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Ouédraogo F, Auger LP, Moreau E, Côté O, Guerrera R, Rochette A, Kairy D. Acceptability of Telerehabilitation: Experiences and Perceptions by Individuals with Stroke and Caregivers in an Early Supported Discharge Program. Healthcare (Basel) 2024; 12:365. [PMID: 38338250 PMCID: PMC10855122 DOI: 10.3390/healthcare12030365] [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: 11/01/2023] [Revised: 12/25/2023] [Accepted: 12/28/2023] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Telerehabilitation (TR) is a promising method for facilitating the delivery and access to post-stroke rehabilitation services. OBJECTIVE The aim of this study was to explore the acceptability of TR and factors influencing its adoption by individuals with stroke and caregivers. METHODS A qualitative descriptive approach was used. Six individuals with stroke and three caregivers participated in individual online interviews. An abductive thematic analysis was employed to analyze the qualitative data, using the Unified Theory of Acceptance and Use of Technology 2 (UTAUT-2) model. RESULTS Participants reported positive experiences with TR, resulting in improvements in functional abilities, such as manual dexterity, balance, and positive interactions with therapists. They found the technology easy to learn and use, facilitating engagement in TR. Participants' prior experiences with technology, along with support from caregivers and therapists, facilitated acceptance and the use of TR. The COVID-19 pandemic also motivated participants to accept TR. However, technical issues, unstable internet connections, and lack of feedback were barriers to the use of TR. CONCLUSION Despite existing obstacles, TR can be used to provide rehabilitation services for individuals with stroke. Addressing these barriers is necessary to promote the widespread and effective use of TR in the context of stroke recovery.
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Affiliation(s)
- Fatimata Ouédraogo
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC H3N 1X7, Canada; (A.R.); (D.K.)
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, QC H3S 1M9, Canada;
| | - Louis-Pierre Auger
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, QC H3S 1M9, Canada;
- Institute of Health Sciences Education, Faculty of Medicine, McGill University, Montréal, QC H3G 1A1, Canada
| | - Emmanuelle Moreau
- Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Centre Intégré Universitaire de Santé et Services Sociaux (CIUSSS) du Centre-Sud-de-l’Île-de-Montréal, Montréal, QC H3S 2J4, Canada; (E.M.); (O.C.); (R.G.)
| | - Odile Côté
- Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Centre Intégré Universitaire de Santé et Services Sociaux (CIUSSS) du Centre-Sud-de-l’Île-de-Montréal, Montréal, QC H3S 2J4, Canada; (E.M.); (O.C.); (R.G.)
| | - Rosalba Guerrera
- Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Centre Intégré Universitaire de Santé et Services Sociaux (CIUSSS) du Centre-Sud-de-l’Île-de-Montréal, Montréal, QC H3S 2J4, Canada; (E.M.); (O.C.); (R.G.)
| | - Annie Rochette
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC H3N 1X7, Canada; (A.R.); (D.K.)
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, QC H3S 1M9, Canada;
- Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Centre Intégré Universitaire de Santé et Services Sociaux (CIUSSS) du Centre-Sud-de-l’Île-de-Montréal, Montréal, QC H3S 2J4, Canada; (E.M.); (O.C.); (R.G.)
| | - Dahlia Kairy
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC H3N 1X7, Canada; (A.R.); (D.K.)
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, QC H3S 1M9, Canada;
- Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Centre Intégré Universitaire de Santé et Services Sociaux (CIUSSS) du Centre-Sud-de-l’Île-de-Montréal, Montréal, QC H3S 2J4, Canada; (E.M.); (O.C.); (R.G.)
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Stonner MM, Skladman R, Bettlach CLR, Kennedy C, Mackinnon SE. Recruiting hand therapists improves disposal of unused opioid medication. J Hand Ther 2023; 36:507-513. [PMID: 35909068 DOI: 10.1016/j.jht.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 03/18/2022] [Accepted: 06/08/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Opioids often remain unused after upper extremity surgery, and leftover prescriptions are frequently diverted. When administered in a hand surgery clinic, an educational brochure outlining a simple method of opioid disposal has been shown to improve disposal rates after surgery. PURPOSE To understand whether administration of an opioid disposal educational brochure in a hand therapy clinic would increase opioid disposal rates, compared to a hand surgery clinic. STUDY DESIGN Prospective cohort study. METHODS Patients who presented to a hand therapy clinic postoperatively were recruited to participate in this prospective cohort study. An educational brochure outlining a simple method of opioid disposal was made available at the hand therapy and surgery clinics. A questionnaire was later issued to obtain: location of brochure receipt, demographic information, pre- and post-operative opioid use history, and opioid disposal patterns. Chi-square tests and multivariable binary logistic regression assessed associations between medication disposal and explanatory variables. RESULTS Patients who received the brochure were significantly more likely to dispose of excess opioid medication, compared to those who did not receive the brochure (57.1% vs 10.8%, p < .001). Patients who received the brochure at the hand therapy clinic were significantly more likely to dispose of excess opioids (86.4%) compared to those who received the brochure at the surgery clinic (25.0%). Older age was predictive of increased disposal (p =.028*). There were no significant associations between gender, length of follow-up, or surgery type with the incidence of opioid disposal. CONCLUSION Recruiting both hand therapists and surgeons in the distribution of a simple, educational brochure on opioid disposal can increase disposal rates. Patients who received the brochure from the hand therapist were more likely to dispose of excess opioids. The longstanding patient-therapist relationship creates an opportunity for educational initiatives and discussion of stigmatized topics, such as opioid use.
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Affiliation(s)
- Macyn M Stonner
- Program in Occupational Therapy, Milliken Hand Rehabilitation Center, Washington University School of Medicine, St. Louis, MO, USA.
| | - Rachel Skladman
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Carrie L Roth Bettlach
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Carie Kennedy
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Susan E Mackinnon
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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Kfrerer ML, Rudman DL, Aitken Schermer J, Wedlake M, Murphy M, Marshall CA. Humor in rehabilitation professions: a scoping review. Disabil Rehabil 2023; 45:911-926. [PMID: 35282727 DOI: 10.1080/09638288.2022.2048909] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Studying humor in the rehabilitation professions is important given its positive effects on health and well-being. We conducted a scoping review to understand how the use of humor has been explored in the existing literature in four rehabilitation professions. The rehabilitation professions included audiology, speech-language pathology, physical therapy, and occupational therapy. MATERIALS AND METHODS The five-stage method identified by Arksey and O'Malley was used to conduct this review. Six databases were searched. We included 57 articles in our final review, summarized in a narrative synthesis. RESULTS We generated seven themes in our analysis: (1) humour as a management strategy in therapy; (2) humour as a power establisher vs. equalizer; (3) humour as a coping mechanism in rehabilitation; (4) conceptualizations of non-verbal humor cues in therapy; (5) Is humour trainable? (6) Humor used to foster group cohesion; and (7) Attitudes and beliefs surrounding humor practice. CONCLUSIONS Our findings emphasize the importance of using humor in the rehabilitation professions, and the ways in which humor is conceptualized in a multitude of ways for both clinician and client. Future work is needed to further understand the presence and use of humor in rehabilitation professions.IMPLICATIONS FOR REHABILITATIONIn a scoping review of the literature, this study showed that humor was used mainly positively in rehabilitation by the included professions of audiology, speech-language pathology, physical therapy, and occupational therapy and contributed to a sense of belonging.Humor may be an effective way to improve management of client/clinician relations as well as improving group cohesion in rehabilitation settings.In the rehabilitation professions of audiology, speech-language pathology, physical therapy, and occupational therapy, non-verbal humor cues were used in instances where communication was difficult or impaired for clients.
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Affiliation(s)
- Marisa L Kfrerer
- Health & Rehabilitation Sciences, University of Western Ontario, London, Canada
| | - Debbie Laliberte Rudman
- School of Occupational Therapy & Graduate Program in Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Western Ontario, London, Canada
| | - Julie Aitken Schermer
- Management and Organizational Studies, Faculty of Social Science, University of Western Ontario, London, Canada
| | - Marnie Wedlake
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, Canada
| | - Michelle Murphy
- School of Occupational Therapy, University of Western Ontario, London, Canada
| | - Carrie Anne Marshall
- School of Occupational Therapy & Graduate Program in Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Western Ontario, London, Canada
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Loomis KJ, Roll SC, Hardison ME. The role of therapist-patient relationships in facilitating engagement and adherence in upper extremity rehabilitation. Work 2023; 76:1083-1098. [PMID: 37248936 DOI: 10.3233/wor-220384] [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] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Active patient engagement and adherence are essential for successful rehabilitation outcomes, particularly in complex cases such as work-related musculoskeletal injuries. Although the therapist-patient relationship is a significant component of successful care coordination, there has been limited examination of this relationship within upper extremity musculoskeletal rehabilitation. OBJECTIVE To explore therapists' perspectives on how the therapist-patient relationship intersects with engagement and adherence in the provision of holistic and collaborative rehabilitation services. METHODS Data were collected from four therapists over three months. Descriptive statistics were generated from the Sport Injury Rehabilitation Adherence Scale (SIRAS) and the Rehabilitation Therapy Engagement Scale (RTES) completed by therapists following visits from a sub-sample of patients (n = 14). Weekly semi-structured group interviews (n = 13) were analyzed using an iterative grounded theory-informed process. Emerging themes were identified, refined, and situated within the context of quantitative results. RESULTS SIRAS scores averaged 14.4 (SD: 1.0) and RTES scores averaged 42.5 (SD: 3.5), indicating high perceived patient engagement and adherence. Four themes emerged from therapist interviews: (1) dynamic power; (2) co-constructed engagement; (3) emotional states; (4) complementary therapy contexts. CONCLUSION In this engaged and adherent setting, therapist-patient relationships were complex and intimate, and extended beyond education and physical interventions. Careful management of this relationship was central to active patient participation and engagement. Incorporating holistic techniques may provide more structure for managing and communicating these aspects of care. These findings provide a preliminary understanding of the impact of therapeutic relationships on engagement and collaborative care.
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Affiliation(s)
- Katherine J Loomis
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Shawn C Roll
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Mark E Hardison
- Occupational Therapy Graduate Program, School of Medicine, University of New Mexico, Albuquerque, NM, USA
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Hutting N, Caneiro JP, Ong'wen OM, Miciak M, Roberts L. Person-centered care for musculoskeletal pain: Putting principles into practice. Musculoskelet Sci Pract 2022; 62:102663. [PMID: 36113362 DOI: 10.1016/j.msksp.2022.102663] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 12/14/2022]
Abstract
Person-centered care specifically focuses on the whole person and is an important component of contemporary care for people with musculoskeletal pain conditions. Evidence suggests however, that some clinicians experience difficulties with integrating person-centered care principles into their clinical practice. Therefore, the purpose of this masterclass is to provide a framework that enables clinicians to incorporate person-centered principles in their management of people with musculoskeletal pain conditions. To support clinicians in overcoming some of the reported obstacles, we provide practical recommendations aimed at putting principles of person-centered care into practice. The framework supporting clinicians' delivery of person-centered care in practice consists of three key-principles: A) a biopsychosocial understanding of the person's experience; B) person-focused communication; and C) supported self-management. The framework includes three phases: 1) identification and goal setting, 2) coaching to self-management, and 3) evaluation. Building a therapeutic relationship underpins these phases and is an overarching element that weaves through the key-principles and phases of the framework. We use a clinical case to illustrate the practical implementation of these recommendations.
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Affiliation(s)
- Nathan Hutting
- Department of Occupation and Health, School of Organisation and Development, HAN University of Applied Sciences, Nijmegen, the Netherlands.
| | - J P Caneiro
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | | | - Maxi Miciak
- University of Alberta, Faculty of Rehabilitation Medicine, Edmonton, Canada
| | - Lisa Roberts
- University of Southampton, School of Health Sciences, Southampton, United Kingdom; University Hospital Southampton NHS Foundation Trust, Therapy Services, Southampton, United Kingdom
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Gilbert AW, May CR, Brown H, Stokes M, Jones J. A qualitative investigation into the results of a discrete choice experiment and the impact of COVID-19 on patient preferences for virtual consultations. Arch Physiother 2021; 11:20. [PMID: 34488898 PMCID: PMC8419808 DOI: 10.1186/s40945-021-00115-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/21/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To conduct a qualitative investigation on a subset of participants from a previously completed Discrete Choice Experiment (DCE) to understand why factors identified from the DCE are important, how they influenced preference for virtual consultations (VC) and how COVID-19 has influenced preference for VC. METHODS A quota sample was recruited from participants who participated in our DCE. We specifically targeted participants who were strongly in favour of face-to-face consultations (F2F - defined as choosing all or mostly F2F in the DCE) or strongly in favour of virtual consultations (VC - defined as choosing all or mostly VC consultations in the DCE) to elicit a range of views. Interviews were conducted via telephone or videoconference, audio recorded, transcribed verbatim and uploaded into NVIVO software. A directed content analysis of transcripts was undertaken in accordance with a coding framework based on the results of the DCE and the impact of COVID-19 on preference. RESULTS Eight F2F and 5 VC participants were included. Shorter appointments were less 'worth' travelling in for than a longer appointment and rush hour travel had an effect on whether travelling was acceptable, particularly when patients experienced pain as a result of extended journeys. Socioeconomic factors such as cost of travel, paid time off work, access to equipment and support in its use was important. Physical examinations were preferable in the clinic whereas talking therapies were acceptable over VC. Several participants commented on how VC interferes with the patient-clinician relationship. VC during COVID-19 has provided patients with the opportunity to access their care virtually without the need for travel. For some, this was extremely positive. CONCLUSIONS This study investigated the results of a previously completed DCE and the impact of COVID-19 on patient preferences for VC. Theoretically informative insights were gained to explain the results of the DCE. The use of VC during the COVID-19 pandemic provided opportunities to access care without the need for face-to-face social interactions. Many felt that VC would become more commonplace after the pandemic, whereas others were keen to return to F2F consultations as much as possible. This qualitative study provides additional context to the results of a previously completed DCE.
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Affiliation(s)
- Anthony W Gilbert
- Therapies Department, Royal National Orthopaedic Hospital, Stanmore, UK.
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
- NIHR Applied Research Collaboration, North Thames, London, UK.
| | - Carl R May
- NIHR Applied Research Collaboration, North Thames, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Hazel Brown
- Therapies Department, Royal National Orthopaedic Hospital, Stanmore, UK
- Centre for Nerve Engineering, UCL, London, UK
| | - Maria Stokes
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- NIHR Applied Research Collaboration, Wessex, UK
- Southampton NIHR Biomedical Research Centre, Southampton, UK
| | - Jeremy Jones
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
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The Efficacy of Tele-Rehabilitation Program for Improving Upper Limb Function among Adults Following Elbow Fractures: A Pilot Study. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11041708] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Active mobilization post-elbow fractures reduces the incidence of complications. Occupational therapists use tele-rehabilitation, incorporating technology into their practices. There is a lack of evidence-based trials regarding the integration of tele-rehabilitation during treatment. We therefore aimed to compare tele-rehabilitation treatment outcomes with conventional rehabilitation in improving the upper limb function post-elbow fractures. Methods: Eighteen participants post-elbow surgery due to fracture were divided into two groups according to age and fracture type. The groups received one month of treatment: the tele-rehabilitation group (N = 9, median age 33.0 ± 27.9 years, range 18.5–61.0) received 1–2 tele-rehabilitation treatments per week via a biofeedback system of elbow motion (the ArmTutor and 3D Tutor systems, MediTouch Ltd., Netanya, Israel) and 1–2 treatments in an outpatient clinic, and the control group (N = 9, median age 60.0 ± 37.0 years, range 20.5–73.0) received 3–4 treatments per week in the clinic. Both groups were instructed to self-practice at home. Four evaluations were performed: before and after the intervention, and 3 months and 1 year from surgery. The outcome measures included the Jebsen–Taylor hand function test; the disabilities of the arm, shoulder, and hand questionnaire; the patient-rated elbow evaluation; satisfaction; passive and active range of motion (ROM); and strength measurements. Results: Findings demonstrated a significant improvement in the ROM and in functional assessments in both groups. No statistically significant differences were found between the groups. The subjects in the tele-rehabilitation group reported a higher level of satisfaction and needed less help from a family member during practice. Conclusions: Tele-rehabilitation programs could be incorporated in the framework of treatment following elbow fractures. Tele-rehabilitation is a cost-effective treatment, suitable for patients with accessibility difficulties or who have difficulty arriving at the clinic.
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Taylor RR, Popova ES. Validation of the Clinical Assessment of Modes-Therapist Version (CAM-T) in Acute Rehabilitation Settings. Am J Occup Ther 2020; 74:7404345030p1-7404345030p8. [PMID: 32602455 DOI: 10.5014/ajot.2020.038448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Assessments that evaluate health care providers' communication in acute rehabilitation settings remain scarce; this article contributes to the knowledge base. OBJECTIVE To assess the reliability and validity of the Clinical Assessment of Modes-Therapist version (CAM-T) from the provider's perspective. DESIGN Cross-sectional, psychometric study. SETTING Acute care and acute inpatient rehabilitation. PARTICIPANTS Ninety-six clients and 32 providers (occupational therapy, physical therapy, and nursing). MEASURES The CAM-T was psychometrically evaluated using classical test theory and Rasch analytic approaches. RESULTS The findings offer strong evidence for the CAM-T's reliability and validity for evaluating overall communication and adequate evidence for evaluating individual communication modes. CONCLUSION AND RELEVANCE The CAM-T may be used by providers as a self-assessment of communication in occupational therapy and in associated rehabilitation professions. WHAT THIS ARTICLE ADDS This article offers evidence in support of the CAM-T's reliability and validity for evaluating health care providers' communication with clients in acute rehabilitation settings. The CAM-T may be used to evaluate providers' overall communication and individual mode use as described in the Intentional Relationship Model.
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Affiliation(s)
- Renée R Taylor
- Renée R. Taylor, MA, PhD, is Professor, Department of Occupational Therapy, University of Illinois at Chicago;
| | - Evguenia S Popova
- Evguenia S. Popova, PhD, OTR/L, is Instructor, Department of Occupational Therapy, Rush University, Chicago
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Stagg K, Douglas J, Iacono T. The perspectives of allied health clinicians on the working alliance with people with stroke-related communication impairment. Neuropsychol Rehabil 2020; 31:1390-1409. [PMID: 32546084 DOI: 10.1080/09602011.2020.1778491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The processes by which working alliances develop in stroke rehabilitation are not well understood. The aim of this study was to explore the ways in which experienced allied health clinicians establish and maintain alliances with people with stroke-related communication impairment, and to identify factors that may influence the strength of these alliances. In-depth interviews were completed with 11 clinicians from the disciplines of occupational therapy, speech-language pathology and physiotherapy. Interview transcripts were coded and analysed using strategies consistent with constructivist grounded theory. Participants described processes that were captured by the themes of enabling interaction, being responsive, building relational capital and building credibility. Practices that supported communication and emphasized responding, both within an interaction and over time, aligned with examples of strong alliances. Professional credibility and relational practices such as everyday conversations and the use of humour were viewed as important. Difficulty accessing a shared mode of communication due to stroke-related communication impairment altered relational processes and influenced perceptions of the alliance, although examples of strong alliances were present. In this study, reflections on challenging alliances highlighted potentially helpful practices. A responsive approach to rehabilitation, supported by reflective practice, may assist clinicians to better navigate their working alliances with this population.
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Affiliation(s)
- Kellie Stagg
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia.,Living with Disability Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Jacinta Douglas
- Living with Disability Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia.,Summer Foundation, Melbourne, Australia
| | - Teresa Iacono
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia.,Living with Disability Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
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Louw A, Goldrick S, Bernstetter A, Van Gelder LH, Parr A, Zimney K, Cox T. Evaluation is treatment for low back pain. J Man Manip Ther 2020; 29:4-13. [PMID: 32091317 DOI: 10.1080/10669817.2020.1730056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective: To investigate the effect of the examination process (history taking and physical examination) on pain and function. Methods: An observational cohort trial of patients presenting to outpatient physical therapy clinics for the first time with low back pain (n = 34, 57.7 ± 18.7 years, 53% female). A blinded investigator measured participants prior to the beginning of the initial evaluation and after each component of evaluation (history taking and physical examination). Another physical therapist provided normal history taking and physical examination as the patient case presented itself. Primary outcome measure was numeric pain rating scale (NPRS) for the low back and leg. Secondary outcomes and time during examination process and connection between PT and patient were also measured as potential confounders. Results: Participants showed a significant reduction in pain through just the history taking and physical exam for both the back with an NPRS reduction of 1.23 and the leg showing a 0.95 NPRS reduction. The most significant reduction occurs after history taking. Discussion: The evaluation process produced small, but significant, therapeutic effects related to pain, fear-avoidance, pain catastrophization, and functional measures of mobility and sensitivity. The therapist's report of connection with the patient did not alter the patient outcome.
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Affiliation(s)
- Adriaan Louw
- International Spine Pain Institute , Story City, IA, USA.,Department of Physical Therapy, St. Ambrose University , Davenport, IA, USA.,Pain Science Fellowship, Evidence in Motion , San Antonio, TX, USA
| | - Steve Goldrick
- International Spine Pain Institute , Story City, IA, USA.,Pain Science Fellowship, Evidence in Motion , San Antonio, TX, USA.,Kitsap Physical Therapy , Silverdale, WA, USA
| | | | | | - Aaron Parr
- ProActive Physical Therapy , Tucson, AZ, USA
| | - Kory Zimney
- International Spine Pain Institute , Story City, IA, USA.,Pain Science Fellowship, Evidence in Motion , San Antonio, TX, USA.,Department of Physical Therapy, University of South Dakota , Vermillion, SD, USA
| | - Terry Cox
- International Spine Pain Institute , Story City, IA, USA.,Department of Physical Therapy, Southwest Baptist University , Bolivar, MO, USA
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Lawton M, Haddock G, Conroy P, Serrant L, Sage K. People with aphasia's perspectives of the therapeutic alliance during speech-language intervention: A Q methodological approach. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 22:59-69. [PMID: 30987440 DOI: 10.1080/17549507.2019.1585949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 10/17/2018] [Accepted: 12/10/2018] [Indexed: 06/09/2023]
Abstract
Purpose: To identify which elements of the therapeutic alliance are important to people with aphasia (PWA) attending speech-language pathology post-stroke.Method: A Q methodology design was adopted to explore which elements of the therapeutic alliance were valued by PWA. Statements (n = 453) relevant to the research question were extrapolated from the literature and qualitative interviews. A representative sample of statements (n = 38) was identified from the expansive data set. PWA (n = 23) sorted statements hierarchically according to whether they thought the statement was important or unimportant. Completed Q sorts were analysed using a by-person factor analysis.Result: Analysis yielded a five-factor solution, representing five distinct viewpoints: (1) acknowledge me, help me to understand; (2) respect me, listen to me; (3) challenge me, direct me; (4) understand me, laugh with me; and (5) hear me, encourage me.Conclusion: The findings highlight the need for clinicians to adopt a flexible and idiosyncratic approach to therapeutic alliance construction in order to meet the relational needs of a heterogeneous population. This is the first study to use Q methodology with PWA, demonstrating that Q methodology is an effective and viable method for investigating subjectivity in this population.
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Affiliation(s)
- Michelle Lawton
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
| | - Gillian Haddock
- School of Health Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, UK
| | - Paul Conroy
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, UK
| | - Laura Serrant
- Faculty of Health and Wellbeing, Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Karen Sage
- Faculty of Health and Wellbeing, Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
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13
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Hercegovac S, Kernot J, Stanley M. How Qualitative Case Study Methodology Informs Occupational Therapy Practice: A Scoping Review. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2019; 40:6-16. [PMID: 31161866 DOI: 10.1177/1539449219850123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Qualitative case study methodology (QCSM) is a useful research approach that has grown in popularity within the social sciences; however, it has received less attention in the occupational therapy literature. The current scoping review aims to explore how studies utilizing a QCSM help inform occupational therapy knowledge and practice. Electronic searches were conducted in April 2017, and the resultant 388 publications were screened by three reviewers in Covidence. In all, 27 publications met the inclusion criteria and were included in the scoping review. Case studies in the occupational therapy literature have explored phenomena relating to the delivery of intervention, theoretical concepts, clinical reasoning, and education and research methods and were situated in a range of different practice areas and contexts. QCSM is a valuable approach in occupational therapy research that contributes to the body of knowledge and theory that informs occupational therapy practice.
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Kinney M, Seider J, Beaty AF, Coughlin K, Dyal M, Clewley D. The impact of therapeutic alliance in physical therapy for chronic musculoskeletal pain: A systematic review of the literature. Physiother Theory Pract 2018; 36:886-898. [PMID: 30265840 DOI: 10.1080/09593985.2018.1516015] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To systematically determine the specific impact of therapeutic alliance (TA) on chronic musculoskeletal pain, identify factors influencing TA between physical therapists and patients with chronic musculoskeletal pain, and determine the working definition of TA across studies. Data Sources: Databases, including PubMed, CINHAL, and Embase, were searched from inception to January 2017. Study Selection: The initial search resulted in 451 papers. After screening, seven studies were identified that examined the role of TA on chronic pain (> 12 weeks) management in physical therapy settings. Data Extraction: Authors extracted data into tables. Risk of bias was assessed using Cochrane Collaboration methodology. Data Synthesis: Three studies examined the influence of a strong TA coupled with physical therapy on pain outcomes. Four studies identified factors that positively and negatively influenced TA. The working definition of TA was identified in each study. Conclusions: Emerging evidence suggests that for individuals participating in physical therapy for chronic musculoskeletal pain, a strong TA may improve pain outcomes. In order to facilitate a strong TA, physical therapists must understand factors that positively and negatively influence the relationship. Studies demonstrate that the definition of TA remains consistent as it transitions to the physical therapy setting.
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Affiliation(s)
- Meredith Kinney
- Outpatient Physical Therapy Department, BreakThrough Physical Therapy , Wake Forest, NC, USA
| | - Jasmine Seider
- Outpatient Physical Therapy Department, Select Physical Therapy , Arlington, VA, USA
| | - Amanda Floyd Beaty
- Department of Physical Therapy and Occupational Therapy, Adult Ambulatory Division, Duke University Health System , Durham, NC, USA
| | - Kaitlin Coughlin
- Outpatient Physical Therapy Department, Back to Work Physical Therapy , Tampa, FL, USA
| | - Maximilian Dyal
- Outpatient Physical Therapy Department, Korunda Medical LLC , Naples, FL, USA
| | - Derek Clewley
- Doctor of Physical Therapy Division, Department of Orthopaedics, Duke University , Durham, NC, USA
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Brun-Cottan N, McMillian D, Hastings J. Defending the art of physical therapy: Expanding inquiry and crafting culture in support of therapeutic alliance. Physiother Theory Pract 2018; 36:669-678. [DOI: 10.1080/09593985.2018.1492656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | - Danny McMillian
- School of Physical Therapy, University of Puget Sound, Tacoma, WA, USA
| | - Jennifer Hastings
- School of Physical Therapy, University of Puget Sound, Tacoma, WA, USA
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Stagg K, Douglas J, Iacono T. A scoping review of the working alliance in acquired brain injury rehabilitation. Disabil Rehabil 2017; 41:489-497. [DOI: 10.1080/09638288.2017.1396366] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kellie Stagg
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
- Living with Disability Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Jacinta Douglas
- Living with Disability Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
- Summer Foundation, Melbourne, Australia
| | - Teresa Iacono
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
- Living with Disability Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
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17
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Louw A, Nijs J, Puentedura EJ. A clinical perspective on a pain neuroscience education approach to manual therapy. J Man Manip Ther 2017; 25:160-168. [PMID: 28694679 PMCID: PMC5498797 DOI: 10.1080/10669817.2017.1323699] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
In recent years, there has been an increased interest in pain neuroscience education (PNE) in physical therapy. There is growing evidence for the efficacy of PNE to decrease pain, disability, fear-avoidance, pain catastrophization, limited movement, and health care utilization in people struggling with pain. PNE teaches people in pain more about the biology and physiology of their pain experience including processes such as central sensitization, peripheral sensitization, allodynia, inhibition, facilitation, neuroplasticity and more. PNE's neurobiological model often finds itself at odds with traditional biomedical models used in physical therapy. Traditional biomedical models, focusing on anatomy, pathoanatomy, and biomechanics have been shown to have limited efficacy in helping people understand their pain, especially chronic pain, and may in fact even increase a person's pain experience by increasing fear-avoidance and pain catastrophization. An area of physical therapy where the biomedical model is used a lot is manual therapy. This contrast between PNE and manual therapy has seemingly polarized followers from each approach to see PNE as a 'hands-off' approach even having clinicians categorize patients as either in need of receiving PNE (with no hands-on), or hands-on with no PNE. In this paper, we explore the notion of PNE and manual therapy co-existing. PNE research has shown to have immediate effects of various clinical signs and symptoms associated with central sensitization. Using a model of sensitization (innocuous, noxious, and allodynia), we argue that PNE can be used in a manual therapy model, especially treating someone where the nervous system has become increasingly hypervigilant. Level of Evidence: VII.
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Affiliation(s)
- Adriaan Louw
- International Spine and Pain Institute, Story City, IA, USA
- Corresponding author.
| | - Jo Nijs
- Faculty of Physical Education and Physiotherapy, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - Emilio J. Puentedura
- Department of Physical Therapy, University of Nevada Las Vegas, School of Allied Health Sciences, Las Vegas, NV, USA
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Babatunde F, MacDermid J, MacIntyre N. Characteristics of therapeutic alliance in musculoskeletal physiotherapy and occupational therapy practice: a scoping review of the literature. BMC Health Serv Res 2017; 17:375. [PMID: 28558746 PMCID: PMC5450083 DOI: 10.1186/s12913-017-2311-3] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/16/2017] [Indexed: 01/08/2023] Open
Abstract
Background Most conventional treatment for musculoskeletal conditions continue to show moderate effects, prompting calls for ways to increase effectiveness, including drawing from strategies used across other health conditions. Therapeutic alliance refers to the relational processes at play in treatment which can act in combination or independently of specific interventions. Current evidence guiding the use of therapeutic alliance in health care arises largely from psychotherapy and medicine literature. The objective of this review was to map out the available literature on therapeutic alliance conceptual frameworks, themes, measures and determinants in musculoskeletal rehabilitation across physiotherapy and occupational therapy disciplines. Methods A scoping review of the literature published in English since inception to July 2015 was conducted using Medline, EMBASE, PsychINFO, PEDro, SportDISCUS, AMED, OTSeeker, AMED and the grey literature. A key search term strategy was employed using “physiotherapy”, “occupational therapy”, “therapeutic alliance”, and “musculoskeletal” to identify relevant studies. All searches were performed between December 2014 and July 2015 with an updated search on January 2017. Two investigators screened article title, abstract and full text review for articles meeting the inclusion criteria and extracted therapeutic alliance data and details of each study. Results One hundred and thirty articles met the inclusion criteria including quantitative (33%), qualitative (39%), mixed methods (7%) and reviews and discussions (23%) and most data came from the USA (23%). Randomized trials and systematic reviews were 4.6 and 2.3% respectively. Low back pain condition (22%) and primary care (30.7%) were the most reported condition and setting respectively. One theory, 9 frameworks, 26 models, 8 themes and 42 subthemes of therapeutic alliance were identified. Twenty-six measures were identified; the Working Alliance Inventory (WAI) was the most utilized measure (13%). Most of the therapeutic alliance themes extracted were from patient perspectives. The relationship between adherence and therapeutic alliance was examined by 26 articles of which 57% showed some correlation between therapeutic alliance and adherence. Age moderated the relationship between therapeutic alliance and adherence with younger individuals and an autonomy support environment reporting improved adherence. Prioritized goals, autonomy support and motivation were facilitators of therapeutic alliance. Conclusion Therapeutic Alliance has been studied in a limited extent in the rehabilitation literature with conflicting frameworks and findings. Potential benefits described for enhancing therapeutic alliance might include better exercise adherence. Several knowledge gaps have been identified with a potential for generating future research priorities for therapeutic alliance in musculoskeletal rehabilitation. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2311-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Folarin Babatunde
- School of rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada.
| | - Joy MacDermid
- School of rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada.,Hand and Upper Limb Centre, St Joseph Hospital, London, ON, Canada.,Department of Physical Therapy, University of Western Ontario, London, ON, Canada
| | - Norma MacIntyre
- School of rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
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Fagundes FRC, de Melo do Espírito Santo C, de Luna Teixeira FM, Tonini TV, Cabral CMN. Effectiveness of the addition of therapeutic alliance with minimal intervention in the treatment of patients with chronic, nonspecific low back pain and low risk of involvement of psychosocial factors: a study protocol for a randomized controlled trial (TalkBack trial). Trials 2017; 18:49. [PMID: 28143504 PMCID: PMC5282714 DOI: 10.1186/s13063-017-1784-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 01/06/2017] [Indexed: 12/30/2022] Open
Abstract
Background The stratified model of care has been an effective approach for the treatment of low back pain. However, the treatment of patients with low risk of psychosocial-factor involvement is unclear. The addition of the therapeutic alliance to a minimal intervention may be an option for the treatment of low back pain. This paper reports on the rationale, design and protocol for a randomized controlled trial with blind assessor to assess the effectiveness of the addition of therapeutic alliance with minimal intervention on pain and disability in patients with chronic, nonspecific low back pain. Methods Two hundred and twenty-two patients with chronic, nonspecific low back pain and low risk of involvement of psychosocial factors will be assessed and randomly allocated into three groups (n = 74 patients per group). The Positive Therapeutic Alliance group will receive counseling and guidance with an emphasis on therapeutic alliance and empathy. The Usual Treatment group will receive the same information and counseling with limited interaction with the therapist. The Control group will not receive any intervention. The treatment will be composed by two intervention sessions with a 1-week interval. A blinded assessor will collect the following outcomes at baseline, 1 month, 6 months and 12 months after randomization: pain intensity (Pain Numerical Rating Scale), specific disability (Patient-specific Functional Scale), general disability (Oswestry Disability Index), global perceived effect (Global Perceived Effect Scale), empathy (Consultation and Relational Empathy Measure), credibility and expectations related to treatment. The analysis will be performed using linear mixed models. Discussion This will be the first study to understand the effect of combining enhanced therapeutic alliance to a treatment based on counseling, information and advice (minimal intervention). The addition of the therapeutic alliance to minimal intervention may improve the treatment of chronic, nonspecific low back pain. Trial registration ClinicalTrials.gov, NCT 02497625. Registered on 10 July 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1784-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Felipe Ribeiro Cabral Fagundes
- Master's and Doctoral Programs in Physical Therapy of the Universidade Cidade de Sao Paulo, Rua Cesário Galeno 475, Tatuapé, São Paulo, SP, CEP: 03071-000, Brazil.
| | | | - Francine Mendonça de Luna Teixeira
- Master's and Doctoral Programs in Physical Therapy of the Universidade Cidade de Sao Paulo, Rua Cesário Galeno 475, Tatuapé, São Paulo, SP, CEP: 03071-000, Brazil
| | - Thaís Vanelli Tonini
- Physical Therapy Department of the Universidade de Taubaté, Av. Marechal Arthur Costa e Silva 1055, Centro, Taubaté, SP, Brazil
| | - Cristina Maria Nunes Cabral
- Master's and Doctoral Programs in Physical Therapy of the Universidade Cidade de Sao Paulo, Rua Cesário Galeno 475, Tatuapé, São Paulo, SP, CEP: 03071-000, Brazil
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20
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Mallows A, Debenham J, Walker T, Littlewood C. Association of psychological variables and outcome in tendinopathy: a systematic review. Br J Sports Med 2016; 51:743-748. [DOI: 10.1136/bjsports-2016-096154] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2016] [Indexed: 12/23/2022]
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21
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Louw A, Farrell K, Landers M, Barclay M, Goodman E, Gillund J, McCaffrey S, Timmerman L. The effect of manual therapy and neuroplasticity education on chronic low back pain: a randomized clinical trial. J Man Manip Ther 2016; 25:227-234. [PMID: 29449764 DOI: 10.1080/10669817.2016.1231860] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective To determine if a neuroplasticity educational explanation for a manual therapy technique will produce a different outcome compared to a traditional mechanical explanation. Methods Sixty-two patients with chronic low back pain (CLBP) were recruited for the study. Following consent, demographic data were obtained as well as pain ratings for low back pain (LBP) and leg pain (Numeric Pain Rating Scale), disability (Oswestry Disability Index), fear-avoidance (Fear-Avoidance-Beliefs Questionnaire), forward flexion (fingertips-to-floor), and straight leg raise (SLR) (inclinometer). Patients were then randomly allocated to receive one of two explanations (neuroplasticity or mechanical), a manual therapy technique to their lumbar spine, followed by post-intervention measurements of LBP, leg pain, forward flexion, and SLR. Results Sixty-two patients (female 35 [56.5%]), with a mean age of 60.1 years and mean duration of 9.26 years of CLBP participated in the study. There were no statistically significant interactions for LBP (p = .325), leg pain (p = .172), and trunk flexion (p = .818) between the groups, but SLR showed a significant difference in favor of the neuroplasticity explanation (p = .041). Additionally, the neuroplasticity group were 7.2 times (95% confidence interval = 1.8-28.6) more likely to improve beyond the MDC on the SLR than participants in the mechanical group. Discussion The results of this study show that a neuroplasticity explanation, compared to a traditional biomechanical explanation, resulted in a measureable difference in SLR in patients with CLBP when receiving manual therapy. Future studies need to explore if the increase in SLR correlated to changes in cortical maps of the low back.
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Affiliation(s)
- Adriaan Louw
- International Spine and Pain Institute, Story City, IA, USA
| | - Kevin Farrell
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Davenport, IA, USA
| | - Merrill Landers
- Department of Physical Therapy, School of Allied Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Martin Barclay
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Davenport, IA, USA
| | - Elise Goodman
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Davenport, IA, USA
| | - Jordan Gillund
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Davenport, IA, USA
| | - Sara McCaffrey
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Davenport, IA, USA
| | - Laura Timmerman
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Davenport, IA, USA
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22
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Louw A, Zimney K, Landers MR, Luttrell M, Clair B, Mills J. A randomised controlled trial of 'clockwise' ultrasound for low back pain. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2016; 72:306. [PMID: 30135888 PMCID: PMC6093130 DOI: 10.4102/sajp.v72i1.306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/17/2016] [Indexed: 01/16/2023] Open
Abstract
Aims To examine how the choice of words explaining ultrasound (US) may influence the outcome of physiotherapy treatment for low back pain (LBP). Methods Sixty-seven patients with LBP < 3 months were randomly allocated to one of three groups – traditional education about US (control group [CG]), inflated education about US (experimental group [EG]) or extra-inflated education about US (extra-experimental group [EEG]). Each patient received the exact same application of US that has shown clinical efficacy for LBP (1.5 Watts/cm2 for 10 minutes at 1 Megahertz, pulsed 20% over a 20 cm2 area), but received different explanations (CG, EG or EEG). Before and immediately after US, measurements of LBP and leg pain (numeric rating scale), lumbar flexion (distance to floor) and straight leg raise (SLR) (inclinometer) were taken. Statistical analysis consisted of mixed-factorial analyses of variance and chi-square analyses to measure differences between the three groups, as well as meeting or exceeding minimal detectable changes (MDCs) for pain, lumbar flexion and SLR. Results Both EG and EEG groups showed a statistically significant improvement for SLR (p < 0.0001), while the CG did not. The EEG group participants were 4.4 times (95% confidence interval: 1.1 to 17.5) more likely to improve beyond the MDC than the CG. No significant differences were found between the groups for LBP, leg pain or lumbar flexion. Conclusion The choice of words when applying a treatment in physiotherapy can alter the efficacy of the treatment.
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Affiliation(s)
- Adriaan Louw
- International Spine & Pain Institute, United States.,Department of Physical Therapy, School of Allied Health Sciences, University of Nevada Las Vegas, United States.,Department of Physical Therapy, St. Ambrose University, United States
| | - Kory Zimney
- International Spine & Pain Institute, United States.,Department of Physical Therapy, School of Health Sciences, University of South Dakota, United States
| | - Merrill R Landers
- Department of Physical Therapy, School of Allied Health Sciences, University of Nevada Las Vegas, United States
| | | | - Bob Clair
- Clair Physical Therapy, United States
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Therapeutic Alliances in Stroke Rehabilitation: A Meta-Ethnography. Arch Phys Med Rehabil 2016; 97:1979-1993. [PMID: 27137094 DOI: 10.1016/j.apmr.2016.03.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/24/2016] [Accepted: 03/22/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To synthesize qualitative studies exploring patients' and professionals' perspectives and experiences of developing and maintaining therapeutic alliances in stroke rehabilitation. DATA SOURCES A systematic literature search was conducted using the following electronic databases: PsycINFO, CINAHL, Embase, MEDLINE, Allied and Complementary Medicine Database, Applied Social Sciences Index and Abstracts, and ComDisDome from inception to May 2014. This was supplemented by hand searching, reference tracking, generic web searching, and e-mail contact with experts. STUDY SELECTION Qualitative peer reviewed articles reporting experiences or perceptions of the patient or professional in relation to therapeutic alliance construction and maintenance in stroke rehabilitation were selected for inclusion. After a process of exclusion, 17 publications were included in the synthesis. DATA EXTRACTION All text identified in the results and discussion sections of the selected studies were extracted verbatim for analysis in a qualitative software program. Studies were critically appraised independently by 2 reviewers. DATA SYNTHESIS Articles were synthesized using a technique of meta-ethnography. Four overarching themes emerged from the process of reciprocal translation: (1) the professional-patient relationship: degree of connectedness; (2) asymmetrical contributions; (3) the process of collaboration: finding the middle ground; and (4) system drivers. CONCLUSIONS The findings from the meta-ethnography suggest that the balance of power between the patient and professional is asymmetrically distributed in the construction of the alliance. However, given that none of the studies included in the review addressed therapeutic alliance as a primary research area, further research is required to develop a conceptual framework relevant to stroke rehabilitation, in order to determine how this construct contributes to treatment efficacy.
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24
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Crepeau EB. “I need someone to keep an eye on me:” the power of attention in patient-practitioner interactions. Disabil Rehabil 2016; 38:2419-27. [DOI: 10.3109/09638288.2015.1129443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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25
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Riessman CK. Ruptures and sutures: time, audience and identity in an illness narrative. SOCIOLOGY OF HEALTH & ILLNESS 2015; 37:1055-1071. [PMID: 25923981 DOI: 10.1111/1467-9566.12281] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
First-person accounts of the illnesses experienced by sociologists have taken hybrid experimental forms. I add my voice to this growing tradition with a story about the discovery and treatment of a soft tissue sarcoma in my thigh, chronicled in a journal I kept over many months. The fragments scribbled in the journal became the basis of an extended illness narrative. I interrogate features of the narrative itself, including the handling of time and imagined audiences - those I was writing for. The illness narrative traces how cancer transformed the many identities I enact on a daily basis and how the invisible labour of particular health workers enabled the restoration of several prized identities. These workers - radiation, occupational and physical therapists - are typically subordinated in the medical hierarchy and the interactional work that they do with patients to restore and reconfigure ruptured identities after serious illness needs attention in medical sociology.
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26
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Meyers RS. A Clinician’s Perspective on Treating Patients Suffering from Insomnia and Pain. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2015. [DOI: 10.1007/s10942-015-0214-y] [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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27
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Eklund M, Erlandsson LK, Wästberg BA. A longitudinal study of the working relationship and return to work: perceptions by clients and occupational therapists in primary health care. BMC FAMILY PRACTICE 2015; 16:46. [PMID: 25887461 PMCID: PMC4397877 DOI: 10.1186/s12875-015-0258-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/16/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND The working relationship between client and therapist can be important to enhance outcomes from vocational rehabilitation for women with stress-related disorders in primary health care. The aim was to investigate the working relationship, as perceived by clients and therapists in the Redesigning Daily Occupations (ReDO™) program, and its relationships to return to work and satisfaction with the rehabilitation. Another aim was to compare the ReDO™ group and a "care-as-usual" (CAU) group regarding perceptions of the working relationship with the social insurance officer. METHOD Forty-two ReDO™ clients and 42 matched controls receiving CAU participated. The study included four measurements (baseline, after 16 weeks rehabilitation and follow-ups after 6 and 12 months). 37 + 37 clients completed. Return to work data was obtained from the Social Insurance Offices (SIO), and the working relationship and client satisfaction were assessed by self-report questionnaires. RESULTS The clients rated the working relationship higher than the therapists (mean rating 101.1 vs. 93.9; p < 0.001). The therapists' rating showed a statistically significant association with return to work at the 12-month follow-up, and the clients' perceptions were statistically significantly related to how they rated satisfaction with the rehabilitation received. The ReDO™ and the CAU groups did not differ regarding how they rated the relationship with the SIO officer (mean ratings 83.9 vs. 77; p = 0.189). The working relationship with the SIO officer was not related to return to work, but an association (rs = 0.70, p < 0.001) to client satisfaction at 16 weeks appeared in the CAU group alone. CONCLUSION The working relationship as perceived by clients and therapists seemed to be partly separate phenomena, the client perceptions being linked with satisfaction with the rehabilitation and the therapist perceptions with the clients' return to work. The relationship to the SIO officers was of no importance to return to work but was of some significance for satisfaction with the rehabilitation among the CAU clients. Therapists should strive to improve the relationship with clients to whom they feel the relationship is fragile since that might enhance the chances for those clients to return to work. TRIAL REGISTRATION Registered at ClinicalTrials.gov (identifier NCT01234961) 2 November 2010.
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Affiliation(s)
- Mona Eklund
- Department of Health Sciences, Lund University, PO Box 157, SE-22100, Lund, Sweden.
| | | | - Birgitta A Wästberg
- Department of Health Sciences, Lund University, PO Box 157, SE-22100, Lund, Sweden.
- Skane University Hospital Malmö-Lund, 221 85, Lund, Sweden.
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28
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Enhanced therapeutic alliance modulates pain intensity and muscle pain sensitivity in patients with chronic low back pain: an experimental controlled study. Phys Ther 2014; 94:477-89. [PMID: 24309616 DOI: 10.2522/ptj.20130118] [Citation(s) in RCA: 171] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Physical therapy influences chronic pain by means of the specific ingredient of an intervention as well as contextual factors including the setting and therapeutic alliance (TA) between provider and patient. OBJECTIVE The purpose of this study was to compare the effect of enhanced versus limited TA on pain intensity and muscle pain sensitivity in patients with chronic low back pain (CLBP) receiving either active or sham interferential current therapy (IFC). DESIGN An experimental controlled study with repeated measures was conducted. Participants were randomly divided into 4 groups: (1) AL (n=30), which included the application of active IFC combined with a limited TA; (2) SL (n=29), which received sham IFC combined with a limited TA; (3) AE (n=29), which received active IFC combined with an enhanced TA; and (4) SE (n=29), which received sham IFC combined with an enhanced TA. METHODS One hundred seventeen individuals with CLBP received a single session of active or sham IFC. Measurements included pain intensity as assessed with a numerical rating scale (PI-NRS) and muscle pain sensitivity as assessed via pressure pain threshold (PPT). RESULTS Mean differences on the PI-NRS were 1.83 cm (95% CI=14.3-20.3), 1.03 cm (95% CI=6.6-12.7), 3.13 cm (95% CI=27.2-33.3), and 2.22 cm (95% CI=18.9-25.0) for the AL, SL, AE, and SE groups, respectively. Mean differences on PPTs were 1.2 kg (95% CI=0.7-1.6), 0.3 kg (95% CI=0.2-0.8), 2.0 kg (95% CI=1.6-2.5), and 1.7 kg (95% CI=1.3-2.1), for the AL, SL, AE, and SE groups, respectively. LIMITATIONS The study protocol aimed to test the immediate effect of the TA within a clinical laboratory setting. CONCLUSIONS The context in which physical therapy interventions are offered has the potential to dramatically improve therapeutic effects. Enhanced TA combined with active IFC appears to lead to clinically meaningful improvements in outcomes when treating patients with CLBP.
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Poulsen AA, Meredith P, Khan A, Henderson J, Castrisos V, Khan SR. Burnout and Work Engagement in Occupational Therapists. Br J Occup Ther 2014. [DOI: 10.4276/030802214x13941036266621] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: Work engagement, characterized by vigour, dedication, and absorption, is often perceived as the opposite of burnout. Occupational therapists with burnout feel exhausted and disengaged from their work. This study aims to investigate demographic and work-related psychosocial factors associated with burnout and work engagement. Method: A cross-sectional postal survey of 951 occupational therapists was conducted. Findings: Two models representing factors associated with burnout (F(15,871) = 28.01, p < .001) and work engagement (F(10,852) = 16.15, p < .001) accounted for 32.54% and 15.93% of the variance respectively. Burnout and work engagement were inversely associated (χ2(n = 941) = 55.16, p < .001). Conclusion: Factors associated with burnout and work engagement were identified. The variables associated with burnout included: low psychological detachment from work during out-of-work hours, low income satisfaction, perceived work overload, difficulty saying ‘no’, < 10 years' experience, low frequency of having a ‘belly laugh’, and not having children. High levels of work engagement were reported by therapists with the following: low psychological detachment from work, high income satisfaction, postgraduate qualifications, > 40 hours work/week, high frequency of having a ‘belly laugh’, and having children. Understanding the factors associated with burnout and work engagement provides prerequisite information to inform strategies aimed at building healthy workforces.
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Affiliation(s)
- Anne A Poulsen
- Senior Research Fellow, The University of Queensland — Division of Occupational Therapy, School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, St Lucia, Queensland, Australia
| | - Pamela Meredith
- Senior Lecturer, The University of Queensland — Division of Occupational Therapy, School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, St Lucia, Queensland, Australia
| | - Asaduzzaman Khan
- Senior Lecturer, The University of Queensland — Division of Occupational Therapy, School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, St Lucia, Queensland, Australia
| | - Julie Henderson
- Occupational Therapist, Occupational Therapy for Children Private Practice, Graceville, Queensland, Australia
| | - Veronica Castrisos
- Occupational Therapist, Association for Preschool Education of Deaf Children Inc., Taigum, Queensland, Australia
| | - Shanchita R Khan
- Doctoral candidate, Queensland University of Technology — Institute of Health and Biomedical Innovation, Brisbane, Queensland, Australia
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Kairy D, Tousignant M, Leclerc N, Côté AM, Levasseur M. The patient's perspective of in-home telerehabilitation physiotherapy services following total knee arthroplasty. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:3998-4011. [PMID: 23999548 PMCID: PMC3799503 DOI: 10.3390/ijerph10093998] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 08/15/2013] [Accepted: 08/16/2013] [Indexed: 11/16/2022]
Abstract
This study aimed at exploring patients’ perceptions regarding telerehabilitation services received post total knee replacement. In this qualitative embedded single case study, semi-structured interviews were conducted with five patients who had previously received in-home telerehabilitation post total knee arthroplasty. Participants were asked to reflect on their 8-week rehabilitation process and on their experience with the home telerehabilitation program. Interviews were transcribed and a qualitative thematic analysis was conducted. Six overarching themes emerged from the patients’ perceptions: (1) improving access to services with reduced need for transportation; (2) developing a strong therapeutic relationship with therapist while maintaining a sense of personal space; (3) complementing telerehabilitation with in-person visits; (4) providing standardized yet tailored and challenging exercise programs using telerehabilitation; (5) perceived ease-of-use of telerehabilitation equipment; and (6) feeling an ongoing sense of support. Gaining a better understating of the patient’s experience in telerehabilitation will be essential as programs continue to be developed and implemented.
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Affiliation(s)
- Dahlia Kairy
- School of Rehabilitation, Université de Montréal and Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal—IRGLM site, 6300 Darlington Avenue, Montreal, Quebec H3S 2J4, Canada
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-514-343-6301; Fax: +1-514-343-6929
| | - Michel Tousignant
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 1036 Belvédère Sud, Sherbrooke, Quebec J1H 4C4, Canada; E-Mails: (M.T.); (N.L.)
| | - Nancy Leclerc
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 1036 Belvédère Sud, Sherbrooke, Quebec J1H 4C4, Canada; E-Mails: (M.T.); (N.L.)
| | - Anne-Marie Côté
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 1036 Belvédère Sud, Sherbrooke, Quebec J1H 4C4, Canada; E-Mails: (A.-M.C.); (M.L.)
| | - Mélanie Levasseur
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 1036 Belvédère Sud, Sherbrooke, Quebec J1H 4C4, Canada; E-Mails: (A.-M.C.); (M.L.)
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Morrison TL, Smith JD. Working alliance development in occupational therapy: a cross-case analysis. Aust Occup Ther J 2013; 60:326-33. [PMID: 24089984 DOI: 10.1111/1440-1630.12053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite reverence afforded the therapeutic relationship construct in occupational therapy, many occupational therapists feel ill equipped to use themselves therapeutically to enhance the relationship with their clients. Furthermore, although occupational therapists often link the strength of the therapeutic relationship to therapy outcomes, related occupational therapy specific research has been limited. According to the psychotherapy literature, the working alliance is one element of the therapeutic relationship which has in fact been linked to therapy outcomes. METHODS A mixed-methods, prospective, multiple case study approach was used to compare the experiences of the working alliance by both occupational therapists and clients across four therapeutic dyads. RESULTS Several key elements were identified in this study's qualitative data as shaping the process of alliance development in occupational therapy including: the fostering of an interpersonal connection; the use of humour as therapeutic modality; an impetus to act that leads to functional enhancements; a shared sense of success and a positive feedback mechanism created through successfully attaining clearly delineated, client-centred therapy goals. CONCLUSIONS By considering these identified elements, occupational therapists may focus upon tangible considerations towards enhanced therapeutic use-of-self in the development of sound working alliance with their clients potentially improving therapy outcomes.
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Affiliation(s)
- Tricia L Morrison
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Holmqvist K, Holmefur M, Ivarsson AB. Therapeutic use of self as defined by Swedish occupational therapists working with clients with cognitive impairments following acquired brain injury: A Delphi study. Aust Occup Ther J 2012; 60:48-55. [PMID: 23414189 DOI: 10.1111/1440-1630.12001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Kajsa Holmqvist
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
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Kayes NM, McPherson KM. Human technologies in rehabilitation: ‘Who’ and ‘How’ we are with our clients. Disabil Rehabil 2012; 34:1907-11. [DOI: 10.3109/09638288.2012.670044] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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