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Morgan KA, Paton S, Patten A, Tucker S, Walker K. Community-based exercise goals of persons with spinal cord injury: Interpreted using the International Classification of Functioning, Disability, and Health. J Spinal Cord Med 2024; 47:229-238. [PMID: 34698620 PMCID: PMC10885771 DOI: 10.1080/10790268.2021.1970896] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To identify goals for exercising among community-dwelling persons with spinal cord injury (PwSCI). DESIGN Qualitative descriptive study. SETTING Community-based exercise facility for persons with a disability. PARTICIPANTS Fifty-five PwSCI identified their exercise goals prior to participation in a community-based exercise intervention. INTERVENTIONS None. OUTCOME MEASURES A modified version of the Canadian Occupational Performance Measure was used to ask about exercise goals. The International Classification of Functioning, Disability, and Health (ICF) was used to code the goals for themes. RESULTS The participants were predominantly male (76%) and Black (56%) with thoracic-level injury (51%) and a mean age of 39.44 (standard deviation [SD] 13.62). A total of 231 goals (mean 4.2 goals per participant; SD 1.25) were identified. Participants rated their performance and satisfaction with their goals as 4.256 (SD 1.55) and 3.57 (SD 1.67), respectively. Participants most frequently reported goals related to endurance, muscle strengthening, weight loss, activities of daily living, transferring, and home and community mobility. The most commonly reported goals fell into five ICF domains: Functions of Cardiovascular, Hematological, Immunological, and Respiratory Systems; Neuromusculoskeletal and Movement-Related Functions; Structures Related to Movement; Mobility; and Self-Care. CONCLUSION PwSCI have goals they would like to achieve through participation in exercise. The goals are multifaceted and encompass improving health and fitness as well as improving performance in everyday activities such as transferring and mobility. Identifying themes of goals for PwSCI to achieve through exercise is an important step in developing programs and interventions needed to support PwSCI living in the community.
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Affiliation(s)
- Kerri A. Morgan
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri, USA
| | - Samantha Paton
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri, USA
| | - Anna Patten
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri, USA
| | - Susan Tucker
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri, USA
| | - Kimberly Walker
- Washington University in St. Louis, School of Medicine, St. Louis, Missouri, USA
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Jackson K, Newbury-Birch D. Patient reported experiences of community rehabilitation and/or support services for people with long term neurological conditions: a narrative review of quantitative studies. Disabil Rehabil 2023:1-18. [PMID: 37905706 DOI: 10.1080/09638288.2023.2266369] [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: 12/13/2022] [Accepted: 09/24/2023] [Indexed: 11/02/2023]
Abstract
Objectives: 1. To identify validated quantitative Patient Reported Experience Measures (PREM's) being used in Community Rehabilitation and/or Support services for people with long term neurological conditions (PwLTNC). 2. To explore how data from quantitative PREM's adds to research on patient experiences of Community Rehabilitation and Support for PwLTNC.Method: Eight data bases were searched for peer reviewed studies (2005-2021) which met inclusion criteria. Data extraction and quality assessment for sixteen studies was performed by two reviewers. Narrative synthesis was conducted.Results: Eleven validated PREM's were identified which captured data for 15,831 PwLTNC. PREM scores indicated positive and negative experiences for people with Multiple Sclerosis (n = 13,123), Parkinson's Disease (n = 2215) and Acquired Brain Injury (n = 493). Negative experiences related to Picker Institute Principles: 1 (accessibility); 3 (coordination/continuity); 4 (involvement/support for family and carers); 5 (information provision), 6 (Involvement in decision making) and 7 (empathy and emotional support).Conclusion: Quantitative PREM's provide evidence of process quality and person-centred care within community rehabilitation and support services across large data sets of heterogeneous neurological conditions and geographical locations. Quality improvement initiatives for people with MS, PD and ABI should target processes relating to Picker Institute Principles 1,3,4,5,6, and 7.Implications for RehabilitationQuantitative validated Patient Reported Experience Measures can be used to evaluate process quality and person- centred care within community rehabilitation and support services for people with long term neurological conditions.Experiences of people with Multiple Sclerosis, Parkinson's Disease and Acquired Brain Injury indicate the need for quality improvement in community rehabilitation.Training in communication skills and person-centred care may enhance information provision and support for self-management for people with long term neurological conditions.
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Affiliation(s)
- Katherine Jackson
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
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Baker A, Cornwell P, Gustafsson L, Stewart C, Lannin NA. Implementation of best practice goal-setting in five rehabilitation services: A mixed-methods evaluation study. J Rehabil Med 2023; 55:jrm4471. [PMID: 37548542 PMCID: PMC10424097 DOI: 10.2340/jrm.v55.4471] [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: 08/23/2022] [Accepted: 04/05/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVE This implementation study aimed to enhance the key elements of clinical practice goal-setting across 5 rehabilitation services. DESIGN This study followed a participatory action research approach guided by the Knowledge to Action framework. METHODS Medical record audits and structured client interviews were conducted prior to and following 12 weeks of implementation, in order to evaluate the success of the goal-setting implementation package. RESULTS Medical record audits and interviews conducted pre-implementation (audits n = 132, interviews n = 64), post-implementation (audits n = 130, interviews n = 56) and at 3-month follow-up (audits n = 30) demonstrated varied success across sites. Following implementation 2 sites significantly improved their common goal focus (site 1 p ≤ 0.001, site 2 p = 0.005), these sites also demonstrated a significant increase in clients reporting that they received copies of their rehabilitation goals (site 1 p ≤ 0.001, site 2 p ≤ 0.001). Four sites improved client action planning, feedback and review, and 3 sites enhanced their specificity of goal-setting. At 3-month follow-up 4 sites had continued to improve their common goal focus; however, all sites decreased the specificity of their goal-setting. CONCLUSION Elements of the implementation package were successful at enhancing the goal-setting process; however, how the package is implemented within the team may impact outcomes.
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Affiliation(s)
- Amanda Baker
- School of Health Sciences and Social Work, Griffith University, Brisbane; Statewide Rehabilitation Clinical Network, Clinical Excellence Division, Queensland Health, Brisbane; Allied Health, Physiotherapy Department, Sunshine Coast Hospital and Health Service, Queensland Health, Sunshine Coast.
| | - Petrea Cornwell
- School of Health Sciences and Social Work, Griffith University, Brisbane; The Hopkins Centre, Menzies Health Institute Queensland, Brisbane
| | - Louise Gustafsson
- School of Health Sciences and Social Work, Griffith University, Brisbane; The Hopkins Centre, Menzies Health Institute Queensland, Brisbane
| | - Claire Stewart
- Allied Health, Physiotherapy Department, Sunshine Coast Hospital and Health Service, Queensland Health, Sunshine Coast
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Alfred Health, Melbourne, Australia
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Lee RW, Choi SH, Hu SH. Effect of temporal distance and goal type on predictions of future information security: Focus on moderation of self-efficacy and social responsibility. Acta Psychol (Amst) 2023; 238:103990. [PMID: 37478773 DOI: 10.1016/j.actpsy.2023.103990] [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: 04/24/2022] [Revised: 10/28/2022] [Accepted: 07/17/2023] [Indexed: 07/23/2023] Open
Abstract
We investigate how predictions of future information security vary according to temporal distance, goal type, and personal characteristics. A total of 368 participants rated the likelihood of achieving the two-goal types at present, and then one and ten years later. The future information security bias was found to be greater for a distant place than shortly, and it was found to be greater for private goal types than public goal types. Personal characteristics were classified into self-efficacy and social responsibility, and their effectiveness was verified. A self-efficacy test revealed that the information security bias for the two types of goals was higher when it was higher than the low self-efficacy group. In the case of social responsibility, the bias was found in the higher group than the lower group only in the public goal type, but not the private goal type. We conclude by presenting some implications for information security policy and suggestions for further research.
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Affiliation(s)
- Ryo-Whoa Lee
- Future Convergence Center, Chung-Ang University, Republic of Korea
| | - Seung-Hyuk Choi
- Department of Psychology, Korea University, Republic of Korea; Department of Psychology, Woo-Suk University, Republic of Korea
| | - Sung-Ho Hu
- Research Information Analysis Center, Korea University, Republic of Korea.
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Morgan KA, Heeb R, Flynn A, Sukow K, Tormey E, Tucker S, Walker K, Hollingsworth H. An observational study of personal and environmental factors associated with attendance at a community-based adaptive fitness center for adults with physical disabilities. Disabil Health J 2022; 15:101342. [PMID: 35710900 DOI: 10.1016/j.dhjo.2022.101342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Regular exercise has many benefits for adults with physical disabilities (AwPD). Despite these benefits, significant barriers to participating in exercise exist for AwPD. Community-based adaptive fitness centers promote exercise for AwPD by minimizing barriers. Research has yet to clearly examine the personal and environmental factors associated with enrollment and attendance rates of AwPD in community-based adaptive fitness centers. OBJECTIVE The purpose of our study was to explore personal and environmental factors associated with AwPD and their attendance at a community-based adaptive fitness center once enrolled. METHODS Individuals aged 18-85 with a physical disability interested in exercising were referred to a community-based adaptive fitness center. At initial assessment, participants completed demographics, health, barriers to exercise, and exercise self-efficacy (ESE) surveys. Following initial assessment, participant visits to the fitness center were tracked for six months. RESULTS Of 106 participants, 27 never visited the facility after initial assessment, and the remaining participants with six months of attendance data (n = 67) averaged 14.9 (SD = 14.2) visits. Correlation results showed a negative curvilinear relationship between number of visits and years living with disability (rs = -0.24, p < 0.05), with higher attendance associated with more recent diagnosis. Logistic and stepwise regressions showed that ESE score (β = 0.107, p = 0.026) was the only significant predictor of attending the fitness center once enrolled. CONCLUSIONS This study demonstrates the importance of understanding personal and environmental factors and assessing ESE for AwPD who are newly enrolled in a community-based adaptive fitness center.
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Affiliation(s)
- Kerri A Morgan
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States.
| | - Rachel Heeb
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States
| | - Ashley Flynn
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States
| | - Kayleigh Sukow
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States
| | - Erin Tormey
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States
| | - Susan Tucker
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States
| | - Kim Walker
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States
| | - Holly Hollingsworth
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States
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Jesus TS, Papadimitriou C, Bright FA, Kayes NM, Pinho CS, Cott CA. The Person-Centered Rehabilitation Model: Framing the concept and practice of person-centered adult physical rehabilitation based on a scoping review and thematic analysis of the literature. Arch Phys Med Rehabil 2021; 103:106-120. [PMID: 34228955 DOI: 10.1016/j.apmr.2021.05.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/04/2021] [Accepted: 05/11/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To develop a cross-professional model framing the concept and practice of Person-Centered Rehabilitation (PCR) in adult populations, based on a scoping review and thematic analysis of the literature. DATA SOURCES Key databases (PubMed, Scopus, CINAHL), snowballing searches, and experts' consultation were the data sources for English-language empirical or conceptual papers, published from January 2007 to February 2020. STUDY SELECTION Two independent reviewers selected adult-based papers addressing at least one of the six categories of PCR-related content, a priori specified in the published review protocol. From 6527 unique references, 147 were finally included in the analysis. Of those, 26 were exclusively conceptual papers. DATA EXTRACTION Two independent reviewers extracted textual data on what PCR entails conceptually or as a practice. No quality appraisals were performed as is typical in scoping reviews. DATA SYNTHESIS A thematic analysis produced thematic categories that were combined into an emergent model (the PCR Model), which was reviewed by five external experts. PCR was framed as a way of thinking about and providing rehabilitation services "with" the person. PCR is embedded in rehabilitation structures and practice across three levels: 1) the person-professional dyad, 2) the micro-system level (typically an interprofessional team, involving significant others) and 3) a macro-system level (organization within which rehabilitation is delivered). Thematic categories are articulated within each level, detailing both the conceptual and practice attributes of PCR. CONCLUSION The PCR model can inform both clinical and service organization practices. The PCR Model may benefit from further developments including obtaining wider stakeholders' input, determining relevance in different cultural and linguistic groups, and further operationalization and testing in implementation projects.
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Affiliation(s)
- Tiago S Jesus
- Global Health and Tropical Medicine (GHTM) & WHO Collaborating Centre for Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine - NOVA University of Lisbon, Rua da Junqueira 100, Lisbon 1349-008, Portugal.
| | | | - Felicity A Bright
- Centre for Person Centred Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Nicola M Kayes
- Centre for Person Centred Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Cátia S Pinho
- ISVOUGA - Superior Institute of Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Cheryl A Cott
- Rehabilitation Sciences Institute, Faculty of Medicine; University of Toronto, Toronto, Canada
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Baker A, Cornwell P, Gustafsson L, Lannin NA. An exploration of goal-setting practices in Queensland rehabilitation services. Disabil Rehabil 2021; 44:4368-4378. [PMID: 33961530 DOI: 10.1080/09638288.2021.1906957] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Goals are vital in rehabilitation; however, how goal-setting occurs varies widely in clinical practice. This study aims to review goal-setting practices across the rehabilitation continuum within varied case mix services in Queensland, Australia. METHOD A descriptive multisite qualitative case study with medical record audits and interviews of adult rehabilitation clients was used to evaluate four propositions across three inpatient and two community rehabilitation services. The propositions evaluated the process in which goal-setting occurs, action planning and review of goals, as well as the type, specificity and client-centeredness of goals set. RESULTS Goals (n = 1120) were often poorly defined, focussed on short term physical functioning and were predominantly set by individual disciplines with the client rather than using an interdisciplinary approach. Clients were not consistently given action plans to pursue goals (n = 59, 18%) and the review of goal progress (n = 60, 18%) was limited. Few clients reported receiving copies of their rehabilitation goals (n = 16, 25%). CONCLUSION Goal-setting in rehabilitation should be specific, meaningful and include the client in action planning, feedback and review. However, goal-setting in rehabilitation is often multidisciplinary and unstructured.Implications for rehabilitationBest-practice rehabilitation team goal-negotiation and goal-setting should include a common goal focus and incorporate components of staff and client action planning, coping planning, feedback and review.Rehabilitation clients prefer shared-decision making approaches to setting meaningful and personalised goals, however, require time and support to engage in the goal-setting and negotiation process.Rehabilitation clinicians need training and support to improve their goal negotiation and goal writing skills to create specific, understandable and meaningful goals with rehabilitation clients.
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Affiliation(s)
- Amanda Baker
- School of Allied Health Sciences, Griffith University, Brisbane, Australia.,Statewide Rehabilitation Clinical Network, Clinical Excellence Division, Queensland Health, Brisbane, Australia.,Allied Health, Department of Physiotherapy, Sunshine Coast Hospital and Health Service, Queensland Health, Nambour, Australia
| | - Petrea Cornwell
- School of Allied Health Sciences, Griffith University, Brisbane, Australia
| | - Louise Gustafsson
- School of Allied Health Sciences, Griffith University, Brisbane, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.,Alfred Health, Melbourne, Australia
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Brunner M, Hemsley B, Togher L, Dann S, Palmer S. Social Media and People With Traumatic Brain Injury: A Metasynthesis of Research Informing a Framework for Rehabilitation Clinical Practice, Policy, and Training. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:19-33. [PMID: 33332986 DOI: 10.1044/2020_ajslp-20-00211] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The aim of the study was to investigate the experiences of people with traumatic brain injury (TBI) and rehabilitation professionals in use of social media after TBI. Design Metasynthesis of a multilevel mixed-methods research design was used in the study. Method A qualitative metasynthesis of (a) evidence in the literature regarding the use of communication technologies and social media after TBI, (b) Twitter data and network analysis, (c) interviews with people with TBI (n = 13), (d) focus groups with TBI rehabilitation professionals (n = 11), and (e) a review of current guidance on safe use of social media was conducted. Results People with TBI adopt a trial-and-error approach to using social media. Their meaningful use and a sense of connection enable them to develop social media mastery. TBI rehabilitation professionals' concerns regarding potential risks associated with using social media might lead them to restrict social media use during rehabilitation. Conclusions Access to proactive training in social media use and a supportive network of rehabilitation professionals, family, and friends can enable people with TBI to develop social media mastery through working collaboratively on social media goals. This metasynthesis of research culminates in an evidence-based protocol for assessing and supporting a person with TBI's social media goals to guide clinical practice and future research in the field.
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Affiliation(s)
- Melissa Brunner
- Department of Speech Pathology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- Department of Speech Pathology, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Bronwyn Hemsley
- Department of Speech Pathology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- Faculty of Education and Arts, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Leanne Togher
- Department of Speech Pathology, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Stephen Dann
- College of Business and Economics, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Stuart Palmer
- Melbourne Centre for the Study of Higher Education, The University of Melbourne, Victoria, Australia
- WorkSafe Victoria, Geelong, Australia
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The Impact of Socio-environmental Barriers on the Process of Engagement in Cardiac Rehabilitation Programs. BEHAVIOUR CHANGE 2020. [DOI: 10.1017/bec.2020.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractCardiac rehabilitation (CR) is a multi-disciplinary intervention designed to stabilise, slow, or reverse CVD, restore health following a cardiac event and facilitate the prevention of further events. The Model of Therapeutic Engagement (MTE) is a comprehensive conceptual model for explaining the process of engagement in rehabilitation. Of concern is that the role of socio-environmental factors is absent from explaining individual engagement in the MTE. There is also a lack of prospective studies investigating the impact of socio-environmental barriers on engagement in CR programs over time. This study aimed to expand the MTE, by illuminating the role of socio-environmental barriers in a three-stage process of engagement in CR programs. A prospective study was conducted, with 217 individuals recruited from the Cardiology Ward in the Gold Coast University Hospital (GCUH) and the Robina Cardiac Rehabilitation Centre. The collected data were examined using a structural equation model that added socio-environmental factors into the MTE, using multi-group analyses. In this study, we found that socio-environmental factors were not associated with intention to engage in the CR program, but were related to actual attendance and maintenance of participation in CR programs. Knowing how these socio-environmental barriers affect the process of engagement at different stages may help to tailor more accessible CR programs for the population.
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Abstract
AbstractThe primary aim of this study was to test the causal structure of the model of therapeutic engagement (MTE) for the first time, to examine whether the model assists in understanding the process of patient engagement in cardiac rehabilitation (CR) programs. This study used a prospective design, following up patients from the Gold Coast University Hospital Cardiology ward who attended Robina Cardiac Rehabilitation Clinic. A structural equation model of the interactions among the proposed variables within the three stages of the MTE (intention to engage in CR programs, CR initiation, and sustained engagement) revealed significant relationships among these variables in a dataset of 101 patients who attended a CR program. However, no relationship was discerned between outcome expectancies and patient intention to engage in CR. Patients’ willingness to consider the treatment also mediated the relationship between perceived self-efficacy and patient intention to engage in CR. These findings help clarify the process proposed by Lequerica and Kortte (2010) in the context of patient engagement in CR programs. The findings also reveal information on how patients engage in CR programs. Importantly, this provides new information for healthcare providers, enabling them to more effectively engage patients according to their stage of engagement.
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Thomson AE, Racher F, Clements K. Person-Centered Psychiatric Nursing Interventions in Acute Care Settings. Issues Ment Health Nurs 2019; 40:682-689. [PMID: 31074676 DOI: 10.1080/01612840.2019.1585495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The knowledge base and understanding regarding psychiatric nursing interventions in acute care settings has been limited. The purpose of this hermeneutic phenomenological study was to explore psychiatric nurses' experiences in providing nursing interventions to adult clients in acute care settings. Six expert psychiatric nurses were recruited through purposive, snowball sampling and participated in key informant interviews. Analysis of the data revealed the central theme of person-centered care (PCC), which involved developing and delivering PCC plans; determining goals; fostering empathy, support, and hope; listening in one-to-one interactions; providing person-centered teaching; and enhancing coping strategies.
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Affiliation(s)
- Andrea E Thomson
- a Department of Psychiatric Nursing, Faculty of Health Studies , Brandon University , Winnipeg , Canada
| | - Fran Racher
- b Department of Psychiatric Nursing, Faculty of Health Studies , Brandon University , Brandon , Canada
| | - Karen Clements
- a Department of Psychiatric Nursing, Faculty of Health Studies , Brandon University , Winnipeg , Canada
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Balancing patient priorities for technical and interactional aspects of care in a measure of primary care quality. Prim Health Care Res Dev 2019; 20:e85. [PMID: 32799986 PMCID: PMC8060840 DOI: 10.1017/s1463423619000392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM This study attempts to strike a balance to measure primary care quality in a way that considers what is important to patients, providers and the healthcare system, all at the same time. BACKGROUND The interest in delivering patient-centered primary care implies a need for patient-centered performance measurement. However, the distinction between measures of patient experience and technical aspects of care raises an unanswerable question: if a provider has good performance on technical measures but not on patient experience measures (or vice versa), what can be said about the quality of care? METHODS We surveyed patients to determine the relative priorities of each of a series of primary care measures in the patients' relationship with their primary care provider. The on-line survey was co-designed with patient co-investigators. The items consisted of 14 primary care quality measures used in pre-existing performance report, 41 additional indicators including a novel set of patient-generated Key Performance Indicators and 17 questions about patients' demographics, health and socioeconomic status as well as open-ended questions. FINDINGS Despite challenges, the study suggests that this is feasible. We argue that it is necessary to get better at measuring and finding ever-better ways to put patients at the center of primary care.
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Goal statements in brain injury rehabilitation: A cohort study of client-centredness and relationship with goal outcome. BRAIN IMPAIR 2019. [DOI: 10.1017/brimp.2019.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground:Currently, there is increasing recognition of the need to use a client-centred approach to goal setting in rehabilitation. However, there is limited research to guide practice with community-dwelling clients with acquired brain injury. An understanding of the characteristics of client-centred goals and the extent to which client-centeredness influences goal outcomes is required.Objective:To examine the relationships between the client-centredness of goals and their characteristics, content, recall and outcomes of client-centred goals in brain injury rehabilitation.Methods:A prospective cohort design study was employed. Participants were 45 clients with brain injury receiving outpatient rehabilitation, who completed measures of client-centredness after goal setting. Each goal was classified according to whether it was specific, measurable, non-jargonistic, and participation-focussed, included a timeframe and was recalled by participants.Results:Participants set 223 goals with 20 clinicians from multiple disciplines. Levels of client-centredness did not differ according to the characteristics, content and recall of goals, with the exception of goal specificity (p< 0.01). Client-centredness was significantly and positively correlated with goal outcomes (p< 0.05).Conclusions:The use of client-centred goals is recommended for improved rehabilitation outcomes. Applying goal documentation criteria does not necessarily mean that goals will be client-centred, and highly specific goal statements may not reflect what is important and meaningful to clients.
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Elf M, Flink M, Nilsson M, Tistad M, von Koch L, Ytterberg C. The case of value-based healthcare for people living with complex long-term conditions. BMC Health Serv Res 2017; 17:24. [PMID: 28077130 PMCID: PMC5225615 DOI: 10.1186/s12913-016-1957-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 12/15/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is a trend towards value-based health service, striving to cut costs while generating value for the patient. The overall objective comprises higher-quality health services and improved patient safety and cost efficiency. The approach could align with patient-centred care, as it entails a focus on the patient's experience of her or his entire cycle of care, including the use of well-defined outcome measurements. Challenges arise when the approach is applied to health services for people living with long-term complex conditions that require support from various healthcare services. The aim of this work is to critically discuss the value-based approach and its implications for patients with long-term complex conditions. Two cases from clinical practice and research form the foundation for our reasoning, illustrating several challenges regarding value-based health services for people living with long-term complex conditions. DISCUSSION Achieving value-based health services that provide the health outcomes that matter to patients and providing greater patient-centredness will place increased demands on the healthcare system. Patients and their informal caregivers must be included in the development and establishment of outcome measures. The outcome measures must be standardized to allow evaluation of specific conditions at an aggregated level, but they must also be sensitive enough to capture each patient's individual needs and goals. Healthcare systems that strive to establish value-based services must collaborate beyond the organizational boundaries to create clear patient trajectories in order to avoid fragmentation. The shift towards value-based health services has the potential to align healthcare-service delivery with patient-centred care if serious efforts to take the patient's perspective into account are made. This is especially challenging in fragmented healthcare systems and for patients with long-term- and multi-setting-care needs.
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Affiliation(s)
- Marie Elf
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden.
| | - Maria Flink
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden
- Department of Social Work, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Marie Nilsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden
- Department of Social Work, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Malin Tistad
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Lena von Koch
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden
- Department of Neurobiology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden
- Functional Area Occupational Therapy & Physiotherapy, Karolinska University Hospital Huddinge, Stockholm, Sweden
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15
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Doig E, Prescott S, Fleming J, Cornwell P, Kuipers P. Reliability of the Client-Centeredness of Goal Setting (C–COGS) Scale in Acquired Brain Injury Rehabilitation. Am J Occup Ther 2016; 70:7004290010. [DOI: 10.5014/ajot.2016.017046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. To examine the internal reliability and test–retest reliability of the Client-Centeredness of Goal Setting (C–COGS) scale.
METHOD. The C–COGS scale was administered to 42 participants with acquired brain injury after completion of multidisciplinary goal planning. Internal reliability of scale items was examined using item–partial total correlations and Cronbach’s α coefficient. The scale was readministered within a 1-mo period to a subsample of 12 participants to examine test–retest reliability by calculating exact and close percentage agreement for each item.
RESULTS. After examination of item–partial total correlations, test items were revised. The revised items demonstrated stronger internal consistency than the original items. Preliminary evaluation of test–retest reliability was fair, with an average exact percent agreement across all test items of 67%.
CONCLUSION. Findings support the preliminary reliability of the C–COGS scale as a tool to evaluate and promote client-centered goal planning in brain injury rehabilitation.
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Affiliation(s)
- Emmah Doig
- Emmah Doig, PhD, BOccThy Hons, is Research Fellow, School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia Campus, Brisbane, Australia;
| | - Sarah Prescott
- Sarah Prescott, BOccThy Hons, is PhD Candidate, School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia Campus, Brisbane, Australia
| | - Jennifer Fleming
- Jennifer Fleming, PhD, BOccThy Hons, is Associate Professor, School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia Campus; Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia; and Occupational Therapist, Centre for Functioning and Health Research, Metro South Health District, Queensland Health, Brisbane, Australia
| | - Petrea Cornwell
- Petrea Cornwell, PhD, BSpPath Hons, is Principal Research Fellow, Metro North Hospital and Health Service, Department of Health, and School of Applied Psychology, Menzies Health Institute, Griffith University, Queensland, Australia, and Associate Professor, School of Allied Health Sciences, Griffith University, Brisbane, Australia
| | - Pim Kuipers
- Pim Kuipers, PhD, BA Hons, MA, Grad Dip Rehab, is Associate Professor, Centre for Functioning and Health Research, Metro South Health District, Queensland Health, and Centre of National Research on Disability and Rehabilitation Medicine, Griffith Health Institute, Griffith University, Brisbane, Australia
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16
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D’Cruz K, Unsworth C, Roberts K, Morarty J, Turner-Stokes L, Wellington-Boyd A, Matchado J, Lannin NA. Engaging patients with moderate to severe acquired brain injury in goal setting. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2016. [DOI: 10.12968/ijtr.2016.23.1.20] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kate D’Cruz
- Lecturer, Department of Community and Clinical Allied Health, La Trobe University, Melbourne, Australia
| | - Carolyn Unsworth
- Professor, Department of Community and Clinical Allied Health, La Trobe University, Melbourne, Australia
| | - Karen Roberts
- Occupational therapist, Alfred Health, Melbourne, Australia
| | - Jacqui Morarty
- Manager, ABI Community and Transitional Living Service, Alfred Health, Melbourne, Australia
| | - Lynne Turner-Stokes
- Herbert Dunhill Professor of Rehabilitation, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London and Director, Regional Rehabilitation Unit, Northwick Park Hospital, Harrow, Middlesex, UK
| | - Anna Wellington-Boyd
- Clinical support and development leader–acute social work, Alfred Health, Melbourne, Australia
| | - Joanne Matchado
- Social worker–acute neurosurgery, Alfred Health, Melbourne, Australia
| | - Natasha A Lannin
- Associate professor in occupational therapy, La Trobe University, Melbourne, Australia
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17
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Ziviani J. Occupational performance: a case for self-determination. Aust Occup Ther J 2015; 62:393-400. [DOI: 10.1111/1440-1630.12250] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Jenny Ziviani
- Children's Health Queensland and School of Health and Rehabilitation Sciences; The University of Queensland; Australia
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18
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Mroz TM, Pitonyak JS, Fogelberg D, Leland NE. Client Centeredness and Health Reform: Key Issues for Occupational Therapy. Am J Occup Ther 2015; 69:6905090010p1-8. [PMID: 26356651 PMCID: PMC4564793 DOI: 10.5014/ajot.2015.695001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Health reform promotes the delivery of patient-centered care. Occupational therapy's rich history of client-centered theory and practice provides an opportunity for the profession to participate in the evolving discussion about how best to provide care that is truly patient centered. However, the growing emphasis on patient-centered care also poses challenges to occupational therapy's perspectives on client-centered care. We compare the conceptualizations of client-centered and patient-centered care and describe the current state of measurement of client-centered and patient-centered care. We then discuss implications for occupational therapy's research agenda, practice, and education within the context of patient-centered care, and propose next steps for the profession.
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Affiliation(s)
- Tracy M Mroz
- Tracy M. Mroz, PhD, OTR/L, is Assistant Professor, Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle;
| | - Jennifer S Pitonyak
- Jennifer S. Pitonyak, PhD, OTR/L SCFES, is Assistant Professor, Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Donald Fogelberg
- Donald Fogelberg, PhD, OTR/L, is Assistant Professor, Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Natalie E Leland
- Natalie E. Leland, PhD, OTR/L, BCG, FAOTA, is Assistant Professor, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, and Davis School of Gerontology, University of Southern California, Los Angeles
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