A value-based practice model of rehabilitation: consumers’ recommendations in action

An ethnographic study exploring person-centred nutrition care in rehabilitation units

PURPOSE

Person-centred care (PCC) is an essential component of high-quality healthcare across professions and care settings. While research is emerging in subacute nutrition services more broadly, there is limited literature exploring the person-centredness of nutrition care in rehabilitation. This study aimed to explore person-centred nutrition care (PCNC) in rehabilitation units, as described and actioned by patients, support persons and staff. Key factors influencing PCNC were also explored.

MATERIALS AND METHODS

An ethnographic study was undertaken across three rehabilitation units. Fifty-eight hours of field work were completed with 165 unique participants to explore PCNC. Field work consisted of observations and interviews with patients, support persons and staff. Data were analysed through the approach of reflexive thematic analysis, informed by PCC theory.

RESULTS

Themes generated were: (1) tensions between patient and staff goals; (2) disconnected moments of PCNC; (3) the necessity of interprofessional communication for PCNC; and (4) the opportunity for PCNC to enable the achievement of rehabilitation goals.

CONCLUSIONS

PCNC was deemed important to different stakeholders but was at times hindered by a focus on profession-specific objectives. Opportunities exist to enhance interprofessional practice to support PCNC in rehabilitation. Future research should consider the system-level factors influencing PCNC in rehabilitation settings.

The value of the whole picture: rehabilitation outcome measurement using patient self-report and clinician-based assessments after spinal cord injury

STUDY DESIGN

This is a retrospective longitudinal study.

OBJECTIVES

To explore the relative impact and contribution of using both the Spinal Cord Independence Measure III (SCIM) and Stoke Mandeville Spinal Needs Assessment Checklist (SMS-NAC) to assess rehabilitation outcome following an acute spinal cord injury (SCI).

SETTING

The study was performed at National Spinal Injuries Centre (NSIC), Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK.

METHODS

A patient self-report SMS-NAC and clinician-rated SCIM were administered on admission and discharge from the NSIC as part of standardised care. This paper presents a retrospective analysis of the rehabilitation outcomes of 195 people with spinal cord injury (PwSCI) following their first admission.

RESULTS

In both measures, PwSCI improved from admission to discharge. Individuals with higher SCI obtained lower scores in both measures, at both admission and discharge. The SMS-NAC demonstrated the greatest increase in knowledge and skill for PwSCI who had higher and more complete injuries. On the SCIM, PwSCI who had lower and less complete injuries demonstrated the greatest increase in outcome.

CONCLUSIONS

Overall, both measures demonstrated responsiveness to change during SCI rehabilitation and enable clinicians to systematically determine areas to focus rehabilitation effort. The relative strengths and contribution to delivering person-centred care for each are identified. The SMS-NAC enables clinicians to record, for people with higher injuries, their subjective self-report of skill and knowledge gains from rehabilitation that may be missed with other measures. Consequently, using both is encouraged in appreciation of the value of recording verbal (instructional) independence as well as functional (physical) independence.

The usual bowel care regimes of people living in the community with spinal cord injury and factors important for integrating bowel care into everyday life

PURPOSE

To describe the usual bowel care regimes of people living in the community with spinal cord injury and factors important for integrating bowel care into everyday life.

METHODS AND MATERIALS

Descriptive and interpretive thematic analysis of transcribed semi-structured interviews with 11 men living with spinal cord injury, aged 23-77 years, 8-45 years post injury.

RESULTS

Participants had different levels and types of injuries. While there were common aspects of the bowel care routines of study participants, none was exactly the same as any other. Each had developed a routine in accordance with the needs of their own body, preferences, and convenience in relation to availability of carers and work commitments. Personal factors in the person with SCI were important for successful integration of bowel care into their everyday life.

CONCLUSION

An appropriate and consistent bowel care routine was found to be significant in enabling people with spinal cord injury to experience wellness and quality in their everyday lives. Characteristics and actions of the person with SCI enabled the person to actively drive the process of integrating bowel care into their everyday life. How best to foster the development of these personal factors warrant further investigation.IMPLICATIONS FOR REHABILITATIONSupport for the ongoing development of self-management of bowel dysfunction expertise by people living with spinal cord injury needs to continue after discharge from hospital.Characteristics of the person with spinal cord injury, such as a state of mind indicating acceptance of their situation, motivation to avoid bowel accidents and constipation, and willingness to take responsibility, are important factors influencing the integration of bowel care into everyday life.Actions undertaken by the person with spinal cord injury, such as discipline to establish, refine and maintain a bowel care regime, and proactive self-management are important factors influencing the integration of bowel care into everyday life.This small study suggests the role of personal factors in the development of self-management expertise, for example the development of a self-management mindset and the acquisition of skills to drive that process, should be considered during rehabilitation.

Falls Occurring After a Spinal Cord Injury: A Scoping Review

IMPORTANCE

Falls have a considerable physical and psychological impact on people with spinal cord injury (SCI). Occupational therapy practitioners require evidence to support the timely development of occupation-based programs that can be applied to fall prevention in daily life.

OBJECTIVE

To determine what is known about falls after SCI, including wheelchair users and people who are ambulatory, and to understand elements of fall prevention to be addressed by occupational therapy practitioners. We applied the Canadian Measure of Occupational Performance and Engagement to understand elements to be addressed in fall education and prevention with this population.

DATA SOURCES

We searched eight databases using the key words falls and spinal cord injury with no limit set on dates. Study Selection and Data Collection: Studies were included that reported on falls among adults with SCI and measured one or more of the following: incidence of falls, consequences of falls, contributing factors for falls, the person's experience of falls, and strategies to prevent falls.

FINDINGS

Thirty-five articles were included. The majority of the articles included information on the incidence (n = 20), consequences (n = 26), and contributing factors (n = 30) of falls. Two articles analyzed the person's experience of falls, and 1 study reviewed a fall prevention program for people with SCI specifically.

CONCLUSIONS AND RELEVANCE

Research on participants' experience of falls and fall prevention programs used in spinal cord rehabilitation is extremely limited. Future research on the lived experience of falls for people with SCI is warranted. What This Article Adds: This review of evidence on falls after SCI highlights gaps in the current available evidence.

Twelve tips for teaching the International Classification of Functioning, Disability and Health with a view to enhancing a biopsychosocial approach to care

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.

Patient reported experiences of using community rehabilitation and/or support services whilst living with a long-term neurological condition: a qualitative systematic review and meta-aggregation

Objectives: The objective of this study is to identify patient reported experiences of using community rehabilitation and/or support services whilst living with a long-term neurological condition, and perceptions of their impact on quality of life.Methods: Nine electronic databases were searched for peer-reviewed qualitative studies from 2005 to 2016, which met the inclusion criteria. Critical appraisal, data extraction, and quality assessment of 37 included papers were performed by three reviewers. One hundred and one findings were extracted. Meta-aggregation was used to synthesize findings.Findings: Seven 'synthesized findings' [SF] were produced: Interactions with some professionals provide active participation, choice, confidence and autonomy [SF1]; Interactions with some professionals are disempowering and depersonalized [SF2]; Effective communication, specialist knowledge and an individualized approach to information provision is needed [SF3]; Indicators of success vary and may not be clear [SF4]; Informal support from family/friends is valued [SF5]; Opportunities for peer support/social interaction is valued [SF6]; Coordination required to ensure continuity during transition to community [SF7].Conclusion: Patient reported experiences identified common factors associated with process quality (respect, choice, autonomy, information provision, communication) and activities of patient centered care (personalized care, shared decision-making, self-management support) despite heterogeneity of neurological conditions, service configurations, and geographical location. These factors impact quality of life.Implications for RehabilitationPatient reported experiences provide useful information about courtesy, respect, choice, autonomy, information provision, and communication.Outcomes of self-efficacy and self-management are important for people with stable and progressive long-term neurological conditions.Interactions with individual professionals influence engagement, self-efficacy, and self-management for people with long-term neurological conditions.Training for health and social care professionals should develop the advanced communication skills and behavior required to facilitate self-efficacy and self-management.

Meaning of Staring and the Starer-Staree Relationship Related to Men Living With Acquired Spinal Cord Injuries

When in public places, many individuals with physical disabilities experience staring. Although staring is typically seen as uncomplicated and something to be "ignored," it has consequences for the person being stared and the staree. Few studies have focused on staring experienced by men following spinal cord injury (SCI). Accordingly, this study explored how adult men with SCI give meaning to the staring from others, the consequences for them, and their responses to the staring and to the starer. Principles of modified grounded theory methods were used to conduct a secondary analysis of interview data for 30 male participants from a larger study of community-dwelling individuals with SCI. Themes revealed through analysis related to context-dependent meanings of staring, negative consequences of staring for some men, and positive opportunities for self-growth and interaction with the public. These findings contribute to a more complex understanding of staring and the relationship between the starer and staree in various social circumstances which can support people living with differences in their public interactions, and improve their quality of life.

Experiences of work among people with disabilities who are HIV-positive in Zambia

This paper focuses on accounts of how having a disability and being HIV-positive influences experiences of work among 21 people (12 women, 9 men) in Lusaka, Zambia. In-depth semi-structured interviews were conducted in English, Bemba, Nyanja, or Zambian sign language. Descriptive and thematic analyses were conducted. Three major themes were generated. The first, a triple burden, describes the burden of having a disability, being HIV-positive, and being unemployed. The second theme, disability and HIV is not inability, describes participants' desire for work and their resistance to being regarded as objects of charity. Finally, how work influences HIV management, describes the practicalities of working and living with HIV. Together these themes highlight the limited options available to persons with disabilities with HIV in Lusaka, not only secondary to the effects of HIV influencing their physical capacity to work, but also because of the attendant social stigma of being a person with a disability and HIV-positive.