medwifery and Therapy, University College Copenhagen, Sigurdsgade 26, DK-2200 N Copenhagen, Denmark
| | - B. Rasmussen
- Department of Occupational Therapy, Institute of Medwifery and Therapy, University College Copenhagen, Sigurdsgade 26, DK-2200 N Copenhagen, Denmark
| | - J. R. Christensen
- Department of Public Health, University of Southern Denmark, JB Winsløwsvej 9A, 5000 Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
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30
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Lloyd A, Bannigan K, Sugavanam T, Freeman J. Experiences of stroke survivors, their families and unpaid carers in goal setting within stroke rehabilitation. ACTA ACUST UNITED AC 2018; 16:1418-1453. [DOI: 10.11124/jbisrir-2017-003499] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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31
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Cameron LJ, Somerville LM, Naismith CE, Watterson D, Maric V, Lannin NA. A qualitative investigation into the patient-centered goal-setting practices of allied health clinicians working in rehabilitation. Clin Rehabil 2018; 32:827-840. [DOI: 10.1177/0269215517752488] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lisa J Cameron
- Occupational Therapy Department, The Alfred, Alfred Health, Melbourne, VIC, Australia
| | - Lisa M Somerville
- Occupational Therapy Department, The Alfred, Alfred Health, Melbourne, VIC, Australia
| | - Catherine E Naismith
- Occupational Therapy Department, The Alfred, Alfred Health, Melbourne, VIC, Australia
| | - Dina Watterson
- Occupational Therapy Department, The Alfred, Alfred Health, Melbourne, VIC, Australia
| | - Valentina Maric
- Occupational Therapy Department, The Alfred, Alfred Health, Melbourne, VIC, Australia
| | - Natasha A Lannin
- Occupational Therapy Department, The Alfred, Alfred Health, Melbourne, VIC, Australia
- School of Allied Health, La Trobe University, Melbourne, VIC, Australia
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32
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Moloney J, Walshe M. “I had no idea what a complicated business eating is…”: a qualitative study of the impact of dysphagia during stroke recovery. Disabil Rehabil 2017; 40:1524-1531. [DOI: 10.1080/09638288.2017.1300948] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Jennifer Moloney
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Republic of Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Republic of Ireland
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33
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Parsons JGM, Plant SE, Slark J, Tyson SF. How active are patients in setting goals during rehabilitation after stroke? A qualitative study of clinician perceptions. Disabil Rehabil 2016; 40:309-316. [DOI: 10.1080/09638288.2016.1253115] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- John G. M. Parsons
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- The Institute of Healthy Ageing, Waikato District Health Board, Hamilton, New Zealand
| | - Sarah E. Plant
- Stroke & Vascular Research Centre, School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, United Kingdom
| | - Julia Slark
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- The Institute of Healthy Ageing, Waikato District Health Board, Hamilton, New Zealand
| | - Sarah F. Tyson
- Stroke & Vascular Research Centre, School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, United Kingdom
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Jesus TS, Bright F, Kayes N, Cott CA. Person-centred rehabilitation: what exactly does it mean? Protocol for a scoping review with thematic analysis towards framing the concept and practice of person-centred rehabilitation. BMJ Open 2016; 6:e011959. [PMID: 27436670 PMCID: PMC4964252 DOI: 10.1136/bmjopen-2016-011959] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Person-centredness is a philosophy for organising and delivering healthcare based on patients' needs, preferences and experiences. Although widely endorsed, the concept suffers from a lack of detail and clarification, in turn accounting for ambiguous implementation and outcomes. While a conceptual framework based on a systematic review defines person/patient-centred care components (Scholl et al, 2014), it applies across healthcare contexts and may not be sensitive to the nuances of the rehabilitation of adults with physical impairments. Accordingly, this study aims to build a conceptual framework, based on existing literature, of what person-centredness means in the rehabilitation of adults with physical impairments in the clinical encounter and broader health service delivery. METHODS AND ANALYSIS We will use a scoping review methodology. Searches on relevant databases will be conducted first, combining keywords for 'rehabilitation', 'person-centered' and associated terms (including patient preferences/experiences). Next, snowball searches (citation tracking, references lists) will be performed. Papers will be included if they fall within predefined selection categories (seen as most likely informative on elements pertaining to person-centred rehabilitation) and are written in English, regardless of design (conceptual, qualitative, quantitative). Two reviewers will independently screen titles and abstracts, followed by screening of the full text to determine inclusion. Experts will then be consulted to identify relevant missing papers. This can include elements other than the peer-reviewed literature (eg, book chapters, policy/legal papers). Finally, information that helps to build the concept and practice of person-centred rehabilitation will be abstracted independently by two reviewers and analysed by inductive thematic analysis to build the conceptual framework. DISSEMINATION The resulting framework will aid clarification regarding person-centred rehabilitation, which in turn is expected to conceptually ground and inform its operationalisation (eg, measurement, implementation, improvement). Findings will be disseminated through local, national and international stakeholders, both at the clinical and service organisation levels.
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Affiliation(s)
- Tiago S Jesus
- Portuguese Ministry of Education. Aggregation of Schools of Escariz, Escariz, Portugal
| | - Felicity Bright
- Centre for Person Centred Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Nicola Kayes
- Centre for Person Centred Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Cheryl A Cott
- Faculty of Medicine, Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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35
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The Importance of Patient Involvement in Stroke Rehabilitation. PLoS One 2016; 11:e0157149. [PMID: 27285997 PMCID: PMC4902299 DOI: 10.1371/journal.pone.0157149] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 05/25/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the perceived needs for health services by persons with stroke within the first year after rehabilitation, and associations between perceived impact of stroke, involvement in decisions regarding care/treatment, and having health services needs met. METHOD Data was collected, through a mail survey, from patients with stroke who were admitted to a university hospital in 2012 and had received rehabilitation after discharge from the stroke unit. The rehabilitation lasted an average of 2 to 4.6 months. The Stroke Survivor Needs Survey Questionnaire was used to assess the participants' perceptions of involvement in decisions on care or treatment and needs for health services in 11 problem areas: mobility, falls, incontinence, pain, fatigue, emotion, concentration, memory, speaking, reading, and sight. The perceived impact of stroke in eight areas was assessed using the Stroke Impact Scale (SIS) 3.0. Eleven logistic regression models were created to explore associations between having health services needs met in each problem area respectively (dependent variable) and the independent variables. In all models the independent variables were: age, sex, SIS domain corresponding to the dependent variable, or stroke severity in cases when no corresponding SIS domain was identified, and involvement in decisions on care and treatment. RESULTS The 63 participants who returned the questionnaires had a mean age of 72 years, 33 were male and 30 were female. Eighty percent had suffered a mild stroke. The number of participants who reported problems varied between 51 (80%, mobility) and 24 (38%, sight). Involvement in decisions on care and treatment was found to be associated with having health services needs met in six problem areas: falls, fatigue, emotion, memory, speaking, and reading. CONCLUSIONS The results highlight the importance of involving patients in making decisions on stroke rehabilitation, as it appears to be associated with meeting their health services needs.
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