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Liddiard KJ, Raynor AJ, Brown CA. The experience of occupational therapists and physiotherapists using a prototype, evidence-informed online knowledge translation resource to learn about patient-defined, personally-meaningful chronic pain rehabilitation. Br J Pain 2024; 18:403-417. [PMID: 39372104 PMCID: PMC11450572 DOI: 10.1177/20494637241241780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2024] Open
Abstract
Purpose Chronic pain is a complex biopsychosocial experience, and rehabilitation helps people to manage pain, and restore valued life roles. Evidence suggests that more positive outcomes occur when clients perceive their rehabilitation to be meaningful. People with chronic pain describe rehabilitation as personally-meaningful when they develop a genuine connection with a credible therapist who they see as a guiding partner, and when rehabilitation holds personal value, is self-defined, and relevant to their sense of self-identity. This paper presents a qualitative study of therapists' experience using an e-learning package on patient-defined, personally-meaningful rehabilitation. Methods A qualitative descriptive design was used to explore rehabilitation therapists' experience of a prototype evidence-informed, online resource developed on the basis of eLearning and web-design principles. Semi-structured interviews and focus groups were conducted with a purposive sample of occupational therapists and physiotherapists, and inductive coding and thematic analysis of transcripts was completed. Findings Twenty-four therapists (12 occupational therapists, 12 physiotherapists) participated, representing a mix of gender and experience (early career; experienced; and specialist). Four themes and 12 sub-themes emerged from the analysis. The resource delivered a positive user experience, which added (translational) value to enhance learning, and participants were highly positive about the future potential of the resource to translate chronic pain rehabilitation research for early career, experienced, and specialist rehabilitation therapists. Conclusion Results suggest that the disparate learning needs of rehabilitation therapists from diverse professional backgrounds and experience, may be addressed through the one resource. Participant feedback provides evidence that the resource fits with current models of learning and behaviour change. This study demonstrates the importance of basing online resources on eLearning and web-design principles to translate complex biopsychosocial chronic pain rehabilitation research for rehabilitation therapists.
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Affiliation(s)
- Katrina J Liddiard
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Annette J Raynor
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Cary A Brown
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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Liddiard KJ, Brown CA, Raynor AJ. Positive Association between Patients' Perception of Chronic Pain Rehabilitation as a Personally Meaningful Experience and the Flourishing Aspect of Well-Being. Healthcare (Basel) 2024; 12:1655. [PMID: 39201213 PMCID: PMC11353923 DOI: 10.3390/healthcare12161655] [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: 05/16/2024] [Revised: 07/15/2024] [Accepted: 08/12/2024] [Indexed: 09/02/2024] Open
Abstract
Chronic pain rehabilitation helps to reduce pain and restore valued life roles. Patients may have more positive outcomes when they perceive rehabilitation to be personally meaningful. This study examined associations between self-reported, personally meaningful rehabilitation and well-being. A pilot study was conducted using an online survey of people with chronic pain and experiences of rehabilitation. The PROMIS Pain Interference Short Form 8a and The Flourishing Scale were used to explore well-being. A modified self-report measure, the Meaningfulness in Rehabilitation Scale, was pilot-tested for construct validity and used in the survey. Of the 48 participants (81% female; 19% male), most attended a generalist therapy practice (62%) once per week (33%) or once per fortnight (29%). No statistically significant relationship was found between self-reported meaningfulness in rehabilitation and pain interference or other patient and therapy characteristics (duration of chronic pain category, type of therapy practice, resolution of rehabilitation category, and frequency of appointments). The nonparametric analysis identified a statistically significant moderate positive correlation between self-reported meaningfulness in rehabilitation and the flourishing aspect of well-being. This raises important questions and suggests that patients' perception of rehabilitation as meaningful warrants further research. This pilot study provides valuable guidance to inform a larger investigation.
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Affiliation(s)
- Katrina J. Liddiard
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia;
| | - Cary A. Brown
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Annette J. Raynor
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia;
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Perego F, Zingale LC, Cesoni Marcelli A, Ranucci L, Rimoldi L, Nsanbayeva N, Natale MR, Dalla Vecchia LA, Gorini A. A human centred innovative approach based on persona in hereditary angioedema. Orphanet J Rare Dis 2024; 19:291. [PMID: 39127675 DOI: 10.1186/s13023-024-03302-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 08/05/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Hereditary Angioedema (HAE) due to C1-inhibitor deficiency (C1INH) is a rare condition, clinically characterised by recurrent swelling. The unpredictability of attacks affects the patients' quality of life (QoL). HAE patients and their families have vast unmet physical, psychological, and social needs. A human-centred design (HCD) approach to describing the needs of different user types is to utilise personas, a data-driven narrative tool for communicating user archetypes that capture the individuals' attitudes, goals, and behaviours. The aim of this study was to create and analyse personas based on HAE patients' and their caregivers' interviews. Semi-structured interviews were conducted through anthropological conversations with patients, patient-caregivers (double role of patient and caregiver), and non-affected caregivers. Qualitative and quantitative insights from analyses formed the basis to create personas. RESULTS We enrolled 17 subjects: 15 patients (6 of them were patient-caregivers) and 2 non-affected caregivers. The mean age of participants was 50.3 ± 14.4 years. Eight patients were on treatment with prophylactic therapy. The mean percentage score of Angioedema Quality of Life (AE-QoL) for HAE patients was 19.8 ± 12.0. Six personas were identified describing the participants' personal history, disease management, and needs: four personas referred to patients, one to patient-caregivers, and one non-affected caregiver personas were identified. Across patient personas, the most expressed needs were psychological support and better awareness amongst healthcare professionals. Caregivers, on their side, desired better information about the disease, including the latest therapies, and higher awareness within the community. CONCLUSION A Human Centred Innovative Approach Based on Persona extends beyond the physical symptoms to encompass the psychological and social aspects of the individual's well-being also including the family in the evaluation.
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Affiliation(s)
- Francesca Perego
- HAE Unit, IRCCS Istituti Clinici Scientifici Maugeri, Via Camaldoli 64, 20138, Milan, Italy.
| | - Lorenza Chiara Zingale
- HAE Unit, IRCCS Istituti Clinici Scientifici Maugeri, Via Camaldoli 64, 20138, Milan, Italy
| | | | - Luca Ranucci
- HAE Unit, IRCCS Istituti Clinici Scientifici Maugeri, Via Camaldoli 64, 20138, Milan, Italy
| | - Lorenzo Rimoldi
- Your Business Partner, London, UK
- Your Business Partner, Milan, Italy
| | - Nurgul Nsanbayeva
- Your Business Partner, London, UK
- Your Business Partner, Milan, Italy
| | | | | | - Alessandra Gorini
- HAE Unit, IRCCS Istituti Clinici Scientifici Maugeri, Via Camaldoli 64, 20138, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Dipartimento di Eccellenza 2023-2027, Università degli Studi di Milan, Milan, Italy
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Webster A, Poyade M, Coulter E, Forrest L, Paul L. Views of Specialist Clinicians and People With Multiple Sclerosis on Upper Limb Impairment and the Potential Role of Virtual Reality in the Rehabilitation of the Upper Limb in Multiple Sclerosis: Focus Group Study. JMIR Serious Games 2024; 12:e51508. [PMID: 38669680 PMCID: PMC11087863 DOI: 10.2196/51508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/14/2024] [Accepted: 03/14/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Finding enjoyable and effective long-term approaches to rehabilitation for improving the upper limb (UL) function of people with multiple sclerosis (MS) is challenging. Using virtual reality (VR) could be a solution to this challenge; however, there is a lack of reporting on the views of people with MS and clinicians on VR-based approaches and recommendations for games for rehabilitation. OBJECTIVE This study aims to identify common UL problems and their related current therapeutic approaches for people with MS, and to explore the opinions of people with MS and specialist clinicians on VR and obtain suggestions for the development and design of VR games. METHODS Separate focus groups were conducted with people with MS, recruited through the MS Society UK's research network, and clinicians, recruited through the MS Trust Therapists in MS network. A total of 10 people with MS (2 focus groups) and 8 clinicians (5 physiotherapists, 2 occupational therapists, and 1 MS nurse in 2 focus groups) were involved. The focus groups were recorded and transcriptions were analyzed using theme-based content analysis. RESULTS People with MS commonly reported that their UL problems interfered with activities of daily living and resulted in the loss of meaningful hobbies such as writing. Many people with MS neglected UL exercise and found strategies for adapting to the UL impairments. Similarly, clinicians stated UL rehabilitation was neglected within their service and that it was challenging to find interesting treatment strategies. VR was suggested by both participant groups as a solution, as it was convenient for people with MS to access and it could provide a more engaging and disguised approach to exercise. There were shared concerns with cybersickness and disengagement with using VR approaches. Both groups agreed games should be meaningful and adaptable for users but suggested different VR activities, with clinicians suggesting games directly reflecting activities of daily living and people with MS suggesting more abstract activities. CONCLUSIONS VR was well received by both people with MS and clinicians for UL rehabilitation. Recommendations were made for the development of VR rehabilitation games which are personalized and customizable for the varying abilities of people with MS.
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Affiliation(s)
- Amy Webster
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Matthieu Poyade
- School of Simulation and Visualisation, Glasgow School of Art, Glasgow, United Kingdom
| | - Elaine Coulter
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Lisa Forrest
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Lorna Paul
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
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Pinto JO, Pontes D, Peixoto B, Dores AR, Barbosa F. Ecological validity of neuropsychological interventions: A systematic review. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-20. [PMID: 38588721 DOI: 10.1080/23279095.2024.2328694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND The concept of ecological validity (EV) in neuropsychological interventions (NI) has been consistently advocated, but there is a lack of reviews focused on how EV is operationalized in NI programmes. This review aims to address this gap by exploring the outcome measures more commonly used for assessing EV and to understand the main characteristics of programmes with good EV. METHOD A literature search was conducted to identify studies that examined the EV of NI programmes, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Collaboration Guidelines. RESULTS A total of twenty-seven studies were included in this review. Among these, only three studies explicitly described the procedures used to assess EV. Additionally, almost half of the studies assumed that interventions had good EV based on the characteristics of the programmes. The inconsistent assessment of EV of NI programmes prevented the identification of specific characteristics of programmes demonstrating good EV. CONCLUSION This systematic review reveals a significant gap in the literature concerning the operationalization of EV within the field of NI. Further research is required to establish a consistent definition of EV in the context of NI and to develop criteria for its effective operationalization.
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Affiliation(s)
- Joana O Pinto
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- ESS, Polytechnic of Porto, Porto, Portugal
- Department of Social, Behavioral Sciences of University Institute of Health Sciences - CESPU, Gandra, Portugal
| | - Diogo Pontes
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Bruno Peixoto
- Department of Social, Behavioral Sciences of University Institute of Health Sciences - CESPU, Gandra, Portugal
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, University Institute of Health Sciences - CESPU, Gandra, Portugal
- UCIBIO - Applied Molecular Biosciences Unit, Translational Toxicology Research Laboratory, University Institute of Health Sciences, (1H-TOXRUN, IUCS-CESPU), Gandra, Portugal
| | - Artemisa R Dores
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- ESS, Polytechnic of Porto, Porto, Portugal
- Center for Rehabilitation Research, ESS, Polytechnic of Porto, Porto, Portugal
| | - Fernando Barbosa
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
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Sear C. Peripheral neuropathic pain: supporting patients with self-management. Nurs Stand 2024; 39:71-75. [PMID: 38495010 DOI: 10.7748/ns.2024.e12318] [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] [Accepted: 02/15/2024] [Indexed: 03/19/2024]
Abstract
Peripheral neuropathic pain is a complex condition that can adversely affect people's quality of life. Alongside pharmacological interventions, nurses can support patients to self-manage their pain using non-pharmacological interventions such as lifestyle changes and exercise. To do this effectively, nurses should be able to recognise the signs and symptoms of peripheral neuropathic pain and be able to educate patients on appropriate self-management approaches. It is important that nurses provide education, advice and information in a way that patients can understand and check this understanding. This article provides an overview of how nurses can support patients to self-manage peripheral neuropathic pain by using various non-pharmacological interventions.
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Affiliation(s)
- Charlotte Sear
- Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, Harefield, England
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Wade DT. A general theory of rehabilitation: Rehabilitation catalyses and assists adaptation to illness. Clin Rehabil 2024; 38:429-442. [PMID: 37885405 PMCID: PMC10898207 DOI: 10.1177/02692155231210151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND There is no general theory of rehabilitation, only definitions and descriptions, with the biopsychosocial model of illness as a structure. OBJECTIVE To develop a general theory of rehabilitation that explains how healthcare rehabilitation changes outcomes and to evaluate its validity. NEED A general rehabilitation theory would help research, improve services, increase understanding, modify resource allocation and explain some anomalies, such as how rehabilitation helps when no natural recovery occurs. BUILDING BLOCKS People adapt to change throughout their lives. Illness is a change, and people adapt to their illness. Adaptation's purpose is to maintain an equilibrium in a person's life. The balanced components are related to Maslow's five needs: basic, safety, affiliation, status and self-fulfilment. The general theory of behaviour suggests that a person's behaviours change to maintain balance, regulated by a central homeostatic mechanism. THE THEORY Rehabilitation aids adaptation to changes associated with illness through accurate diagnosis and formulation, catalysing adaptation, optimising the environment and assisting the person in making necessary changes by safely practising activities and teaching self-management. IMPLICATIONS The theory makes the person the central active agent, emphasises the importance of the environment in facilitating adaptation, explains why all conditions may benefit, including progressive and static conditions, suggests that health can be equated to someone maintaining their equilibrium and explains why a small dose may be very effective. CONCLUSION The general theory of rehabilitation emphasises the catalytic effects of rehabilitation in facilitating and guiding adaptation and suggests areas for research and improvement.
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Affiliation(s)
- Derick T Wade
- Centre for Movement, Occupation and Rehabilitation Sciences (MOReS), Oxford Brookes University, Oxford, UK
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8
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Baldwin DS, Adair M, Micheelsen A, Åstrøm DO, Reines EH. Goal setting and goal attainment in patients with major depressive disorder: a narrative review on shared decision making in clinical practice. Curr Med Res Opin 2024; 40:483-491. [PMID: 38294154 DOI: 10.1080/03007995.2024.2313108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/29/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE Narrative review of the processes of goal setting and goal attainment scaling, as practical approaches to operationalizing and implementing the principles of shared decision making (SDM) in the routine care of people living with major depressive disorder (MDD). METHODS We searched electronic databases for clinical studies published in English using key terms related to MDD and goal setting or goal attainment scaling. Two clinical studies of goal setting in MDD are considered in detail to exemplify the practicalities of the goal setting approach. RESULTS While SDM is widely recommended for people living with mental health problems, there is general agreement that it has thus far been implemented variably. In other areas of medicine, the process of goal setting is an established way to engage the patient, facilitate motivation, and assist the recovery process. For people living with MDD, the concept of goal setting is in its infancy, and only few studies have evaluated its clinical utility. Two clinical studies of vortioxetine for MDD demonstrate the utility of goal attainment scaling as an appropriate outcome for assessing functional improvement in ways that matter to the patient. CONCLUSIONS Goal setting is a pragmatic approach to turning the principles of SDM into realities of clinical practice and aligns with the principles of recovery that encompasses the notions of self-determination, self-management, personal growth, empowerment, and choice. Accumulating evidence supports the use of goal attainment scaling as an appropriate personalized outcome measure for use in clinical trials.
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Affiliation(s)
- David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Mood Disorders Service, Southern Health NHS Foundation Trust, Southampton, UK
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9
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Elvén M, Prenkert M, Holmström IK, Edelbring S. Reasoning about reasoning - using recall to unveil clinical reasoning in stroke rehabilitation teams. Disabil Rehabil 2024:1-10. [PMID: 38392962 DOI: 10.1080/09638288.2024.2320263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/14/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE The study objective was to investigate how health care providers in stroke teams reason about their clinical reasoning process in collaboration with the patient and next of kin. MATERIALS AND METHODS An explorative qualitative design using stimulated recall was employed. Audio-recordings from three rehabilitation dialogs were used as prompts in interviews with the involved staff about their clinical reasoning. A thematic analysis approach was employed. RESULTS A main finding was the apparent friction between profession-centered and person-centered clinical reasoning, which was salient in the data. Five themes were identified: the importance of different perspectives for a rich picture and well-informed decisions; shared understanding in analysis and decision-making - good intentions but difficult to achieve; the health care providers' expertise directs the dialog; the context's impact on the rehabilitation dialog; and insights about missed opportunities to grasp the patient perspective and arrive at decisions. CONCLUSIONS Interprofessional stroke teams consider clinical reasoning as a process valuing patient and next of kin perspectives; however, their professional expertise risks preventing individual needs from surfacing. There is a discrepancy between professionals' intentions for person-centeredness and how clinical reasoning plays out. Stimulated recall can unveil person-centered practice and enhance professionals' awareness of their clinical reasoning.
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Affiliation(s)
- Maria Elvén
- School of Health, Care, and Social Welfare, Mälardalen University, Västerås, Sweden
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Malin Prenkert
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Inger K Holmström
- School of Health, Care, and Social Welfare, Mälardalen University, Västerås, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Samuel Edelbring
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Okita Y, Kawaguchi Y, Inoue Y, Ohno K, Sawada T, Levack W, Tomori K. Characteristics of goal-setting tools in adult rehabilitation: A scoping review. Clin Rehabil 2024; 38:234-250. [PMID: 37644842 PMCID: PMC10725121 DOI: 10.1177/02692155231197383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/09/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES This scoping review aims to map the literature on goal-setting tools in adult rehabilitation, exploring their characteristics, target users and supporting evidence to inform practice and future research in this area. METHODS We completed a comprehensive search of four databases to identify relevant articles on tools for goal setting in rehabilitation. We followed Arkey and O'Malley's scoping review process to guide article selection, data extraction and data analysis. RESULTS We identified a total of 165 studies that reported on 55 different goal-setting tools, including tools for goal selection and goal documentation (n = 31), goal setting and intervention planning (n = 15), and for measuring the quality of the goal-setting process (n = 9). Over half of the tools were primarily designed for use in rehabilitation of physical disabilities (n = 32). Some tools fell under multiple sub-categories based on their characteristics as follows: 22 framework tools, 12 interview tools, 9 outcome measurement tools for goal achievement, 6 outcome measurement tools for goal quality and 25 documentation tools. The majority of goal-setting instruments targeted goals at the level of activity and participation (n = 51) and aimed to facilitate a client-centred or shared decision-making approach to rehabilitation planning (n = 46). CONCLUSIONS This study provides a comprehensive overview of existing goal-setting tools, highlighting their characteristics, target users and identified needs. These findings can enhance practitioners' awareness of the range of goal-setting tools available and can enable more effective utilization of these tools in clinical practice. Further research should investigate how clinicians can combine multiple tools to deliver goal setting.
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Affiliation(s)
- Yuho Okita
- School of Health Science, Swinburne University of Technology, Melbourne, Australia
| | - Yuko Kawaguchi
- Department of Rehabilitation, Kaikoukai Rehabilitation Hospital, Aichi, Japan
| | - Yuki Inoue
- Central Rehabilitation Department, Yokohama Rousai Hospital, Kanagawa, Japan
| | - Kanta Ohno
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Tatsunori Sawada
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - William Levack
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Kounosuke Tomori
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
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Ripley S, Alizadehsaravi N, Affoo R, Hunter S, Middleton LE, Moody E, Weeks LE, McArthur C. Resident-, family-, and staff-identified goals for rehabilitation of long-term care residents with dementia: a qualitative study. BMC Geriatr 2024; 24:108. [PMID: 38287257 PMCID: PMC10825995 DOI: 10.1186/s12877-024-04674-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/04/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Long-term care (LTC) residents with dementia can benefit from rehabilitation to improve function and quality of life. However, specific goals for rehabilitation with this population are not always clear. The purpose of this study was to describe the goals for rehabilitation for LTC residents with dementia from the perspective of residents, family, and staff. METHODS This was a phenomenological qualitative study. LTC residents with moderate to severe dementia, family members, and staff were recruited from two LTC homes in Halifax, Nova Scotia. Data were collected through semi-structured interviews and field notes from observations with residents while they were being active within the home. Data were analyzed via the principles of thematic content analysis, mapped onto the International Classification of Functioning, Disability, and Health (ICF) Model, and reported by the participant group (i.e., residents, family, or staff). RESULTS The 15 participants were three female residents aged 82 to 98 years, seven predominantly (86%) female family members aged 56 to 74 years, and five staff members (two females, three males, aged 22 to 55 years) who were physiotherapists, a physiotherapy assistant, a healthcare aide, and a registered licenced practical nurse. Most identified goals fell within the activities and participation constructs of the ICF model and focused on maintaining or improving function, mobility, and quality of life. Specific themes included preventing falls, walking or locomoting, stair climbing, maintaining activities of daily living, engaging in enjoyable exercise, maintaining independence and human connections, keeping busy, leaving the home for activities, and participating in group activities. CONCLUSIONS Rehabilitation goals for LTC residents living with dementia often focus on quality of life and functional activities and participation in LTC and family activities and events. Function and quality of life are interrelated, whereby functional goals influence quality of life. While some goals focus on improvement in function, maintenance or prevention of decline were also key elements. Future work should ensure rehabilitation interventions are developed relative to individually identified goals, and interventional success is measured in relation to the goal.
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Affiliation(s)
- Sara Ripley
- Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada
| | | | - Rebecca Affoo
- Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada
| | - Susan Hunter
- Western University, 1151 Richmond Street, N6A 3K7, London, ON, Canada
| | - Laura E Middleton
- University of Waterloo, 200 University Avenue West, N2L 3G1, Waterloo Ontario, Canada
- Schlegel-UW Research Institute for Aging, 250 Laurelwood Drive, N2J 0E2, Waterloo, ON, Canada
| | - Elaine Moody
- Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada
- Centre of Excellence, Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI, Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada
| | - Lori E Weeks
- Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada
- Centre of Excellence, Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI, Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada
| | - Caitlin McArthur
- Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada.
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Kato M, Kikuchi T, Watanabe K, Sumiyoshi T, Moriguchi Y, Oudin Åström D, Christensen MC. Goal Attainment Scaling for Depression: Validation of the Japanese GAS-D Tool in Patients with Major Depressive Disorder. Neuropsychiatr Dis Treat 2024; 20:49-60. [PMID: 38239870 PMCID: PMC10796153 DOI: 10.2147/ndt.s441382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024] Open
Abstract
Purpose Goal attainment scaling (GAS) has been proposed as a person-centric, semi-quantitative measure that assimilates achievement of individually set goals into a single standardized "goal attainment score" that can be compared at the population level. We aimed to examine the reliability and validity of the Japanese version of the GAS for depression (GAS-D) tool in assessing goal attainment in people living with major depressive disorder (MDD). Patients and Methods This was a prespecified analysis of a prospective, 24-week, multicenter, observational cohort study of employed Japanese outpatients with MDD initiating treatment with vortioxetine according to the Japanese label (JRCT1031210200). Participants were assessed using the Japanese version of the GAS-D and other clinical rating scales at baseline and Weeks 8, 12 and 24. Results Goal attainment was significantly associated with symptom severity as assessed by the Montgomery-Åsberg Depression Rating Scale (MADRS) scale, confirming convergent validity. In particular, GAS-D scores were significantly related to MADRS total score at Weeks 12 and 24, indicating that improvements in overall symptom severity with vortioxetine treatment were likely to be reflected in the achievement of individualized treatment goals. With an intraclass correlation coefficient of 0.67 (95% CI 0.45-0.82), the GAS-D also showed moderate test-retest reliability between Weeks 8 and 12 while proving independent of demographic characteristics. Conclusion The results of this open-label study support the use of the GAS-D as a valid and sensitive outcome measure in the assessment of treatment response in MDD.
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Affiliation(s)
- Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Toshiaki Kikuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Tomiki Sumiyoshi
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
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Mendes Pereira C, Matos M, Carvalho D, Macedo P, Calheiros JM, Alves J, Paulino Ferreira L, Dias TL, Neves Madeira R, Jones F. Building Bridges between People with Stroke, Families, and Health Professionals: Development of a Blended Care Program for Self-Management. J Clin Med 2024; 13:300. [PMID: 38202307 PMCID: PMC10779663 DOI: 10.3390/jcm13010300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
Evidence-informed interventions for stroke self-management support can influence functional capability and social participation. People with stroke should be offered self-management support after hospital discharge. However, in Portugal, there are no known programs of this nature. This study aimed to develop a person-centered and tailored blended care program for post-stroke self-management, taking into account the existing evidence-informed interventions and the perspectives of Portuguese people with stroke, caregivers, and health professionals. An exploratory sequential mixed methods approach was used, including qualitative methods during stakeholder consultation (stage 1) and co-production (stage 2) and quantitative assessment during prototyping (stage 3). After ethical approval, recruitment occurred in three health units. Results from a literature search led to the adaptation of the Bridges Stroke Self-Management Program. In stage one, 47 participants were interviewed, with two themes emerging: (i) Personalized support and (ii) Building Bridges through small steps. In stage two, the ComVida program was developed, combining in-person and digital approaches, supported by a workbook and a mobile app. In stage three, 56 participants evaluated prototypes, demonstrating a strong level of quality. Understandability and actionability of the developed tools obtained high scores (91-100%). The app also showed good usability (A-grade) and high levels of recommendation (5 stars).
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Affiliation(s)
- Carla Mendes Pereira
- Department of Physiotherapy, School of Health, Polytechnic University of Setúbal, 2910-761 Setúbal, Portugal; (M.M.); (T.L.D.)
- Comprehensive Health Research Centre (CHRC), NOVA University of Lisbon, 1150-082 Lisbon, Portugal
| | - Mara Matos
- Department of Physiotherapy, School of Health, Polytechnic University of Setúbal, 2910-761 Setúbal, Portugal; (M.M.); (T.L.D.)
| | - Daniel Carvalho
- Local Health Unit Litoral Alentejano (ULSLA), 7540-230 Santiago do Cacém, Portugal;
| | - Patricia Macedo
- Research Center for Engineering a Sustainable Development (Sustain.RD), Setúbal School of Technology, Polytechnic University of Setúbal, 2910-761 Setúbal, Portugal; (P.M.); (R.N.M.)
- Center of Technology and Systems (UNINOVA-CTS), NOVA School of Science and Technology, 2829-516 Caparica, Portugal
| | - José M. Calheiros
- Institute for Research, Innovation and Development (FP-I3ID), University Fernando Pessoa, 4249-004 Porto, Portugal;
| | - Janice Alves
- Neurology Department, Setúbal Hospital Centre, 2910-446 Setúbal, Portugal;
| | - Luís Paulino Ferreira
- Department of Psychiatry and Mental Health, Setúbal Hospital Centre, 2910-446 Setúbal, Portugal;
| | - Teresa L. Dias
- Department of Physiotherapy, School of Health, Polytechnic University of Setúbal, 2910-761 Setúbal, Portugal; (M.M.); (T.L.D.)
| | - Rui Neves Madeira
- Research Center for Engineering a Sustainable Development (Sustain.RD), Setúbal School of Technology, Polytechnic University of Setúbal, 2910-761 Setúbal, Portugal; (P.M.); (R.N.M.)
- NOVA Laboratory of Computer Science and Informatics (NOVA LINCS), NOVA School of Science and Technology, NOVA University of Lisbon, 2829-516 Caparica, Portugal
| | - Fiona Jones
- Population Health Research Institute, St George’s, University of London, London SW17 ORE, UK;
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Kafel T, Šuc L, Vidovič M, Smith M. Methods of Goal-Setting in Rehabilitation of Adults with Physical Dysfunctions-A Scoping Review. Occup Ther Health Care 2023:1-30. [PMID: 38157219 DOI: 10.1080/07380577.2023.2294817] [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: 05/26/2023] [Accepted: 12/09/2023] [Indexed: 01/03/2024]
Abstract
This scoping review utilized the JBI methodology to investigate methods of goal-setting used in the rehabilitation of adults with physical dysfunctions. Electronic databases were searched for articles published in the last 5 years. The inclusion of articles and data extraction were performed by two independent reviewers. Results were presented and synthesized numerically and thematically analyzed. Results suggest that goals should be client-centered and specific and long-term goals, should be complemented with medium and short-term goals. While various goal-setting methods are used in current practice, their full potential is often not realized due to improper implementation. Therefore, there is a need for educating clinicians to improve the goal-setting process and ensure its effectiveness.
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Affiliation(s)
- Tibor Kafel
- School of Health Professions, University of Plymouth, Plymouth, UK
- Department of Occupational Therapy, University Rehabilitation Institute of Republic of Slovenia Soča, Ljubljana, Slovenia
| | - Lea Šuc
- Department of Occupational Therapy, University Rehabilitation Institute of Republic of Slovenia Soča, Ljubljana, Slovenia
| | - Marko Vidovič
- Department of Occupational Therapy, University Rehabilitation Institute of Republic of Slovenia Soča, Ljubljana, Slovenia
| | - Marnie Smith
- School of Health Professions, University of Plymouth, Plymouth, UK
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Gayton J, Monga A. Goal setting in physiotherapy-led adult musculoskeletal care: A scoping review. Musculoskeletal Care 2023; 21:1315-1340. [PMID: 37641529 DOI: 10.1002/msc.1803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/29/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Goal setting is a key part of rehabilitation across various fields of physiotherapy. It is less clear what evidence exists to underpin its effectiveness and to practically guide its use within musculoskeletal physiotherapy. OBJECTIVES This scoping review provides an overview of current research regarding goal setting in adult physiotherapy-led musculoskeletal care with three aims: 1) to identify and analyse any gaps in the literature, 2) to identify relevant features of goal setting theory and 3) to make recommendations for future research. The principal research question was what does the literature tell us about the role of goal setting for adults over the age of 18 with musculoskeletal pain accessing outpatient physiotherapy services? INCLUSION CRITERIA The population, concept and context framework was used to define the inclusion criteria. Key definitions were adults over the age of 18 with musculoskeletal conditions, goal setting, and physiotherapy-led interventions. METHODS This scoping review followed the guidance set out by the Joanna Briggs Institute Manual for Evidence Synthesis. Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature Plus with Full Text, MEDLINE, American Psychological Association PsycInfo and the Cochrane Database of Systematic Reviews, Protocols and Trials were searched using pre-defined search criteria. Data were extracted from screened full-text articles and presented in basic statistical and narrative form. RESULTS 41 articles were included in the review. Several broad themes and research methods were identified. The nature of the studies suggested that the clinical application of goal setting is complex and the depth of understanding is limited. Most studies suggested that goal setting is feasible and has a positive impact on outcomes. A common finding was a lack of clear definitions regarding goal setting terminology and approaches. Study samples were generally defined by biomedical categories, suggesting a pathoanatomical approach to researching a cognitive construct. Theoretical underpinning was lacking in many studies. No frameworks guiding goal setting in physiotherapy-led musculoskeletal rehabilitation have been identified. CONCLUSIONS Goal setting is a popular tool within musculoskeletal outpatient physiotherapy. Further research is required to clarify its efficacy and provide guidance on its role and application in clinical practice.
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Affiliation(s)
- Jonathan Gayton
- Advanced Physiotherapy Practitioner, Musculoskeletal Service, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Aastha Monga
- School of Allied Health Professions, Keele University, Keele, UK
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16
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McNaughton H, Fu V. Intrinsic motivation. Pract Neurol 2023; 23:489-492. [PMID: 37524439 DOI: 10.1136/pn-2023-003763] [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] [Accepted: 07/11/2023] [Indexed: 08/02/2023]
Abstract
The prevailing wisdom in neurological rehabilitation, and particularly for stroke, is that physical therapies are the key to improvements in function. Despite accepting the importance of 'the motivated patient', the lack of simple, proven ways to improve intrinsic motivation has hindered efforts to combine physical therapies with motivation. Now there is available a simple, free, well-validated approach to encourage intrinsic motivation ('Take Charge'). The benefits for people who have had a stroke are well-established but this could be applied to people with a range of neurological and other disorders. We provide the evidential support for this approach and suggest ways of incorporating it into daily practice.
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Affiliation(s)
- Harry McNaughton
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Stroke Department, Royal Derby Hospital, Derby, UK
| | - Vivian Fu
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Department of Clinical Neuroscience, University of Calgary, Calgary, Alberta, Canada
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Ørtenblad L, Maribo T, Quistgaard B, Madsen E, Handberg C. The ambiguity of goal-setting: a study of patients' perspectives on goal-setting in outpatient multidisciplinary rehabilitation of patients with spinal cord injury. Disabil Rehabil 2023; 45:3342-3351. [PMID: 36131619 DOI: 10.1080/09638288.2022.2125087] [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: 12/17/2021] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Spinal cord injury (SCI) is a complex health condition requiring long-term rehabilitation. Person-centred goal-setting is a central component of rehabilitation. However, knowledge of patients' perspectives on the goal-setting in SCI rehabilitation is scarce. The purpose was therefore to explore patients' perspectives on goal-setting in multidisciplinary SCI rehabilitation. MATERIALS AND METHODS An anthropological study combining participant-observation and individual interviews. Data were analysed using reflexive thematic analysis. The COREQ checklist was used to report study quality. RESULTS Patients with SCI perceived goal-setting as ambiguous. On the one hand, they considered it insignificant, because it was complicated to transform complex needs of everyday life to recommended criteria of goals being measurable, specific, and realistic. On the other hand, they considered it a potentially useful guiding tool. Patients were uncertain of impact of goals and perceived goal-setting as vague during rehabilitation. Patient involvement was challenged by insufficient integration of patients' experience-based knowledge of everyday life and clinicians' profession-based knowledge. CONCLUSIONS Goal-setting in rehabilitation is not the patients' need but they accept it as the clinicians' framework for rehabilitation. For goal-setting to become meaningful to patients with SCI, patient involvement should be strengthened by equally integrating the patients' perspectives in the goal-setting process.Implications for rehabilitationHealth-care professionals have to strengthen patient involvement in SCI rehabilitation by to a greater extent integrating the patients' knowledge of their everyday life and preferences rather than primarily focusing on profession-based knowledge.Health-care professionals must support patients in setting goals which are practically meaningful and relevant to the patients' everyday life and achievably and if needed go beyond the structured measurement of SMART goals.In an acknowledgement of the dynamic nature of goal-setting, clinicians should emphasise formulating goals in a flexible and non-directive manner, thereby providing room for patients' changing needs and challenges over time.Goals in SCI rehabilitation cover a wide range from broad, value-based goals to more specific goals, and the health-care professionals must ensure inclusion of such a wide range of goals.
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Affiliation(s)
- Lisbeth Ørtenblad
- DEFACTUM - Public Health and Rehabilitation Research, Central Denmark Region, Denmark
| | - Thomas Maribo
- DEFACTUM - Public Health and Rehabilitation Research, Central Denmark Region, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Britta Quistgaard
- The Specialized Hospital for Polio- and Accident Victims, Rødovre, Denmark
| | - Ellen Madsen
- The Specialized Hospital for Polio- and Accident Victims, Rødovre, Denmark
| | - Charlotte Handberg
- Department of Public Health, Aarhus University, Aarhus, Denmark
- The National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark
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18
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Ørtenblad L, Maribo T, Quistgaard B, Madsen E, Handberg C. Goal-Setting in clinical practice: a study of health-care professionals' perspectives in outpatient multidisciplinary rehabilitation of patients with spinal cord injury. Disabil Rehabil 2023; 45:3330-3341. [PMID: 36137224 DOI: 10.1080/09638288.2022.2125086] [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: 12/17/2021] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Spinal cord injury is a complex condition requiring long-term rehabilitation. Goal-setting is considered an essential part of rehabilitation, however, knowledge of how goal-setting is practised across health-care professions, settings and diagnoses are scarce. The purpose of the study was therefore to explore health-care professionals' perspectives on goal-setting practice in outpatient multidisciplinary rehabilitation targeting patients with spinal cord injury. MATERIALS AND METHODS An anthropological study combining participant-observation and focus group interviews. Data were analysed using reflexive thematic analysis. COREQ checklist was used to report the study quality. RESULTS Health-care professionals experienced a field of tension between internationally recommended goal-setting criteria, requiring goals to be specific, measurable, realistic and time-based, and a practice influenced by patients presenting complex needs. The challenges were managed using a negotiation strategy characterized by a tinkering approach to adjust notions of measurability, realism and time frame into practice. Also, health-care professionals were challenged in relation to practising a person-centred rehabilitation approach. CONCLUSIONS We suggest rethinking the goal-setting process by allowing recommended goal-setting criteria to be adapted to a specific practice context while acknowledging goal-setting practice in its variety and flexibility as a strength. Furthermore, improved incorporation of patients' perspectives in the practice is needed. Implications for rehabilitationTo strengthen person-centred rehabilitation practice, clinicians should actively search for and engage patient-identified needs and preferences in shared goal-setting.Standard criteria of goal-setting should comply with the individual and specific participation in the everyday life of patients with SCI.SMART goals are not always the right way to formulate rehabilitation goals.A flexible and pragmatic approach is needed to reach a balance between the patients' complex needs and the recommendations for goals to be specific, measurable, realistic, and time-based.
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Affiliation(s)
- Lisbeth Ørtenblad
- DEFACTUM - Public Health and Rehabilitation Research, Central Denmark Region, Aarhus, Denmark
| | - Thomas Maribo
- DEFACTUM - Public Health and Rehabilitation Research, Central Denmark Region, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Britta Quistgaard
- The Specialized Hospital for Polio- and Accident Victims, Rødovre, Denmark
| | - Ellen Madsen
- The Specialized Hospital for Polio- and Accident Victims, Rødovre, Denmark
| | - Charlotte Handberg
- Department of Public Health, Aarhus University, Aarhus, Denmark
- The National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark
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Abri D, Boll T. Use of Assistive Technologies and Alternative Means by Older People: The "Actional Model of Older People´s Coping with Health-Related Declines". Integr Psychol Behav Sci 2023; 57:960-1001. [PMID: 36163456 DOI: 10.1007/s12124-022-09729-w] [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] [Accepted: 09/11/2022] [Indexed: 11/05/2022]
Abstract
This paper presents the "Actional Model of Older people´s Coping with Health-Related Declines" to explain the use of a broad range of action alternatives of older persons for dealing with current or anticipated diseases, functional declines, activity limitations and participation restrictions. The general background is the action-theoretical model of intentional self-regulation of human development (e.g., Brandtstädter, 2006; Rothermund & Brandtstädter, 2019). Yet, our model provides an increased specification of major model components toward the situation of older people coping with current or anticipated health-related declines. The model development follows an adapted theory construction methodology (TCM) by Borsboom et al. (Perspectives on Psychological Science, 16(4), 756-766, 2021) and adapted principles for constructing practically useful theories by Berkman & Wilson (Perspectives on Psychological Science, 16(4), 864-874, 2021). Regarding content, we further draw on models of the use of assistive technologies (ATs) and medical services, qualitative studies on reasons for using ATs, and quantitative studies on health-related goals. The resulting model includes these components: (1) Discrepancies between perceived or anticipated and desired health-related development, (2) health-related discrepancy reduction and prevention goals, (3) action possibilities for reducing or preventing health-related discrepancies, (4) further motivating and demotivating goals, (5) beliefs about effective means for reaching the goals (2) and (4), (6) generation of the particular coping actions by goals (2) and (4) in combination with beliefs about effective means, (7) external context factors, and (8) modes of joint decision-making and decision-making on behalf of older people. The explanatory and practical value of the model are discussed as well as its implications for future research and geropsychology teaching.
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Affiliation(s)
- Diana Abri
- Department of Behavioural and Cognitive Sciences, Institute for Lifespan Development, Family, and Culture, University of Luxembourg, 11, Porte des Sciences, L-4366, Esch-sur-Alzette, Luxembourg.
| | - Thomas Boll
- Department of Behavioural and Cognitive Sciences, Institute for Lifespan Development, Family, and Culture, University of Luxembourg, 11, Porte des Sciences, L-4366, Esch-sur-Alzette, Luxembourg
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Liapi F, Chater AM, Kenny T, Anderson J, Randhawa G, Pappas Y. Evaluating step-down, intermediate care programme in Buckinghamshire, UK: a mixed methods study. BMC Public Health 2023; 23:1087. [PMID: 37280556 PMCID: PMC10242590 DOI: 10.1186/s12889-023-15868-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/10/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Intermediate care (IC) services are models of care that aim to bridge the gap between hospital and home, enabling continuity of care and the transition to the community. The purpose of this study was to explore patient experience with a step-down, intermediate care unit in Buckinghamshire, UK. METHODS A mixed-methods study design was used. Twenty-eight responses to a patient feedback questionnaire were analysed and seven qualitative semi-structured interviews were conducted. The eligible participants were patients who had been admitted to the step-down IC unit. Interview transcripts were analysed using thematic analysis. FINDINGS Our interview data generated five core themes: (1) "Being uninformed", (2) "Caring relationships with health practitioners", (3) "Experiencing good intermediate care", (4) "Rehabilitation" and (5) "Discussing the care plan". When comparing the quantitative to the qualitative data, these themes are consistent. CONCLUSIONS Overall, the patients reported that the admission to the step-down care facility was positive. Patients highlighted the supportive relationship they formed with healthcare professionals in the IC and that the rehabilitation that was offered in the IC service was important in increasing mobility and regaining their independence. In addition, patients reported that they were largely unaware about their transfer to the IC unit before this occurred and they were also unaware of their discharge package of care. These findings will inform the evolving patient-centred journey for service development within intermediate care.
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Affiliation(s)
- Fani Liapi
- Institute for Health Research, University of Bedfordshire, Luton, LU2 8LE, UK.
| | - Angel Marie Chater
- Institute for Sport and Physical Activity Research, University of Bedfordshire, MK41 9EA, Bedford, UK
- University College London, Centre for Behaviour Change, WC1E 7HB, London, UK
| | - Tina Kenny
- Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK
| | - Juliet Anderson
- Buckinghamshire Health and Social Care Academy, Aylesbury, HP21 7Q, UK
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, LU2 8LE, UK
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Luton, LU2 8LE, UK
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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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Connor EO, Dolan E, Horgan F, Galvin R, Robinson K. A qualitative evidence synthesis exploring people after stroke, family members, carers and healthcare professionals' experiences of early supported discharge (ESD) after stroke. PLoS One 2023; 18:e0281583. [PMID: 36780444 PMCID: PMC9925006 DOI: 10.1371/journal.pone.0281583] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/26/2023] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVE Early supported discharge (ESD) after stroke has been shown to generate significant cost savings and reduce both hospital length of stay, and long-term dependency. This study aimed to systematically review and synthesise qualitative studies of the experiences and views of ESD from the perspective of people after stroke, their family members, carers and healthcare professionals. METHOD A systematic search of eleven databases; CINAHL, PubMed Central, Embase, MEDLINE, PsycINFO, Sage, Academic Search Complete, Directory of Open Access Journal, The Cochrane Library, PsycARTICLES and SCOPUS, was conducted from 1995 to January 2022. Qualitative or mixed methods studies that included qualitative findings on the perspectives or experiences of people after stroke, family members, carers and healthcare professionals of an ESD service were included. The protocol was registered with the Prospero database (Registration: CRD42020135197). The methodological quality of studies was assessed using the 10-item CASP checklist for qualitative studies. Results were synthesised using Thomas and Harden's three step approach for thematic synthesis. RESULTS Fourteen studies were included and five key themes were identified (1) ESD eases the transition home, but not to community services, (2) the home environment enhances rehabilitation, (3) organisational, and interprofessional factors are critical to the success of ESD, (4) ESD is experienced as a goal-focused and collaborative process, and (5) unmet needs persisted despite ESD. CONCLUSION The findings of this qualitative evidence synthesis highlight that experiences of ESD were largely very positive. The transition from ESD to community services was deemed to be problematic and other unmet needs such as information needs, and carer support require further investigation.
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Affiliation(s)
- Elaine O. Connor
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Castletroy, Limerick, Ireland
- Connolly Hospital, Blanchardstown, Dublin, Ireland
- * E-mail:
| | - Eamon Dolan
- Connolly Hospital, Blanchardstown, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Castletroy, Limerick, Ireland
| | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Castletroy, Limerick, Ireland
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Gajardo-Burgos R, Valdebenito-Tejos C, Gálvez-García G, Bascour-Sandoval C. Pain and Psychological Readiness to Return to Sport in Elite Volleyball Players: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2492. [PMID: 36767858 PMCID: PMC9915367 DOI: 10.3390/ijerph20032492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 06/18/2023]
Abstract
UNLABELLED Pain is modulated by multiple factors. A relevant psychological process peculiar to athletes and which could be associated with pain is Psychological Readiness to Return to Sport (PRRS). The analysis of this association in competition context is particularly important. OBJECTIVE To determine the correlation between the PRRS and pain intensity in elite volleyball players during their participation in a continental sporting event. METHODS A cross-sectional study was conducted. Data from 107 male volleyball players (23.50 ± 4.08 years of age) participating in the South American Volleyball Championship were used. The athletes answered a self-report questionnaire on the day the championship began regarding their history of injuries in the previous six months. The athletes who declared injuries were asked about the current pain intensity using the Pain Numeric Rating Scale (NRS) and Psychological Readiness to Return to Sport using the Injury-Psychological Readiness to Return to Sport scale (I-PRRS). RESULTS 43.93% (n = 47) of the athletes (23.70 ± 3.54 years) reported an injury in the six months prior to the championship. They presented a median on the NRS of three (interquartile range (IQR), 2-5), and 54 (IQR, 46-58) on the I-PRRS. The Spearman's Rho correlation test showed an inversely and moderate correlation (rs = -0.36; p = 0.011; CI: -0.64--0.08) between pain intensity and PRRS. CONCLUSIONS In male elite volleyball players who participate in a Continental Championship in South America, higher levels of PRRS was correlated to lower pain intensity.
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Affiliation(s)
- Rubén Gajardo-Burgos
- Instituto de Aparato Locomotor y Rehabilitación, Facultad de Medicina, Universidad Austral de Chile, Valdivia 5090000, Chile
- Programa de Magister en Terapia Física, Mención Musculoesquelética, Universidad de La Frontera, Avenida Francisco Salazar 01145, Temuco 4780000, Chile
| | - Camila Valdebenito-Tejos
- Dirección de Desarrollo Estudiantil, Universidad de La Frontera, Avenida Francisco Salazar 01145, Temuco 4780000, Chile
| | - Germán Gálvez-García
- Departamento de Psicología, Universidad de La Frontera, Avenida Francisco Salazar 01145, Temuco 4780000, Chile
- Departamento de Psicología Básica, Psicobiología y Metodología de las Ciencias del Comportamiento, Facultad de Psicología, Campus Ciudad Jardín, Universidad de Salamanca, 37005 Salamanca, Spain
| | - Claudio Bascour-Sandoval
- Programa de Magister en Terapia Física, Mención Musculoesquelética, Universidad de La Frontera, Avenida Francisco Salazar 01145, Temuco 4780000, Chile
- Departamento de Ciencias de la Rehabilitación, Universidad de La Frontera, Avenida Francisco Salazar 01145, Temuco 4780000, Chile
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Contribution of individual and cumulative frailty-related health deficits on cardiac rehabilitation completion. BMC Geriatr 2023; 23:34. [PMID: 36658538 PMCID: PMC9854083 DOI: 10.1186/s12877-022-03624-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 11/14/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Despite the high burden of frailty among cardiac rehabilitation (CR) participants, it is unclear which frailty-related deficits are related to program completion. METHODS Data from a single-centre exercise- and education-based CR program were included. A frailty index (FI) based on 25 health deficits was constructed. Logistic regression was used to estimate the odds of CR completion based on the presence of individual FI items. The odds of completion for cumulative deficits related to biomarkers, body composition, quality of life, as well as a composite of traditional and non-traditional cardiovascular risk factor domains were examined. RESULTS A total of 3,756 individuals were included in analyses. Eight of 25 FI variables were positively associated with program completion while 8 others were negatively associated with completion. The variable with the strongest positive association was the food frequency questionnaire score (OR 1.27 (95% CI 1.14, 1.41), whereas the deficit with strongest negative association was a decline in health over the last year (OR 0.74 (95% CI 0.58, 0.93). An increased number of cardiovascular deficits were associated with an increased odds of CR completion (OR per 1 deficit increase 1.16 (95% CI 1.11, 1.22)). A higher number of traditional CR deficits were predictive of CR completion (OR 1.22 (95% CI 1.16, 1.29)), but non-traditional measures predicted non-completion (OR 0.95 (95% CI 0.92, 0.97)). CONCLUSION A greater number of non-traditional cardiovascular deficits was associated with non-completion. These data should be used to implement intervention to patients who are most vulnerable to drop out to maximize retention.
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Otaka E, Oguchi K, Yagihashi K, Hoshino T, Munakata S, Hayakawa A, Otaka Y. Feasibility and efficacy of an activity-monitoring approach using pedometer in patients undergoing subacute rehabilitation: A pilot study. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1050638. [PMID: 37033197 PMCID: PMC10073503 DOI: 10.3389/fresc.2023.1050638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023]
Abstract
Wearable devices for the quantification of walking have recently been adopted for gait rehabilitation. To apply this method in subacute rehabilitation settings, this approach must be effective in these populations and implemented as a feasible method in terms of adherence and safety, especially the risk of falling. This study aimed to investigate the feasibility and efficacy of an activity monitoring approach in subacute rehabilitation using a commercially available pedometer validated with slow walking. This randomized controlled study with blinded assessors recruited 29 patients admitted to a rehabilitation ward. The participants were randomly assigned to either the feedback (intervention) or the no-feedback (control) group. Participants in both groups received at least 120 min of therapy sessions every day for 6 or 7 days per week while wearing pedometers on their unaffected ankles from the day they were permitted to walk independently till discharge. Only participants in the feedback group received weekly encouragement and the next goals. The primary outcome was the change in the 6-minute walking distance (Δ6MD). Feasibility (percentage of pedometer data acquisition days in the total observational period and the number of falls) and other efficacy outcomes (step counts, gait speed, 30-seconds chair stand test, Berg Balance Scale, and Timed Up and Go Test) were also evaluated. Regarding feasibility outcomes, the data acquisition rate was 94.1% and the number of falls during the observation period was one in the feedback group. Regarding efficacy outcomes, Δ6MD was not significantly greater in the feedback group [mean (standard deviation): 79.1 (51.7) m] than in the no-feedback group [86.1 (65.4) m] (p = 0.774) and the other five secondary outcomes showed no between-group difference. Considering the large number of steps per day in both groups [6,912 (4,751) and 5,600 (5,108) steps in the feedback and no-feedback group, respectively], the effect of the intended intervention might have been masked by the effect of simply wearing pedometers in the control group. This study revealed that the activity monitoring approach using an ankle-worn pedometer was practical in terms of adherence and safety. Further clinical trials are required to elucidate ways to effectively use wearable devices in subacute rehabilitation.
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Affiliation(s)
- Eri Otaka
- Department of Rehabilitation Medicine, Kariya Toyota General Hospital, Kariya, Japan
- Assistive Robot Center, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kazuyo Oguchi
- Department of Rehabilitation Medicine, Kariya Toyota General Hospital, Kariya, Japan
| | - Kei Yagihashi
- Department of Rehabilitation Medicine, Kariya Toyota General Hospital, Kariya, Japan
| | - Takashi Hoshino
- Department of Rehabilitation Medicine, Kariya Toyota General Hospital, Kariya, Japan
| | - Sachiko Munakata
- Department of Rehabilitation Medicine, Kariya Toyota General Hospital, Kariya, Japan
| | - Atsuko Hayakawa
- Department of Rehabilitation Medicine, Kariya Toyota General Hospital, Kariya, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
- Correspondence: Yohei Otaka
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Kang E, Jethani P, Foster ER. Person-centered goal setting is feasible in people with Parkinson's disease who have subjective cognitive decline: a mixed methods study. Disabil Rehabil 2023; 45:90-97. [PMID: 35023794 PMCID: PMC9719695 DOI: 10.1080/09638288.2022.2025930] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/21/2021] [Accepted: 12/31/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE Evaluate the feasibility of person-centered goal setting in people with Parkinson's disease (PD) who have subjective cognitive decline and explore characteristics of the formulated goals. MATERIALS AND METHODS Participants completed person-centered goal setting as a part of two cognitive intervention studies. Participants were guided to develop at least three goals and rate the importance of each goal using a 10-point scale (1: not at all important - 10: extremely important). To evaluate the feasibility of person-centered goal setting, we calculated the mean number of formulated goals per person and the importance level of all goals. To explore goal characteristics, two independent authors coded all goals and synthesized them using deductive content analysis in consultation with the senior author. RESULTS Thirty participants formulated a total of 166 goals. The mean number of formulated goals per participant was 5.53 (SD = 2.22, range = 3 - 10). The mean importance level of all formulated goals was 8.3 (SD = 1.49, range = 4 - 10). Formulated goals ranged across diverse domains and categories. CONCLUSIONS Person-centered goal setting is feasible to guide people with PD to formulate personally meaningful goals. Findings highlight the diverse cognitive rehabilitation needs of people with PD, potential cognitive rehabilitation priorities, and future goal setting research directions.Implications for rehabilitationRehabilitation clinicians and researchers should not assume that people with PD who have subjective cognitive decline are not capable of engaging in their goal setting.Rehabilitation clinicians and researchers should acknowledge and act on our responsibility to enable people with PD who have subjective cognitive decline to engage in goal setting.Rehabilitation clinicians and researchers are encouraged to explore diverse goal domains to optimize goal setting and rehabilitation care among people with PD who have subjective cognitive decline.
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Affiliation(s)
- Eunyoung Kang
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Pooja Jethani
- Program in Occupational Therapy, Louisiana State University of Health Sciences, Shreveport, LA, USA
| | - Erin R. Foster
- Program in Occupational Therapy, Department of Neurology, & Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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McNaughton H, Gommans J, McPherson K, Harwood M, Fu V. A cohesive, person-centric evidence-based model for successful rehabilitation after stroke and other disabling conditions. Clin Rehabil 2022; 37:975-985. [DOI: 10.1177/02692155221145433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Harry McNaughton
- Medical Research Institute of New Zealand, Wellington, New Zealand
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - John Gommans
- Te Whatu Ora – Health New Zealand, Te Matau – a Māui Hawke’s Bay, New Zealand
- Stroke Foundation of New Zealand, Wellington, New Zealand
| | | | | | - Vivian Fu
- Medical Research Institute of New Zealand, Wellington, New Zealand
- University of Calgary, Calgary, Canada
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Valaas HL, Klokkerud M, Hildeskår J, Hagland AS, Kjønli E, Mjøsund K, Øie L, Wigers SH, Eppeland SG, Høystad TØ, Klokkeide Å, Larsen M, Kjeken I. Rehabilitation goals described by patients with rheumatic and musculoskeletal diseases: content and attainment during the first year after rehabilitation. Disabil Rehabil 2022; 44:7947-7957. [PMID: 34854330 DOI: 10.1080/09638288.2021.2003879] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE We explored the content and attainment of rehabilitation goals the first year after rehabilitation among patients with rheumatic and musculoskeletal diseases. METHODS Participants (n = 523) recorded goals in the Patient Specific Functional Scale at admission and reported goal attainment at admission, discharge, and 12 months after rehabilitation on an 11-point numeric rating scale. Goal content was linked to the ICF coding system and summarized as high, maintained, or no attainment. Changes in absolute scores were investigated using paired samples t-tests. RESULTS Goals had high attainment with a significant positive change (-1.83 [95% CI -2.0, -1.65], p > 0.001) during rehabilitation, whereas goals had no attainment with a significant negative change (0.36 [0.14, 0.57], p > 0.001) between discharge and 12 months after rehabilitation. Goals focusing on everyday routines, physical health, pain management, and social or work participation were highly attained during rehabilitation. Goals that were difficult to enhance or maintain after rehabilitation addressed everyday routines, physical health, and work participation. CONCLUSION The positive changes in goal attainment largely occurred during rehabilitation, but they appeared more difficult to maintain at home. Therefore, rehabilitation goals should be reflected in the follow-up care planned at discharge.Implications for rehabilitationThe contents of rehabilitation goals reflect the complexity and wide range of challenges patients with rheumatic and musculoskeletal diseases experience.Positive changes in goal attainment largely occur during rehabilitation and appear to be more difficult to enhance or maintain at home.Rehabilitation interventions and follow-up care should be tailored to support patients in maintaining their attained goals for healthy self-management.Rehabilitation goals should be reflected in the follow-up care planned at discharge.
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Affiliation(s)
- Helene Lindtvedt Valaas
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Mari Klokkerud
- Regional Center for Knowledge Translation in Rehabilitation, Sunnaas Hospital, Oslo, Norway
| | | | | | | | | | - Lars Øie
- North-Norway Rehabilitation Centre, Tromsø, Norway
| | | | | | | | | | - Mona Larsen
- The Norwegian Rheumatism Association, Oslo, Norway
| | - Ingvild Kjeken
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Moens M, Alliet W, Billot M, De Smedt A, Flamée P, Vanhonacker D, Roulaud M, Rigoard P, Goudman L. Goals, Expectations, and the Definition of Success for Neuromodulation for Pain According to Representatives of Neuromodulation Device Manufacturers. J Pers Med 2022; 12:jpm12091457. [PMID: 36143243 PMCID: PMC9500654 DOI: 10.3390/jpm12091457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/03/2022] [Accepted: 09/04/2022] [Indexed: 11/19/2022] Open
Abstract
Representatives of neuromodulation device manufacturers are expected to facilitate the relationship between patients and healthcare providers. Nevertheless, the goals, expectations, and definition of success for neuromodulation for pain have not yet been explored. Representatives present at the 2nd Joint Congress of the INS European Chapters in September 2021 completed a survey to ascertain their opinions about the goals to achieve with neuromodulation, the factors that they expect to change, and their definition of success for neuromodulation. In total, 39 representatives completed the survey. To provide excellent service for patients (22.4%), to become a trusted partner for physicians (21.5%), and to provide excellent service for physicians (20.7%) were the highest ranked goals. The most frequently reported factors that were expected to change were pain intensity (23.1%), patient satisfaction (19.7%), mobility/functioning (14.5%), and capacity to return to work (13.7%). Within the definitions of success, increased quality of life of the patient was stated in 21% of the definitions, closely followed by pain control (19.3%) and happiness/patient satisfaction (15.8%). The goals of representatives of neuromodulation device manufacturers seem to focus on ensuring a good relationship with physicians on the one hand and providing good service towards patients on the other hand, whereby pain control, quality of life, and patient satisfaction seem to be important for company representatives.
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Affiliation(s)
- Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
- STIMULUS Consortium (reSearch and TeachIng neuroModULation Uz bruSsel), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - William Alliet
- Department of Anesthesiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Maxime Billot
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France
| | - Ann De Smedt
- STIMULUS Consortium (reSearch and TeachIng neuroModULation Uz bruSsel), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Physical Medicine and Rehabilitation, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Panagiotis Flamée
- Department of Anesthesiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Domien Vanhonacker
- Department of Anesthesiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Manuel Roulaud
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France
| | - Philippe Rigoard
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France
- Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, 86021 Poitiers, France
- Pprime Institute UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, 86360 Chasseneuil-du-Poitou, France
| | - Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
- STIMULUS Consortium (reSearch and TeachIng neuroModULation Uz bruSsel), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Research Foundation—Flanders (FWO), 1090 Brussels, Belgium
- Correspondence: ; Tel.: +32-2477-5514
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Nielsen IH, Poulsen I, Larsen K, Larsen NS. Life goals as a driving force in traumatic brain injury rehabilitation: a longitudinal dyadic perspective. Brain Inj 2022; 36:1158-1166. [PMID: 36047479 DOI: 10.1080/02699052.2022.2109748] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Traumatic brain injury significantly impacts survivors and their families. Rehabilitation following traumatic brain injury is often complex due to the physical, psychological, and socio-economic problems survivors face. Life goals are considered a motivational factor in rehabilitation. OBJECTIVE The aim was to explore expectations, problems, and strategies for goal setting in survivors of traumatic brain injury and their family caregivers for one-year during rehabilitation. METHODS A longitudinal qualitative study using dyadic interviews with survivors and family caregivers was carried out at three time points during the first year following traumatic brain injury. Data was analyzed according to Braun and Clarke's thematic analysis. RESULTS Eight survivors of traumatic brain injury and their family caregivers completed 24 interviews. Three themes and one sub-theme were identified: 1) life goals as a driving force (subtheme: dyadic discrepancies and conflicts); 2) conflicts between specific, measurable, achievable, realistic, and timed (SMART) goals and life goals; and 3) changing perceptions of the impact of impairments. CONCLUSIONS Life goals are important motivation in the rehabilitation process. Health care professionals must integrate life goals and rehabilitation goals (i.e. SMART goals) to decrease barriers and survivor ambivalence about rehabilitation. Involving both survivors and family caregivers in goal setting increases rehabilitation success.
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Affiliation(s)
- Iben Husted Nielsen
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
| | - Ingrid Poulsen
- Department of Brain and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Hvidovre, Denmark.,Department of Nursing and Health Care, Aarhus University, Aarhus C, Denmark
| | - Kristian Larsen
- Department of Public Health, University of Copenhagen, Copenhagen N, Denmark.,Copenhagen University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital - Rigshospitalet, Copenhagen N, Denmark.,Faculty of Health Sciences, Oslo Metropolitan University, Norway
| | - Niels Sandholm Larsen
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
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Lampart P, Schäppi L, Langewitz WA, Rubinelli S, Sigrist-Nix D, Scheel-Sailer A. Health care professionals’ experiences with goal setting during initial rehabilitation after newly acquired spinal cord injury/ disorder – a qualitative focus group study. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:982321. [PMID: 36189066 PMCID: PMC9397958 DOI: 10.3389/fresc.2022.982321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022]
Abstract
IntroductionGoal setting (GS) is an important aspect of initial spinal cord injury/ disorder (SCI/D) rehabilitation. However, because expected outcomes are individual and often difficult to determine, GS is not straightforward. The aim of this study was to explore the health care professionals' (HCP's) experiences with and perspectives on the goal-setting process (GSP) during initial SCI/D rehabilitation.MethodFive semi-structured focus groups (FG) (22 purposively sampled HCP, mostly in leadership positions, six different professions). The FG were transcribed verbatim. We analyzed the transcripts for qualitative content analysis following Braun and Clarke (2013).ResultsHCP described GS-influencing aspects at the macro, meso and micro levels. At the macro level, participants spoke about restrictions imposed by health insurers or difficulties in planning the post-inpatient setting. Regarding the meso level, HCP spoke of institutional structures and culture that facilitated the GSP. At the micro level, knowledge of the diagnosis, expected outcomes, and individual patient characteristics were mentioned as important to the rehabilitation process. It was important for HCP to be patient and empathetic, to endure negative emotions, to accept that patients need time to adjust to their new situation, and to ensure that they do not lose hope. Open communication and interprofessional collaboration helped overcome barriers in the GSP.DiscussionThis paper shows the complex relationship between external (e.g., health insurers), emotional, and communication aspects. It calls for a comprehensive approach to optimizing the GSP, so that patients' experiences can be fully considered as a basis to identify the most appropriate care pathway.
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Affiliation(s)
- Patricia Lampart
- Swiss Paraplegic Center, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Livia Schäppi
- Swiss Paraplegic Center, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Sara Rubinelli
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | | | - Anke Scheel-Sailer
- Swiss Paraplegic Center, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Reasons Affecting the Choice of Patient-Identified Goals Set by Occupational Therapists in Low Vision Rehabilitation. TOPICS IN GERIATRIC REHABILITATION 2022; 38:187-194. [DOI: 10.1097/tgr.0000000000000361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Usage of Mobile Applications or Mobile Health Technology to Improve Diet Quality in Adults. Nutrients 2022; 14:nu14122437. [PMID: 35745167 PMCID: PMC9230785 DOI: 10.3390/nu14122437] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 02/06/2023] Open
Abstract
The use of mobile applications for dietary purposes has dramatically increased along with the consistent development of mobile technology. Assessing diet quality as a dietary pattern or an indicator across key food groups in comparison to those recommended by dietary guidelines is useful for identifying optimal nutrient intake. This systematic review aims to explore mobile applications and their impact on the diet quality of the user. The electronic databases of The Cumulative Index to Nursing and Allied Health Literature (Cinahl), The American Psychological Association’s (APA Psycinfo), and PubMed were systematically searched for randomised and non-randomised controlled trials to retrieve papers from inception to November 2021. Ten studies with 1638 participants were included. A total of 5342 studies were retrieved from the database searches, with 10 articles eligible for final inclusion in the review. The sample sizes ranged from 27 to 732 participants across the included studies, with 1638 total participants. The ratio of female to male participants in the studies was 4:1. The majority of the mobile applications or M-health interventions were used to highlight dietary health changes (six studies), with the remainder used to reduce weight or blood sugar levels (four studies). Each study used a different measure to quantify diet quality. Studies were either assessed by diet quality scoring or individual dietary assessment, of the ten studies, six studies reported an improvement in diet quality following diet-related mobile application use. Mobile applications may be an effective way to improve diet quality in adults; however, there is a need for more targeted and longer-term studies that are expressly designed to investigate the impact using mobile applications has on diet quality.
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Ghaidar D, Sippel A, Riemann-Lorenz K, Kofahl C, Morrison R, Kleiter I, Schmidt S, Dettmers C, Schulz H, Heesen C. Experiences of persons with multiple sclerosis with rehabilitation-a qualitative interview study. BMC Health Serv Res 2022; 22:770. [PMID: 35690766 PMCID: PMC9188711 DOI: 10.1186/s12913-022-08150-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background Managing multiple sclerosis (MS) includes different treatment approaches. Rehabilitation is a key strategy in MS for improving functioning, activity and participation. As part of a larger study on overall patient experiences with different treatment approaches, this study aims to give an overview of different patients’ experiences and perspectives on inpatient rehabilitation in MS. Methods We conducted problem-centered interviews in 50 persons with MS in Germany, of whom most had relapsing–remitting MS. We used the maximum variation sampling method during recruitment. Data were analyzed thematically. Results As a result of the analysis, three major themes were identified: 1) factors contributing to the decision-making concerning rehabilitation, 2) experience with the rehabilitation setting, 3) benefits of rehabilitation treatments. The treating physicians’ attitude had a major impact on the decision to either opt for rehabilitation or not. Setting goals prior to rehabilitation was given a high priority. Exchanging experiences with other persons with MS presented a major benefit from rehabilitation while for some being separated from regular daily life resulted in a more ambiguous attitude ranging from appreciation of escaping daily hassles to substantial behavioral change management. Conclusion Patients reported various experiences in the process of decision-making with regard to rehabilitation. Physicians´ advice, goal setting and the selection of the most suitable rehabilitation clinic were considered most relevant. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08150-8.
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Affiliation(s)
- Donya Ghaidar
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
| | - Anna Sippel
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christopher Kofahl
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Ingo Kleiter
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | | | | | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Enemark Larsen A, Christensen JR, Wehberg S. The responsiveness of the Danish version of the Canadian Occupational Performance Measure. Br J Occup Ther 2022. [DOI: 10.1177/03080226211067422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Introduction To establish the responsiveness of the Danish version of the Canadian Occupational Performance Measure (COPM-DK). Method A cross-sectional study was performed in three Danish settings, including 88 clients, 40 men, aged 16–90 years, with a variety of diagnoses. To determine construct responsiveness, the mean changes of the COPM performance and satisfaction score (COPM-P/S) were compared and correlated with the mean changes in the five-item World Health Organization (WHO) Well-Being Index (WHO-5) and the EuroQol–five domains–five levels questionnaire (EQ-5D-5L). To determine the responsiveness, data were analysed with ROC curves to establish the optimal cut-point values for the COPM-DK scores. Minimal important change (MIC) was assessed in relation to anchor-based questions. Results The mean change for COPM-P/S was 3.1 and 3.0, respectively. Small positive correlations were found between the COPM-DK scores and the WHO-5 and EQ-5D-5L scores. The AUC were 0.76 and 0.75, respectively. The optimal cut-point values for the COPM-P/S-scores based on either all positive answers or to the two highest, were 1.2 or 4.20 (COPM-P) and 1.67 or 5.80 (COPM-S), respectively Conclusions The capability of the COPM to detect changes in perceived occupational performance issues is supported. We recommend an MIC on 3.5 points on both scales.
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Affiliation(s)
- Anette Enemark Larsen
- Occupational Therapy, Department of Therapist and Midwifery, University College Copenhagen Faculty of Health Science, Kobenhavn N, Denmark
| | - Jeanette R Christensen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Syddansk Universitet, Syddanmark, Denmark
| | - Sonja Wehberg
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Syddansk Universitet, Syddanmark, Denmark
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Otaka E, Oguchi K, Kondo I, Otaka Y. Effectiveness of Self-Monitoring Approach Using Fitness Trackers to Improve Walking Ability in Rehabilitation Settings: A Systematic Review. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:752727. [PMID: 36188816 PMCID: PMC9397729 DOI: 10.3389/fresc.2021.752727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/28/2021] [Indexed: 11/29/2022]
Abstract
Background: A self-monitoring approach utilizing fitness trackers that provide feedback regarding physical activities has been recently applied to rehabilitation patients to promote voluntary walking activities. Although this approach has been proven to increase physical activity, it is uncertain whether the intervention improves walking ability. Aim: This review investigated whether the additional self-monitoring approach using activity trackers would improve walking ability in any type of rehabilitation setting. Methods: A systematic search was performed in four databases [PubMed (MEDLINE), The Cochrane Library, SPORTDiscus, and Cumulative Index to Nursing and Allied Health Literature] to identify studies that examined the self-monitoring approach combined with rehabilitative intervention vs. the same rehabilitative intervention only in participants with any unhealthy conditions. Two review authors independently assessed the eligibility of all the retrieved English literature published from 2009 to 2019, then discussed the final inclusion. The risk of bias was assessed referring to the criteria of the Cochrane Risk of Bias tool. The key findings were synthesized using narrative synthesis. In addition, a quantitative synthesis was conducted when more than two studies investigating the same disease were identified. Results: Eleven randomized controlled trials satisfied the eligibility criteria, nine of which had a lower risk of bias. The types of diseases included stroke, chronic obstructive pulmonary disease (COPD), cancer, Parkinson's disease, hemophilia, peripheral artery disease, post-total knee arthroplasty, and geriatric rehabilitation. Eight studies reported measures of walking endurance and four reported measures of gait speed. In the quantitative synthesis of two studies investigating COPD, there was a significant between-group difference in terms of changes in the 6-min walking distance from the baseline, which was favorable to the additional self-monitoring intervention group (mean difference: 13.1 m; 95% confidence interval, 1.8-24.5; 2 studies, 124 participants; p = 0.02; I 2 = 0%). Other available data revealed no consistent evidence regarding effectiveness of the intervention. Conclusions: The findings indicate that there is little evidence suggesting the effectiveness of the self-monitoring approach in improving walking ability in rehabilitation settings. However, a weak recommendation for patients with stable COPD was implicated in the quantitative synthesis. Further research would be required to explore the best indications for this self-monitoring approach. Systematic Review Registration: CRD 42020157695.
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Affiliation(s)
- Eri Otaka
- Assistive Robot Center, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Rehabilitation Medicine, Kariya Toyota General Hospital, Kariya, Japan
| | - Kazuyo Oguchi
- Department of Rehabilitation Medicine, Kariya Toyota General Hospital, Kariya, Japan
| | - Izumi Kondo
- Assistive Robot Center, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
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Littooij E, Doodeman S, Holla J, Ouwerkerk M, Post L, Satink T, Ter Steeg AM, Vloothuis J, Dekker J, de Groot V. Setting meaningful goals in rehabilitation: A qualitative study on the experiences of clients and clinicians in working with a practical tool. Clin Rehabil 2021; 36:415-428. [PMID: 34730459 PMCID: PMC8850761 DOI: 10.1177/02692155211046463] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To evaluate the experience of clients and clinicians in working with a tool
to help set goals that are personally meaningful to rehabilitation
clients. Design We have applied the tool in the outpatient rehabilitation setting. Clients’
and clinicians’ experiences in working with the tool were evaluated in
individual, semi-structured interviews and focus group interviews,
respectively. Thematic analysis was used to analyze the data. Setting A university medical center and a rehabilitation center. Subjects Clients with a first-time stroke (n = 8) or multiple
sclerosis (n = 10), and clinicians
(n = 38). Intervention The tool to help set meaningful goals consisted of a session (i) to explore
the client's fundamental beliefs, goals and attitudes and (ii) to identify a
meaningful overall rehabilitation goal. The results of that session were
used by the multidisciplinary rehabilitation team (iii) to help the client
to set specific rehabilitation goals that served to achieve the meaningful
overall rehabilitation goal. Results Both clients and clinicians reported that the tool helped to set a meaningful
overall rehabilitation goal and specific goals that became meaningful as
they served to achieve the overall goal. This contributed to clients’
intrinsic rehabilitation motivation. In some clients, the meaningfulness of
the rehabilitation goals facilitated the process of behavior change. Both
clients and clinicians made suggestions on how the tool could be further
improved. Conclusion In the opinion of both clients and clinicians, the tool does indeed result in
goal setting that is personally meaningful. Further development,
implementation and evaluation of the tool is warranted.
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Affiliation(s)
- Elsbeth Littooij
- Amsterdam Rehabilitation Research Center, Reade, the Netherlands
| | - Suzan Doodeman
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, the Netherlands
| | - Jasmijn Holla
- Amsterdam Rehabilitation Research Center, Reade, the Netherlands
| | - Maaike Ouwerkerk
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, the Netherlands.,Nieuw Unicum, the Netherlands
| | - Lenneke Post
- Department of Spiritual Care, Amsterdam University Medical Centers, the Netherlands.,Faculty of Religion and Theology, VU University, the Netherlands
| | - Ton Satink
- Department of Occupational Therapy & Research Group Neurorehabilitation, HAN University of Applied Sciences, the Netherlands
| | | | - Judith Vloothuis
- Amsterdam Rehabilitation Research Center, Reade, the Netherlands
| | - Joost Dekker
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, the Netherlands
| | - Vincent de Groot
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, the Netherlands
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Enthoven P, Eddeborn F, Abbott A, Schröder K, Fors M, Öberg B. Patients' experiences of the BetterBack model of care for low back pain in primary care - a qualitative interview study. Int J Qual Stud Health Well-being 2021; 16:1861719. [PMID: 33393455 PMCID: PMC7782354 DOI: 10.1080/17482631.2020.1861719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose: The aim of this study was to describe patient experiences of received primary care for low back pain (LBP) according to the BetterBack Model of Care (MoC) with a focus on illness beliefs and self-management enablement. Methods: Individual interviews were conducted with 15 adults 4–14 months after receiving treatment according to the BetterBack MoC for LBP in primary care in Sweden. Data were analysed using content analysis. Results: When analysing the data, the following theme emerged; “Participant understanding of their treatment for low back pain and self-management strategies—a matter of support systems”, comprising the following categories: “Knowledge translation”, “Interaction and dialogue”, “The health care professional support” and “Form organization”. Participants experienced that they had better knowledge about their LBP and received tools to better manage their health condition. The participants expressed good communication with the treating physiotherapist and provided suggestions to further improve the treatment of LBP. Conclusions: Participants experienced that they had gained new knowledge about their health problems and after the treatment they had the tools to handle their back problems. This suggests that the BetterBack MoC may be used as a basis for a support system to provide valuable tools for self-management for patients with low back pain.
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Affiliation(s)
- Paul Enthoven
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University , Linköping, Sweden
| | - Fredrik Eddeborn
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University , Linköping, Sweden.,Rehab West, Region Östergötland, and Department of Health, Medicine and Caring Sciences, Linköping University , Linköping, Sweden
| | - Allan Abbott
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University , Linköping, Sweden
| | - Karin Schröder
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University , Linköping, Sweden
| | - Maria Fors
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University , Linköping, Sweden.,Department of Activity and Health, and Department of Health, Medicine and Caring Sciences, Linköping University , Linköping, Sweden
| | - Birgitta Öberg
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University , Linköping, Sweden
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Te Ao B, Harwood M, Fu V, Weatherall M, McPherson K, Taylor WJ, McRae A, Thomson T, Gommans J, Green G, Ranta A, Hanger C, Riley J, McNaughton H. Economic analysis of the 'Take Charge' intervention for people following stroke: Results from a randomised trial. Clin Rehabil 2021; 36:240-250. [PMID: 34414801 DOI: 10.1177/02692155211040727] [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: 11/17/2022]
Abstract
OBJECTIVE To undertake an economic analysis of the Take Charge intervention as part of the Taking Charge after Stroke (TaCAS) study. DESIGN An open, parallel-group, randomised trial comparing active and control interventions with blinded outcome assessment. SETTING Community. PARTICIPANTS Adults (n = 400) discharged to community, non-institutional living following acute stroke. INTERVENTIONS The Take Charge intervention, a strengths based, self-directed rehabilitation intervention, in two doses (one or two sessions), and a control intervention (no Take Charge sessions). MEASURES The cost per quality-adjusted life year (QALY) saved for the period between randomisation (always post hospital discharge) and 12 months following acute stroke. QALYs were calculated from the EuroQol-5D-5L. Costs of stroke-related and non-health care were obtained by questionnaire, hospital records and the New Zealand Ministry of Health. RESULTS One-year post hospital discharge cost of care was mean (95% CI) $US4706 (3758-6014) for the Take Charge intervention group and $6118 (4350-8005) for control, mean (95% CI) difference $ -1412 (-3553 to +729). Health utility scores were mean (95% CI) 0.75 (0.73-0.77) for Take Charge and 0.71 (0.67-0.75) for control, mean (95% CI) difference 0.04 (0.0-0.08). Cost per QALY gained for the Take Charge intervention was $US -35,296 (=£ -25,524, € -30,019). Sensitivity analyses confirm Take Charge is cost-effective, even at a very low willingness-to-pay threshold. With a threshold of $US5000 per QALY, the probability that Take Charge is cost-effective is 99%. CONCLUSION Take Charge is cost-effective and probably cost saving.
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Affiliation(s)
| | | | - Vivian Fu
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | | | | | - Anna McRae
- Auckland District Health Board, Auckland, New Zealand
| | - Tom Thomson
- Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - John Gommans
- Hawkes Bay District Health Board, Hastings, New Zealand
| | - Geoff Green
- Counties-Manukau District Health Board, Auckland, New Zealand
| | | | - Carl Hanger
- Canterbury District Health Board, Christchurch, New Zealand
| | - Judith Riley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Harry McNaughton
- Medical Research Institute of New Zealand, Wellington, New Zealand
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Preede L, Soberg HL, Dalen H, Nyquist A, Jahnsen R, Saebu M, Bautz-Holter E, Røe C. Rehabilitation Goals and Effects of Goal Achievement on Outcome Following an Adapted Physical Activity-Based Rehabilitation Intervention. Patient Prefer Adherence 2021; 15:1545-1555. [PMID: 34276210 PMCID: PMC8277449 DOI: 10.2147/ppa.s311966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/23/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To explore the goal-setting process carried out at a rehabilitation facility providing adapted physical activity, by 1) identifying goals set by individuals with chronic disabilities, 2) comparing these goals to the negotiated goals set in collaboration with the rehabilitation team and 3) assessing goal achievement and its association with self-reported functioning after 12 months. METHODS A prospective observational study where adults (18-67 years) admitted to Beitostølen Healthsports Centre (n=151) reported mental and physical functioning measured by the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) administered at baseline (eight weeks before rehabilitation), admission, discharge and follow-up 12 months after rehabilitation. The participants provided their individual goals for rehabilitation in the admission questionnaire. Individual goals were compared to negotiated goals set by the participants and the rehabilitation team together as part of the goal-setting process at the facility. The goals were linked to The International Classification of Functioning, Disability and Health (ICF) for comparison. Goal achievement was assessed on a 10-point numeric rating scale (NRS) in the discharge questionnaire. The association between SF-12 physical and mental functioning at long-term follow-up and goal achievement was explored. RESULTS The 293 individual goals and the 407 negotiated goals were most frequently linked to the ICF-component Body Functions. When comparing negotiated to individual goals, negotiated goals were more frequently linked to activities and participation. Goals to wide to be linked to the ICF were less frequent. For 76% of the participants, content of individual goals was captured in negotiated goals. Goal achievement with NRS scores ≥9 points was reported by 66% of the included participants. Goal achievement was a significant predictor for long-term mental functioning (p=0.04). CONCLUSION Collaboration between participants and health professionals resulted in more specific goals directed towards the activities and participation component. Goal achievement predicted long-term mental functioning following rehabilitation.
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Affiliation(s)
- Line Preede
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Beitostølen Healthsports Centre, Beitostølen, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Helene L Soberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Håkon Dalen
- Beitostølen Healthsports Centre, Beitostølen, Norway
| | | | - Reidun Jahnsen
- Beitostølen Healthsports Centre, Beitostølen, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Martin Saebu
- Beitostølen Healthsports Centre, Beitostølen, Norway
| | - Erik Bautz-Holter
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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41
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Stewart V, McMillan SS, Roennfeldt H, El-Den S, Ng R, Wheeler AJ. Exploring goal planning in mental health service delivery: a systematic review protocol. BMJ Open 2021; 11:e047240. [PMID: 34059514 PMCID: PMC8169485 DOI: 10.1136/bmjopen-2020-047240] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Goal planning is widely recognised as an integral part of mental health service delivery and an important element in supporting recovery. Goal planning identifies priorities for treatment through discussion and negotiation between service users and health practitioners. Goal planning enhances motivation, directs effort, and focuses the development of strategies and treatment options to improve recovery outcomes and promote service users' ownership of the recovery process. While goal planning is a common practice in mental health settings, evidence regarding its impact on treatment outcomes is lacking. This paper outlines a protocol for a systematic review that aims to explore the types of goals planned, experiences of service users and practitioners, and the effectiveness of goal planning as a mental health intervention. METHODS AND ANALYSIS A systematic search will be conducted during March 2021 by searching Medline, CINAHL, Embase, Scopus and PsycINFO electronic databases to answer the following questions: (1) What types of goals are being developed within mental healthcare?; (2) What is the evidence for the effectiveness of goal planning on health and well-being for mental health service users?; (3) What are the experiences of mental health service users and their treating healthcare practitioners in relation to goal planning?; and (4) What are the barriers and facilitators to effective goal planning in mental health settings? Two independent researchers will screen the articles, selecting literature that meets criteria. All literature, regardless of study design that involves adult participants, with a mental illness and reporting on goal planning will be considered for inclusion. Data will be extracted from all eligible articles regardless of study design and summarised in a table. Appropriate quality assessment and data synthesis methods will be determined based on included study designs. ETHICS AND DISSEMINATION No ethics approval is required. The results will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42020220595.
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Affiliation(s)
- Victoria Stewart
- School of Human Services and Social Work, Griffith University, Meadowbrook, Queensland, Australia
- Menzies Health Institute, Griffith University, Nathan, Queensland, Australia
| | - Sara Sinclair McMillan
- School of Pharmacy and Pharmacology, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
| | - Helena Roennfeldt
- Menzies Health Institute, Griffith University, Nathan, Queensland, Australia
- Centre for Psychiatric Nursing, The University of Melbourne, Carlton, Victoria, Australia
| | - Sarira El-Den
- Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Ricki Ng
- Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Amanda J Wheeler
- Menzies Health Institute, Griffith University, Nathan, Queensland, Australia
- Faculty of Health and Medical Sciences, The University of Auckland, Auckland, New Zealand
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Chen S, Wang J, Zhu J, Chung RYN, Dong D. Quality of life and its contributors among adults with late-onset Pompe disease in China. Orphanet J Rare Dis 2021; 16:199. [PMID: 33933104 PMCID: PMC8088713 DOI: 10.1186/s13023-021-01836-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/20/2021] [Indexed: 01/04/2023] Open
Abstract
Background Pompe disease (PD) is a rare inherited disorder caused by the deficiency of acid-α glucosidase, which leads to the impairment of organ and tissue functions and causes disabilities. As the first national survey on patients with late-onset PD (LOPD) in China, this study investigated the quality of life (QOL) of adult patients with LOPD in China and explored its contributors. Methods Data were derived from a nation-based, cross-sectional, self-response survey on rare diseases (RDs) in early 2018. Answers from 68 adult Chinese patients with LOPD were used for data analysis. QOL was measured using the World Health Organization Quality of Life: Brief Version. Covariates included age, gender, education, employment, reliance on assistive devices, medication history, social support, and disease economic burden. Data were analyzed using linear regression in R. Results For adult patients with LOPD, the average scores and standard deviations (SD) of the four dimensions of QOL were physical health = 33.77 (SD = 18.28), psychological health = 43.81 (SD = 21.70), environmental health = 39.43 (SD = 16.93), and social relationship = 46.20 (SD = 19.76); the scoring for each dimension was evaluated on a scale of 0 to 100. At the significance level of p < 0.05, with increasing age, the patients experienced a significant decrease in physical health QOL (β = − 0.75) and environmental health QOL (β = − 0.79). Those who relied heavily on assistive devices had lower perceived physical health (β = − 17.8), psychological health (β = − 22.76), environmental health (β = − 17.8), and social relationships (β = − 22.12) than those who did not. A one-unit increase in the amount of social support, as a form of social interaction, led to a significant increase in physical health (β = 0.28), psychological health (β = 0.71), environmental health (β = 0.72), and social relationships (β = 0.70). Conclusion Adult Chinese patients with LOPD had a lower physical health and QOL compared to their counterparts with other RDs. Being employed was found to affect the QOL of adult Chinese patients with LOPD in almost all dimensions. Encouraging adult Chinese patients with LOPD to be socially active and help them become more involved in social life might improve their QOL.
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Affiliation(s)
- Shanquan Chen
- The School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Jingxuan Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, 4/F School of Public Health, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jianfeng Zhu
- School of Social Development and Public Policy, Fudan University, Shanghai, China
| | - Roger Yat-Nork Chung
- JC School of Public Health and Primary Care, Faculty of Medicine, 4/F School of Public Health, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.,CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dong Dong
- JC School of Public Health and Primary Care, Faculty of Medicine, 4/F School of Public Health, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China. .,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, Guangdong, China.
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43
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Chen P, Zanca J, Esposito E, Barrett AM. Barriers and Facilitators to Rehabilitation Care of Individuals With Spatial Neglect: A Qualitative Study of Professional Views. Arch Rehabil Res Clin Transl 2021; 3:100122. [PMID: 34179758 PMCID: PMC8212009 DOI: 10.1016/j.arrct.2021.100122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To identify barriers and facilitators to achieving optimal inpatient rehabilitation outcome among individuals with spatial neglect (SN). Design Cross-sectional, semistructured focus group discussions. Setting Rehabilitation hospitals. Participants A total of 15 occupational therapists and 14 physical therapists treating patients with SN on 3 campuses of a rehabilitation hospital system (N=29). Six focus group sessions were conducted and audio-recorded for transcription. Interventions Not applicable. Main Outcome Measures Not applicable. Results Participants identified several patient-related characteristics that posed barriers to treatment, including the symptoms of SN itself, cognitive issues, physical weakness, comorbidities, and reduced therapy engagement. Supportive family members were considered a key facilitator, but lack of preparedness to assume caregiving roles, poor understanding of SN and rehabilitation goals, and inadequate levels of involvement were family-related barriers to successful treatment. Participants expressed that having resources and technologies available at their center to support SN treatment facilitated positive outcomes and perceived limited staff knowledge and skills and poor interclinician communication as barriers to treatment. At the health care system level, barriers included a lack of responsive measures of SN progress and insurer-related issues. Strong continuity of care between transitions was considered an important factor for enabling effective treatment. Conclusions Barriers and facilitators to the current practice of SN care were identified from occupational and physical therapists’ point of view. Opportunities exist to promote identified facilitators and minimize barriers to improve SN rehabilitation. The present study makes a unique contribution in identifying specific needs for innovative interventions that involve family support and training, promotion of interdisciplinary collaboration, development of interprofessional vocabulary, and continuous treatment and follow-up assessment for SN through care transitions.
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Affiliation(s)
- Peii Chen
- Kessler Foundation, West Orange, New Jersey, United States.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, New Jersey, United States
| | - Jeanne Zanca
- Kessler Foundation, West Orange, New Jersey, United States.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, New Jersey, United States
| | - Emily Esposito
- Department of Psychology, University of California, Riverside, California, United States
| | - A M Barrett
- Department of Neurology, Emory University, Atlanta, Georgia, United States.,Atlanta VA Health Care System, U.S. Department of Veterans Affairs, Decatur, Georgia, United States
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Scholten I, Barradell S, Bickford J, Moran M. Twelve tips for teaching the International Classification of Functioning, Disability and Health with a view to enhancing a biopsychosocial approach to care. MEDICAL TEACHER 2021; 43:293-299. [PMID: 32645280 DOI: 10.1080/0142159x.2020.1789082] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The World Health Organization International Classification of Functioning, Disability and Health has the power to shape professional behaviour and positively influence all aspects of health and social care practice. The visual depiction of the ICF framework belies the complexity of this multifaceted classification and coding system which students and practitioners can find challenging to grasp. This guide offers twelve integrated practical tips to help health and social care educators embed the ICF throughout the curriculum with a view to supporting student learning and ultimately interprofessional and inclusive practice.
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Affiliation(s)
| | - Sarah Barradell
- Department of Health Professions, Swinburne University of Technology, Hawthorn, Australia
| | - Jane Bickford
- Speech Pathology, Flinders University, Adelaide, Australia
| | - Monica Moran
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Australia
- Occupational Therapy, Central Queensland University, Rockhampton, Australia
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45
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McNaughton H, Weatherall M, McPherson K, Fu V, Taylor WJ, McRae A, Thomson T, Gommans J, Green G, Harwood M, Ranta A, Hanger C, Riley J. The effect of the Take Charge intervention on mood, motivation, activation and risk factor management: Analysis of secondary data from the Taking Charge after Stroke (TaCAS) trial. Clin Rehabil 2021; 35:1021-1031. [PMID: 33586474 DOI: 10.1177/0269215521993648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To use secondary data from the Taking Charge after Stroke study to explore mechanisms for the positive effect of the Take Charge intervention on physical health, advanced activities of daily living and independence for people after acute stroke. DESIGN An open, parallel-group, randomised trial with two active and one control intervention and blinded outcome assessment. SETTING Community. PARTICIPANTS Adults (n = 400) discharged to community, non-institutional living following acute stroke. INTERVENTIONS One, two, or zero sessions of the Take Charge intervention, a self-directed rehabilitation intervention which helps a person with stroke take charge of their own recovery. MEASURES Twelve months after stroke: Mood (Patient Health Questionnaire-2, Mental Component Summary of the Short Form 36); 'ability to Take Charge' using a novel measure, the Autonomy-Mastery-Purpose-Connectedness (AMP-C) score; activation (Patient Activation Measure); body mass index (BMI), blood pressure (BP) and medication adherence (Medication Adherence Questionnaire). RESULTS Follow-up was near-complete (388/390 (99.5%)) of survivors at 12 months. Mean age (SD) was 72.0 (12.5) years. There were no significant differences in mood, activation, 'ability to Take Charge', medication adherence, BMI or BP by randomised group at 12 months. There was a significant positive association between baseline AMP-C scores and 12-month outcome for control participants (1.73 (95%CI 0.90 to 2.56)) but not for the Take Charge groups combined (0.34 (95%CI -0.17 to 0.85)). CONCLUSION The mechanism by which Take Charge is effective remains uncertain. However, our findings support a hypothesis that baseline variability in motivation, mastery and connectedness may be modified by the Take Charge intervention.
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Affiliation(s)
- Harry McNaughton
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Mark Weatherall
- Department of Medicine, University of Otago, Wellington, New Zealand
| | | | - Vivian Fu
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - William J Taylor
- Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand
| | - Anna McRae
- Auckland District Health Board, Auckland, New Zealand
| | - Tom Thomson
- Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - John Gommans
- Hawkes Bay District Health Board, Hastings, New Zealand
| | - Geoff Green
- Counties-Manukau District Health Board, Auckland, New Zealand
| | - Matire Harwood
- Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand
| | - Annemarei Ranta
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Carl Hanger
- Canterbury District Health Board, Christchurch, New Zealand
| | - Judith Riley
- Medical Research Institute of New Zealand, Wellington, New Zealand
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46
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Toro J, Martiny K. New perspectives on person-centered care: an affordance-based account. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:631-644. [PMID: 32886295 DOI: 10.1007/s11019-020-09977-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 06/11/2023]
Abstract
Despite the growing interest and supporting evidence for person-centered care (PCC), there is still a fundamental disagreement about what makes healthcare person-centered. In this article, we define PCC as operating with three fundamental conditions: personal, participatory and holistic. To further understand these concepts, we develop a framework based on the theory of affordances, which we apply to the healthcare case of rehabilitation and a concrete experiment on social interactions between persons with cerebral palsy and physio- and occupational therapists. Based on the application of the theory, we argue that in order for healthcare to be considered as PCC, professionals need to adopt a personalistic attitude in their care, defined (at the how-level) in terms of mutual affordances: how the professional and the person of care acknowledges each other as a person in an interaction. In opposition, we define (at the what level) the functionalistic attitude in terms of object affordances, those related to a concrete goal. We show that PCC requires a balance of personalistic and functionalistic attitudes, since this contributes to a participatory and holistic conception of, and interaction with, the person of care.
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Affiliation(s)
- Juan Toro
- Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark.
- The Enactlab, Copenhagen, Denmark.
| | - Kristian Martiny
- Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
- The Enactlab, Copenhagen, Denmark
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