A critical discourse analysis of the attitudes of occupational therapists and physiotherapists towards the systematic use of standardised outcome measurement

Abstract

Purpose: To investigate discourses relating to the implementation of standardised outcome measurement within rehabilitation practise. Method: It is a critical discourse analysis of texts in professional occupational therapist (OT) and physiotherapist (PT) journals, along with transcriptions from three focus group interviews with 25 OTs and PTs in local rehabilitation settings. Results: Although positive attitudes towards outcome measurement were expressed in the professional journals, OTs and PTs in local settings had professional reservations about standardisation of the rehabilitation practise. The therapists were caught in what they considered to be a dilemma between taking a holistic approach and performing standardised practise. Systematic outcome measurement challenged the core values of their practise. Therapists often felt that ‘it did not make sense’ to use outcome measurement and this became a barrier to its implementation. Conclusion: If the use of standardised outcome measurement is to be increased, reflection is needed on how the measurements can be integrated to provide a meaningful contribution to individual rehabilitation processes. To optimise implementation, it is essential to make use of research in knowledge translation and adapt it to fit with the ways in which new ideas and recommendations are implemented in local rehabilitation contexts.Implications for RehabilitationSuccessful implementation of standardised outcome measurements depends on whether occupational therapists and physiotherapists have an experience of the measurements as being meaningful.Enforcement of standardised outcome measurements must be done by means of more than a few isolated arguments, if professional acceptance is to be gained.To reject established dogmas on, e.g. standardisation, deliberate and conscious reflections in local settings are needed. It is necessary to go beyond normal and familiar professional reflections. To this end, newcomers’ opinions are valuable.