Involvement In Rehabilitation Research Articles

Client-Centered Rehabilitation for Outpatients With Hand-Related Injuries

Background: There is evidence to support client-centeredness as an approach in occupational therapy, because it improves functioning in everyday living. However, client-centeredness is difficult to measure. Only a few studies investigate client-centeredness from the client’s perspective and few questionnaires measure clients’ experiences of the approach. To our knowledge, no one has measured the approach from an outpatient perspective. Because the approach was developed from theory and the professionals’ viewpoint, and because studies show only moderate agreement between clients’ and therapists’ views, it seems relevant to develop a questionnaire to measure the client’s perspective of client-centeredness in outpatient rehabilitation. Objective: The objective of this study was to develop a questionnaire to categorize the experience of client-centeredness in rehabilitation among patients with hand-related disorders. Materials and Methods: Focus group interviews in patients with hand-related disorders in different outpatient settings in Denmark have been completed to investigate the patient’s perspective of client-centeredness. Data were analyzed by deductive content analysis. Items have been generated from the interviews and core values from occupational therapy research. The preliminary questionnaire has been cognitively tested. Results: A preliminary analysis of the patient’s perspective of client-centeredness shows the following important themes: information, coordination between wards and professionals, involvement in decision making, being listened to, evaluation of body function, activity and participation, and enabling everyday life activities. A final analysis and a preliminary questionnaire will be presented at IFSHT-16. Conclusion: The preliminary analysis shows consistency in core values from occupational therapy literature and themes mentioned by patients with hand-related injuries. Patients consider involvement in rehabilitation to be crucial. It seems to be important for the quality of rehabilitation that measurement instruments to evaluate patients’ perceptions of client-centeredness are developed.

Sensitive periods and language in cochlear implant users.

This study explores the hypothesis that the existence of a short sensitive period for lower-level speech perception/articulation skills, and a long one for higher-level language skills, may partly explain the language outcomes of children with cochlear implants (CIs). The participants were fourteen children fitted with a CI before their second birthday. Data about their language skills and the environmental conditions (e.g. Family Involvement in rehabilitation) were obtained over a period of three years. Age at implantation correlated exclusively with the ratio of errors of place of articulation, a phonological feature for which CIs provide insufficient information. The degree of Family Involvement was significantly correlated with the remaining language measures. We conclude that small plasticity reductions affecting lower-level skills may partly explain the difficulties of some CI users in developing language.

The involvement of older people in their rehabilitation: Generating a substantive grounded theory

Aims: To identify the process of involvement in rehabilitation and produce a substantive theory of involvement based on data from a grounded theory study. Methods: Qualitative data were collected longitudinally from 4 older people and 15 health care staff during the older people's stay in a rehabilitation unit in the UK and after discharge. Data were collected as recorded interviews with the older person in rehabilitation, interviews with their practitioners and routine conversations between the participants and staff. Results: This study describes the components of involvement and how they interact within therapeutic relationships. The results suggest that involvement in rehabilitation operates through a set of involvement attributes, which are either psychologically based or action-based. The involvement attributes are: vision and incentive with goal planning, setting and achievement; a disposition towards rehabilitation; personal learning; and risk taking, all of which operate within therapeutic relationships. To be maximally involved, the involvement attributes have to be strong and balanced, with alignment between the psychologically based and action-based attributes. Conclusions: The findings of this research and substantive grounded theory suggest that the process of involvement is managed through a set of involvement attributes within therapeutic relationships. This substantive theory of involvement is associated with earlier research and provides a fuller understanding of the process of involvement of older people in rehabilitation. Further research is now needed to demonstrate the transferability of this substantive theory in other settings and with other client groups.

Understanding nursing practice in stroke units: a Q-methodological study

Purpose: Nurses represent the largest professional group working with stroke-survivors, but there is limited evidence regarding nurses’ involvement in post-stroke rehabilitation. The purpose of this study was to identify and explore the perspectives of nurses and other multidisciplinary stroke team members on nurses’ practice in stroke rehabilitation. Method: Q-methodological study with 63 multidisciplinary stroke unit team members and semi-structured interviews with 27 stroke unit team members. Results: Irrespective of their professional backgrounds, participants shared the view that nurses can make an active contribution to stroke rehabilitation and integrate rehabilitation principles in routine practice. Training in stroke rehabilitation skills was viewed as fundamental to effective stroke care, but nurses do not routinely receive such training. The view that integrating rehabilitation techniques can only occur when nursing staffing levels were high was rejected. There was also little support for the view that nurses are uniquely placed to co-ordinate care, or that nurses have an independent rehabilitation role. Conclusions: The contribution that nurses with stroke rehabilitation skills can make to effective stroke care was understood. However, realising the potential of nurses as full partners in stroke rehabilitation is unlikely to occur without introduction of structured competency-based multidisciplinary training in rehabilitation skills.Implications for RehabilitationMultidisciplinary rehabilitation in stroke units is a cornerstone of effective stroke care.Views of stroke unit team members on nurses’ involvement in rehabilitation have not been reported previously.Nurses can routinely incorporate rehabilitation principles in their care.Specialist competency-based stroke rehabilitation training needs to be provided for nurses as well as for allied health professionals.

A day in the life of older people in a rehabilitation setting: an observational study

Purpose: Nurses' contribution during inpatient rehabilitation is well documented. However, despite being the largest professional group in this setting, the specialty of rehabilitation nursing is poorly recognised. This article reports on the first of a four-phase study that aimed to clarify and develop the nursing contribution to inpatient rehabilitation for older persons. The aim of this study was to identify activity patterns and time use during daytime and evenings of older adult patients undergoing inpatient rehabilitation. Methods: Direct observation using behavioural modelling was undertaken of a convenience sample of 37 older people undergoing inpatient rehabilitation in a specialist unit of a large tertiary hospital in New Zealand. The primary outcome was the observation of meaningful activity. Binomial logistic regression was used to study the association between relevant variables. Findings: Meaningful activity was most likely to involve walking without assistance and to occur 08:00 to 14:00 h and 16:00 to 21:00 h during weekdays. Patients were more likely to receive treatment during the weekend. Irrespective of time, registered nurses were the health professionals most often present with patients. Conclusions: There is likely to be unrealised opportunities for registered nurses to support improved rehabilitation outcomes. Registered nurses' involvement in rehabilitation needs to be actively optimised.Implications for RehabilitationNurses' engagement with older adults in rehabilitation settings is likely to be substantial, placing them as key members of the rehabilitation team.Nurses make a pivotal contribution to inpatient rehabilitation based on specialised knowledge and skills but this contribution is not well understood.Opportunities are likely, at times when allied health professionals are less often present, e.g. evenings and weekends, for registered nurses to more intentionally overlap rehabilitation activities with other care requirements.

Embracing life after prostate cancer. A male perspective on treatment and rehabilitation

This study explores prostate cancer patients' experiences of rehabilitation after radiotherapy with androgen deprivation therapy (ADT). Patients who had completed a multidisciplinary rehabilitation programme with psychosocial support and physiotherapy were interviewed in two focus groups: Group 1 consisted of six men who came to the rehabilitation with their spouses, and Group 2 of seven men who came alone. Meaning condensation was used to analyse the interviews. Radiotherapy was described as full-time work. Adverse effects due to ADT influencing masculinity and identity were emphasised. The men embraced life with a particular sense of humour. Whether rehabilitation was experienced as useful depended on the health professionals' approach, and on the patients' motivation and effort to contribute to health promotion, and to convert experiences into coping strategies. The supportive role of the spouse was emphasised by several, but some men preferred to handle the process alone. In conclusion, men undergoing ADT should be carefully informed of the consequences. Spousal involvement in rehabilitation must be decided by the patient. The focus group interviews themselves had a positive impact on the men's understanding of their rehabilitation processes. The specific male approach and differences between the needs of female and male cancer patients are important to understand when planning rehabilitation.

Learning via participation – a user perspective on user involvement in mental health rehabilitation

Abstract The aim of the study is to gain insight into the user's perspective on user involvement in mental health rehabilitation. The study was designed as a field study lasting 15 months in two supported housing schemes. An ethnographic approach by James Spradley was employed, involving participant observation, informal conversations, and individual- and group-interview. A phenomenological-hermeneutic approach inspired by Paul Ricoeur's theory on text interpretation was used, including theories of situated learning. The results of the study show that the users experienced their involvement in rehabilitation to be associated with learning processes in interaction with residents as well as professionals. Learning took place via legitimate peripheral participation, via support from and negotiations with professionals and support from peer residents. Both opportunities for and limitations for learning were experienced. The transferability of knowledge and skills to life in a community was questioned, as limi...

Nursing contribution to the rehabilitation of older patients: patient and family perspectives

This article reports a study of the perspective of older patients and their family members on the role of nurses in inpatient rehabilitation. Rehabilitation services are used increasingly by older patients as life expectancy increases. The role of rehabilitation nurses in the multidisciplinary team has, however, yet to be clearly articulated. Previous research has focussed on the views of health professionals about nursing involvement in rehabilitation, but none has sought family members' perspectives. With the expectation of patient-centred care, it is important to consider what older patients and their families expect and require from nurses. Grounded theory was used to collect and analyse data from interviews in an inpatient rehabilitation unit in New Zealand with seven patients, aged 72-89 years, and six family members, during 2009-2010. A substantive theory was developed which recognizes that the older patient values the relationship they build with nurses more than any specific role nurses perform. Participants acknowledged that rehabilitation nurses' roles included 'looking after', 'stepping in' and 'coaching independence' but 'best fit' nurses were identified by patients based on their 'nature', 'being available' and 'being attuned' to the patient's individual needs. If a 'connection' was formed, then this 'best fit relationship' maximized the older person's motivation to participate in his or her rehabilitation therapy. Patients and family members appreciate 'best fit relationships' where nurses seek to enter into the older person's world of disability to form a partnership which enhances their motivation to achieve independence.

User involvement in mental health rehabilitation: a struggle for self-determination and recognition

Aim: The study aimed to explore service user involvement in supported housing schemes as experienced by adults with mental illness in interplay with professionals during rehabilitation. Method: The study was designed as a field study in two supported housing schemes, using an ethnographic approach to data collection, including participant observation, informal conversations, and individual and group interview. Twelve participants aged 22 to 45 were included. The data analysis was informed by Ricoeur's theory of textual interpretation, and followed his three levels of interpretation: naive reading, structural analysis, and critical interpretation. Findings: The study showed that user involvement in rehabilitation was experienced by the users as a struggle for self-determination and recognition. Being able to decide and to have influence on daily activities and everyday life, together with having goals to reach during rehabilitation, were viewed as valuable. Situations without influence or involving coercion were reported especially during periods of illness or hospitalization. Conclusions: The results of this study contribute to knowledge about user involvement from service users' perspective, and highlight the difficulties experienced in achieving self-determination and recognition during rehabilitation.

Provider Perspectives on Rehabilitation of Patients With Polytrauma

Friedemann-Sánchez G, Sayer NA, Pickett T. Provider perspectives on rehabilitation of patients with polytrauma. ObjectivesTo describe, from the perspective of U.S. Department of Veterans Affairs (VA) polytrauma rehabilitation providers, (1) patients with combat-related polytrauma and their rehabilitation, (2) polytrauma patient family member involvement in rehabilitation, and (3) the impact on providers of providing polytrauma rehabilitation. DesignQualitative study based on rapid assessment process methodology, which included semistructured interviews, observation, and use of a field liaison. SettingThe 4 VA polytrauma rehabilitation centers (PRCs). ParticipantsFifty-six purposefully selected PRC providers and providers from consulting services. InterventionsNot applicable. Main Outcomes MeasuresProvider self-report of polytrauma patient characteristics, polytrauma patient family member involvement in rehabilitation, and the impact of polytrauma rehabilitation on providers themselves. ResultsAccording to PRC providers, polytrauma patients are younger than VA rehabilitation patients. Strong military identities affect rehabilitation needs and reactions to severe injury. The public and the media have particular interest in war-injured patients. Patients with blast-related polytrauma have unique constellations of visible (including amputations, craniectomies, and burns) and invisible (including traumatic brain injury, pain, and posttraumatic stress disorder) injuries. Providers have adjusted treatment strategies and involved services outside of rehabilitation because of this clinical complexity. Family members are intensely involved in rehabilitation and have service needs that may surpass those of families of rehabilitation patients without polytrauma. Sources of provider stress include new responsibilities, media attention, increased oversight, and emotional costs associated with treating severely injured young patients and their families. Providers also described the work as deeply rewarding. ConclusionsThe VA should prioritize the identification or development and implementation of strategies to address family member needs and to monitor and ensure that PRC providers have access to appropriate resources. Future research should determine whether findings generalize to patients injured in other wars and to people who sustain polytraumatic injuries outside of a war zone, including victims of terrorist attacks.

Benefits and challenges of providing transitional rehabilitation services to people with spinal cord injury from regional, rural and remote locations

To identify the factors influencing participation and outline the benefits and challenges of providing transitional rehabilitation for people with spinal cord injury (SCI) from rural and regional locations. Grounded Theory analysis of service records and policy documents. One transitional rehabilitation service for people with SCI. Service records of 40 individuals with SCI from non-metropolitan locations who participated in transitional rehabilitation and 29 individuals with SCI who declined transitional rehabilitation over a two-year period. Home-based transitional rehabilitation programs offered by a multidisciplinary team including physiotherapy, occupational therapy, nursing and social work. Participation was measured using the percentage of people from non-metropolitan locations who decline transitional rehabilitation. The benefits and challenges of transitional rehabilitation were identified using open, axial and selective coding of service records. People with SCI from non-metropolitan areas were underrepresented among transitional rehabilitation participants, with 69% of those declining transitional rehabilitation coming from regional or rural areas. The study identified five functions of transitional rehabilitation that presented both benefits and challenges of this model in assisting people from non-metropolitan locations. These included: (1) the identification, education, coordination and funding of local care providers; (2) family involvement in rehabilitation; (3) contact with social and community supports; (4) specialist support to problem-solve discharge needs; and (5) skill acquisition and transfer in a community environment. The transitional rehabilitation model offers many advantages over traditional hospital-based rehabilitation but still faces challenges in offering an equitable model for people with SCI from non-metropolitan locations.

People with arthritis and their families in rehabilitation, care and research

People with arthritis play major roles in treatment and research. This review summarises the current knowledge on tools for enhancing shared-decision making in arthritis care; individual and family involvement in rehabilitation; and the consumer's role in arthritis research. There are discrepancies in the use of appropriate arthritis treatment. To facilitate evidence-informed treatment choices, a number of decision aids have been developed. A recent systematic review concluded that decision aids could improve the shared-decision making process in a variety of diseases; but only one clinical trial was found on a musculoskeletal condition (back surgery). The evidence on family member participation in arthritis education programs is mixed, partly due to a lack of content specifically targeting family members in some studies. Finally, people with arthritis are playing important roles as collaborators in research. Early experience indicates a mutually beneficial relationship for both the individual and researchers. This review offers three recommendations: First, further clinical trials are needed to test the effectiveness of decision aids in arthritis management. Second, education programs involving strong social support training for family members may improve client outcomes. Third, we encourage further studies to examine the experiences and challenges of people living with arthritis when participating as research partners.

The views of patients with spinal cord injuries on their rehabilitation experience

Background and Purpose: Spinal rehabilitation programs seek toenhance the residual functional abilities of people who have an acquired disabling impairment because of SCI. Very little has been published on how patients experience rehabilitation, and what the implication of their experience is on rehabilitation outcomes. The aim of this pilot study was to explore the views of patients with SCI regarding their experience of rehabilitation while in hospital.Materials and Methods: A qualitative exploratory study using semi-structured interviews was employed. Twelve patients constituted the sample of convenience. Qualitative techniques were used to analyze the data.Results: The study revealed a variety of psycho-emotional issues related to the patients’ experience of rehabilitation. Positive issues included being treated humanly, being told the truth abouttheir condition early on, family involvement in rehabilitation and being allowed to contribute to decision making regarding their rehabilitation. Negative issues were mainly their lack of insight into their health condition.Conclusion: The study highlighted important psycho-emotional issues related to the patients’ experience of rehabilitation. Rehabilitation personnel must consider these issues when working with patients with spinal cord injury, to ensure effective rehabilitation outcomes.

Psychiatric rehabilitation on an inpatient unit

This article describes an organizational improvement project carried out in an Australian inpatient psychiatric unit. It examined nurses' perception of rehabilitation and how their involvement in rehabilitation could be facilitated. The findings highlight the importance of collaboration in bringing about changes in service delivery.

Enabling people with aphasia to discuss quality of life

This article describes a study that examined the effectiveness of Talking Mats, a low-tech communication framework, in allowing people with communication difficulties as a result of stroke to discuss their quality of life. The study included 12 people in different residential situations. The findings have implications for consumer involvement in rehabilitation.

Assessing Family Involvement in Traumatic Brain Injury Rehabilitation: The Development of a New Instrument

A measure for assessing family involvement in traumatic brain injury rehabilitation (TBI) was developed. The Family Involvement Assessment Scale (FIAS) is theoretically based on Barrer's (1988) model of family involvement in TBI rehabilitation, which highlights two dimensions, "support" and "involvement." An initial pool of 337 items believed to be related to the constructs of "support" and "involvement" was generated. Forty-nine items were systematically selected from the initial pool and included in a preliminary assessment form in which 172 professionals rated the items on the dimensions of support and involvement. Eleven items were subsequently eliminated from the original pool based on these ratings. The remaining 38 items were used by 181 of the professionals to evaluate the involvement of actual family members of patients receiving TBI rehabilitation services in their programs. A factor analysis was performed on a remaining pool of 38 items. Three factors with an eigenvalue greater than 2.0 accounted for 48.8% of the total variance. One item that did not significantly load on any of the factors was eliminated. The FIAS includes a final set of 37 items, comprised of three subscales based on the factor analysis. Two of the scales, the Involvement-Rehabilitation (IR) scale and the Support (S) scale correspond, respectively, to Barrer's (1988) dimensions of "involvement" and "support." The third scale, Involvement-Patient (IP), is a unique construct that measures the degree to which a family member is involved in the rehabilitation process with respect to their involvement and relationship with the patient. The three scales yielded adequate internal reliabilities. Correlation coefficients between the scales indicated that the IR and S scale are not statistically related, but the IP scale is significantly related to both the IR and S scales. Interrater and test-retest reliability, and concurrent and predictive validity for the FIAS are still to be determined.

Assessing Family Involvement in Traumatic Brain Injury Rehabilitation: The Development of a New Instrument

A measure for assessing family involvement in traumatic brain injury rehabilitation (TBI) was developed. The Family Involvement Assessment Scale (FIAS) is theoretically based on Barrer's (1988) model of family involvement in TBI rehabilitation, which highlights two dimensions, “support” and “involvement.” An initial pool of 337 items believed to be related to the constructs of “support” and “involvement” was generated. Forty-nine items were systematically selected from the initial pool and included in a preliminary assessment form in which 172 professionals rated the items on the dimensions of support and involvement. Eleven items were subsequently eliminated from the original pool based on these ratings. The remaining 38 items were used by 181 of the professionals to evaluate the involvement of actual family members of patients receiving TBI rehabilitation services in their programs. A factor analysis was performed on a remaining pool of 38 items. Three factors with an eigenvalue greater than 2.0 accounted for 48.8% of the total variance. One item that did not significantly load on any of the factors was eliminated. The FIAS includes a final set of 37 items, comprised of three subscales based on the factor analysis. Two of the scales, the Involvement-Rehabilitation (IR) scale and the Support (S) scale correspond, respectively, to Barrer's (1988) dimensions of “involvement” and “support.” The third scale, Involvement-Patient (IP), is a unique construct that measures the degree to which a family member is involved in the rehabilitation process with respect to their involvement and relationship with the patient. The three scales yielded adequate internal reliabilities. Correlation coefficients between the scales indicated that the IR and S scale are not statistically related, but the IP scale is significantly related to both the IR and S scales. Interrater and test-retest reliability, and concurrent and predictive validity for the FIAS are still to be determined. © 1997 National Academy of Neuropsychology. Published by Elsevier Science Ltd

Improving stroke care through action research.

Stroke accounts for approximately 20% of beds occupied on general medical wards yet nurses felt inadequately prepared to participate fully in the interdisciplinary approach to stroke rehabilitation. An action research project was established to improve stroke care and rehabilitation in a general medical ward. Results indicate a correlation between knowledge and attitudes: the greater the nurse's understanding the more positive the nurse is towards nursing involvement in rehabilitation. It was concluded that nurses have a vital part to play in the rehabilitation of stroke patients and that their contribution can be enhanced through greater understanding. Further research is needed to determine the effects of greater nursing involvement in terms of quality of patient recovery and length of patient stay.

Ecological evaluation of goal planning and advocacy in a rehabilitation environment for spinal cord injured people

A behavioural mapping procedure was used to describe the behavioural profile, pattern of interaction and location of patients in a rehabilitation unit for traumatically spinal cord injured people. Naturalistic observations were obtained during two observational periods (9 months) before and after the implementation of a Goal Planning/Patient Advocate Programme. Results from the first observational study revealed that patients spent a considerable proportion of their time in solitary disengaged behaviours and large amounts of time in the ward area during the 'Therapeutic Day'. The Goal Planning System was introduced to increase involvement in rehabilitation and reduce institutionalisation. The second study which evaluated the ecological impact revealed that patients were observed to spend significantly less time in disengaged behaviours, more time in verbal interaction and significantly less time in the ward area during the Therapeutic Day. It is concluded that the Goal Planning System used is an effective way of maximising the therapeutic potential of the rehabilitative environment.

Introduction

Born in the Ukraine in 1888 and educated as a teacher, A. S. Makarenko is widely cited in the Soviet educational literature as one of the central figures in the efforts to develop educational systems appropriate to the philosophical and practical realities of the early Soviet state. Though influenced by a wide range of educational theories, Makarenko's perspectives on education were defined in many respects by his experiences in socializing and educating children who had been made homeless during the period of the revolution—some of whom had roamed the countryside of the Soviet Union in criminal gangs. Much of Makarenko's early reputation in the Soviet Union reflects his involvement in rehabilitation and production settlements such as the Gorky Colony and the Dzerzhinskii Commune. Indeed, many of those interested in Makarenko's work outside the Soviet Union are concerned with the rehabilitation and education of orphaned, homeless, and delinquent children (e.g., Kristen D. Juul [1986], International Journal of Special Education], 1:193-96); Bob Caskey [1979], Comparative Education, 15:277-86).