Person-centered Rehabilitation Research Articles

Identification of factors associated with hospitalization in an outpatient population with mental health conditions: a case-control study.

Addressing relevant determinants for preserved person-centered rehabilitation in mental health is still a major challenge. Little research focuses on factors associated with psychiatric hospitalization in exclusive outpatient settings. Some variables have been identified, but evidence across studies is inconsistent. This study aimed to identify and confirm factors associated with hospitalization in a specific outpatient population. A retrospective monocentric case-control study with 617 adult outpatients (216 cases and 401 controls) from a French community-based care facility was conducted. Participants had an index outpatient consultation between June 2021 and February 2023. All cases, who were patients with a psychiatric hospitalization from the day after the index outpatient consultation and up to 1 year later, have been included. Controls have been randomly selected from the same facility and did not experience a psychiatric hospitalization in the 12 months following the index outpatient consultation. Data collection was performed from electronic medical records. Sociodemographic, psychiatric diagnosis, historical issues, lifestyle, and follow-up-related variables were collected retrospectively. Uni- and bivariate analyses were performed, followed by a multivariable logistic regression. Visit to a psychiatric emergency within a year (adjusted odds ratio (aOR): 13.02, 95% confidence interval (CI): 7.32-23.97), drug treatment discontinuation within a year (aOR: 6.43, 95% CI: 3.52-12.03), history of mental healthcare without consent (aOR: 5.48, 95% CI: 3.10-10.06), medical follow-up discontinuation within a year (aOR: 3.17, 95% CI: 1.70-5.95), history of attempted suicide (aOR: 2.50, 95% CI: 1.48-4.30) and unskilled job (aOR: 0.26, 95% CI: 0.10-0.65) are the independent variables found associated with hospitalization for followed up outpatients. Public health policies and tools at the local and national levels should be adapted to target the identified individual determinants in order to prevent outpatients from being hospitalized.

Student Competition (Clinical/Best Practice Implementation) ID 1984705

Background The foremost reported unmet health need for Canadians with chronic neurological conditions is linked to physical maintenance. One way to address this issue is through activity programing offered through public institutions, where rehabilitation can be integrated into secondary health care settings. Parkwood Institute in London, Ontario has developed several programs, including virtual exercise classes, day programs, and a community fitness center. People who have participated in these initiatives can provide insights that could be used to create more robust person-centered rehabilitation physical activity programing. Objectives To explore the lived experiences of individuals participating in activity programs offered through Parkwood Institute to develop recommendations for future program development. Methods Using purposive sampling of individuals with a chronic neurological health condition who have participated in a physical activity program offered through Parkwood, we will use a grounded theory methodology to explore individual perspectives. Data will be collected using semi-structured interviews to gather critical perspectives and data will be analyzed using constant comparative analysis. Data collection and analysis will be an iterative process, meaning codes and categories will be developed from initial interviews, with subsequent data being continuously compared to identify similarities and differences. Results The findings of this research will, once completed, describe the impact of various physical activity programs, including benefits, challenges, and recommendations for future development. Conclusions The theoretical interpretations of the findings will be presented as a list of recommendations for activity programs offered through rehabilitation centers to assist researchers, clinicians, and policy makers in decision-making.

"It's a lot more complicated than it seems": physiotherapists' experiences of using compensation strategies in people with Parkinson's.

Gait disturbances often result in functional limitations in daily activities and negatively impact the quality of life in people with Parkinson's disease. Physiotherapists often employ compensation strategies in an attempt to improve patients' walking. However, little is known about physiotherapists' experiences in this regard. We evaluated how physiotherapists adopt compensation strategies and what they draw on to inform their clinical decision-making. We carried out semi-structured online interviews with 13 physiotherapists with current or recent experience working with people with Parkinson's disease in the United Kingdom. Interviews were digitally recorded and transcribed verbatim. Thematic analysis was utilized. Two main themes were developed from the data. The first theme, optimizing compensation strategies through personalized care, shows how physiotherapists accounted for the individual needs and characteristics of people with Parkinson's, which resulted in them individually tailoring compensation strategies. The second theme, delivering compensation strategies effectively, considers the available support and perceived challenges with work settings and experience that impact physiotherapists' ability to deliver compensation strategies. Although physiotherapists strived to optimize compensation strategies, there was a lack of formal training in this area, and their knowledge was primarily acquired from peers. Furthermore, a lack of specific knowledge on Parkinson's can impact physiotherapists' confidence in maintaining person-centered rehabilitation. However, the question that remains to be answered is what accessible training could address the knowledge-practice gap to contribute to the delivery of better-personalized care for people with Parkinson's.

Digital health systems: SMART-system for remote support of hybrid E-rehabilitation services and activities

The top-priority challenges were faced by the medical rehabilitation system in Ukraine. Particularly important tasks include, first of all, the rehabilitation of patients who have recovered from COVID-19 disease and people with Combat stress reaction. This fact is well understood both by the society and the leadership of the Ministry of Health of Ukraine, which is creating a special working group on this problem. Ukraine has a system of medical and prophylactic institutions designed for psychological and physical rehabilitation of military personnel; these use modern rehabilitation technologies. However, long-term rehabilitation in such centers is not available to everyone. Therefore, the use of telerehabilitation technology for patients with post-traumatic stress disorder and similar disorders in com- bination with a means of objective control of the functional state is extremely important. One of the most effective solutions in medical rehabilitation assistance is remote patient / person-centered rehabilitation. Rehabilitation also needs effective methods for the "Physical therapist – Patient – Multidisciplinary team" system, including the statistical processing of large volumes of data. Therefore, along with the traditional means of rehabilitation, as part of the "Transdisciplinary intelligent information and analytical system for the rehabilitation processes support in a pandemic (TISP)" in this paper, we introduce and define: the revised and completed basic concepts of the hybrid e-rehabilitation notion and its fundamental foundations; the formalization concept of the new Smart-system for remote support of hybrid e-rehabilitation services and activities; and the methodological foundations for the use of services (UkrVectōrēs and vHealth) of the remote Patient / Person- centered Smart-system. The software implementation of the services of the Smart-system has been developed.

The use of patient experience feedback in rehabilitation quality improvement and codesign activities: Scoping review of the literature

Objective To characterize the literature, reported enablers, and gaps on the use of patient experience feedback for person-centered rehabilitation quality improvement and codesign activities. Design Scoping Review. Data sources Scientific databases (PubMed, CINAHL, Rehabdata, Scopus, Web of Science, ProQuest), website searches (e.g. Beryl Institute), snowballing, and key-informant recommendations. Methods Two independent reviewers performed title and abstract screenings and full-text reviews. Eligibility focused on English-language, peer-reviewed (all time) and gray literature (last five years) that used patient experience feedback in rehabilitation improvement activities. The aims, settings, methods, findings, implications, and reported limitations were extracted, followed by content analyses identifying reported enablers and gaps. Results Among the 901 unique references and 52 full texts reviewed, ten were included: four used patient experience surveys for improving patient experiences; six used codesign methodologies to engage patient feedback in service improvement activities. Implementation enablers included securing managerial support, having a structured methodology and facilitator, using efficient processes, engaging staff experiences, and using appreciative inquiry. Reported study gaps included limited follow-up, low sample sizes, analytical limitations, lack of reported limitations, or narrow range of perspectives (e.g. not from people with severe impairments). Conclusion Few examples of the use of patient experience feedback in quality improvement or codesign activities were found in the rehabilitation literature. Patient experience improvement activities relied exclusively on retrospective survey data, which were not combined with often more actionable forms (e.g. qualitative, real time) of patient experience feedback. Further research might consider design of activities that collect and use patient experience feedback for rehabilitation service improvements.

Detecting Changes in Human Agency of Older Adults in Rehabilitation

ABSTRACT Tools assessing person-centered rehabilitation should promote client self-awareness as well as measure the target outcomes. The aim of this study was to evaluate the ability of the Assessment of Perceived Agency (ATPA19) to track changes in rehabilitation for older adults. Older adults (mean age 79) participated in a ten-month intervention (baseline n = 97, and follow-up n = 63). The ATPA19 and WHOQOL-BREF physical domain showed the strongest correlation and were the only tools that detected significant changes in older adults. The ATPA-19 is an agency-based tool that can reveal new effects complementing those of the assessment tools commonly used in rehabilitation in older adults.

Hybrid e-rehabilitation services: SMART-system for remote support of rehabilitation activities and services.

One of the most effective solutions in medical rehabilitation assistance is remote patient / person-centered rehabilitation. Rehabilitation also needs effective methods for the "Physical therapist - Patient - Multidisciplinary team" system, including the statistical processing of large volumes of data. Therefore, along with the traditional means of rehabilitation, as part of the "Transdisciplinary intelligent information and analytical system for the rehabilitation processes support in a pandemic (TISP)" in this paper, we introduce and define: the basic concepts of the new hybrid e-rehabilitation notion and its fundamental foundations; the formalization concept of the new Smart-system for remote support of rehabilitation activities and services; and the methodological foundations for the use of services (UkrVectōrēs and vHealth) of the remote Patient / Person-centered Smart-system. The software implementation of the services of the Smart-system has been developed.

Goals and Action Plans Across Time and Place-A Qualitative Study Exploring the Importance of "Context" in Person-Centered Rehabilitation.

BackgroundPerson-centeredness is increasingly addressed in relation to rehabilitation interventions. Collaborative goal setting and action plans are key measures in person-centered rehabilitation. There is a lack of knowledge about how person-centered goals and action plans developed away from the patient's everyday life are experienced by patients after discharge.PurposeThis aim of the study is to explore how patients with rheumatic diseases experience the relevance of goals and action plans after discharge from inpatient rehabilitation hospital stay.MethodsIndividual narrative interviews were conducted with eight patients with rheumatic diseases, aged between 40 and 60. A convenience sampling strategy was applied. Data collection, analysis and interpretation of data were performed within a phenomenological-hermeneutic framework inspired by Paul Ricoeur's interpretative philosophy.ResultsThe analysis derived one core theme, “The relevance of goals and action plans is contextual” and three subthemes: “Admission—a protected bubble,” “Back home—a harsh reality,” and “Need for post-discharge support.”ConclusionThis study indicates that the relevance of goals and action plans to patients with rheumatic diseases is context specific. On the basis of the study, it is suggested that the context should be considered in rehabilitation practice, including the social network of the patients. This is in order to support patients in rehabilitation interventions to manage everyday life with disease after discharge to their own homes. Moreover, the concept of context in person-centered rehabilitation should be reconsidered. The study also concludes that there is a need for further development and research in follow up programs, as it is not clear what may constitute an optimal design of follow up support.

The Individual Rehabilitation Project as the core of person-centered rehabilitation: the Physical and Rehabilitation Medicine Section and Board of the European Union of Medical Specialists Framework for Rehabilitation in Europe.

To facilitate the interaction between the health professional and the patient, a framework to guide the rehabilitation process is needed. This framework would encompass three interwoven aspects: the rehabilitation management plan, Individual Rehabilitation Project (IRP), and rehabilitation cycle(s). All three framework aspects focus on the patient and on the aim of rehabilitation, i.e. to optimize a person's functioning across the continuum of care. An IRP is a multi-element, person-centered rehabilitation management scheme, in which rehabilitation is generally provided by a multiprofessional team under the leadership of a physical and rehabilitation medicine (PRM) physician, working in an interdisciplinary manner and together with the patient (or proxy). A reference system for operationalizing functioning and standardizing the process is the International Classification of Functioning, Disability and Health (ICF) - for assessing functioning needs, defining rehabilitation goals and outcomes. The objective of this paper is to present the IRP as a framework for rehabilitation in Europe (EUR-IRP). The specific aims are: 1) to introduce the IRP; and 2) to describe the framework components, elements and variables of the IRP. Demonstration projects (case studies) using the EUR-IRP will be conducted. The present paper presents the efforts to date for developing the EUR-IRP, a key part of the action plan of the PRM Section and Board of the European Union of Medical Specialists to implement the ICF systemwide across the care continuum. This paper serves as another step to bring together practice, science and governance in calling for contribution from rehabilitation clinicians and researchers and professional societies in PRM and beyond.

Cross-cultural adaptation and validation of the Spanish version of the Client-Centred Rehabilitation Questionnaire (CCRQ)

Purpose The aim of the study is to present the process of translation, adaptation and validation of the Client-Centred Rehabilitation Questionnaire (CCRQ) in the Spanish context. Methods The process integrates two sequential phases. Phase 1 consists of a questionnaire translation and back-translation process conducted by a panel of experts, and a pilot study. In phase 2, CCRQ-e (Spanish version) was administered to 305 rehabilitation inpatients to collect evidence on the reliability and validity of the instrument. Results The exploratory and confirmatory analysis confirmed seven original domains, eliminating four items from the original scale. CCRQ-e has a good internal consistency. Discriminative construct validity distinguished significant differences based on age, educational level, and severity of diagnosis. Criterion validity of the CCRQ and EQ-5D showed negative significant correlations between CCRQ-e and the general perception of health EQ-VAS, and a positive correlation between CCRQ-e and EQ pain and EQ anxiety (higher scores in CCRQ-e mean lower client-centered practice perceived). Conclusions The Spanish version of the CCRQ is suitable for evaluating person-centered rehabilitation from the person’s perspective. It includes aspects related to the comfort, decision-making, and participation of the client, as well as questions about the provision of service and the environment. Implications for rehabilitation The original seven domains of the CCRQ could be replicated in the sample of patients from Spanish rehabilitation services. By eliminating four items from the original scale, the validated scale, known as the CCRQ-e (Spanish version), was obtained. The CCRQ-e allows a reliable and valid evaluation of the perception of the person-centeredness of the Spanish rehabilitation services. The CCRQ-e is the first self-reported measure in Spanish of an individual's experience during the rehabilitation service.

The delivery of the ReWork-Stroke program: A process evaluation.

BACKGROUND:The ReWork-Stroke program was developed to meet the need for a person-centered rehabilitation program addressing return to work after stroke and was provided by occupational therapists (OTs).OBJECTIVE:To gain knowledge on the implementation process of the ReWork-Stroke program, the mechanisms of impact, and the contextual factors that might have affected the process.METHODS:A case study design was used. Data were collected by interviews with two ReWork-Stroke providers and their logbooks of 13 clients. Content analysis was applied.RESULTS:The ReWork-Stroke program varied in duration (12–48 weeks) and was largely implemented according to plan regarding components and how they were provided. It was mostly delivered at the workplace. Mechanisms of impact were building alliances with clients, providing intervention at the workplace, informing about stroke, assigning co-workers as tutors for clients, and collaboration between stakeholders.CONCLUSIONS:The ReWork-Stroke program can be implemented according to plan and is a flexible person-centered program in which stakeholders, coordinated by an OT, plan and take actions, mostly at the workplace, for the client’s return to work. A key factor was recognizing the current work ability after stroke. Further program development includes a more structured evaluation and technical solutions for supporting stakeholders.

What Person-Centered Rehabilitation Means in Concept and Practice: The Person-Centered Rehabilitation Model for Adult Physical Rehabilitation Derived from a Scoping Review and Thematic Synthesis

<h3>Objective(s)</h3> To frame the concept and practice of Person-Centered Rehabilitation (PCR) in adult physical rehabilitation, derived from a scoping review and thematic synthesis of the literature. <h3>Data Sources</h3> English-language empirical or conceptual papers, published from January 2007 to February 2020, were found through searches in databases (PubMed, Scopus, CINAHL), snowballing searches, and experts' consultation. <h3>Study Selection</h3> Two independent reviewers selected papers with PCR-related content, using the criteria in the published review protocol. From 6527 unique references, 147 were used in the analysis, 18% of them exclusively conceptual. <h3>Data Extraction</h3> Textual data on the PCR concepts or practices were extracted by two independent reviewers. <h3>Data Synthesis</h3> The thematic analysis and experts' consultation gave rise to the Person-Centered Rehabilitation Model (PCR Model): a cross-professional model for the concept and practice of PCR in adult physical rehabilitation settings. At the person-professional dyad, PCR was framed as: a respectful of and tailored to the person; reflexive and adaptive to the situation; compassionate and caring; focused on strengths and hopes - beyond deficits, and empowering and collaborative - toward a co-constructed rehabilitation. At the team level, a PCR approach includes significant others, is delivered in a welcoming and secure environment, and is articulated through a PCR team. At the organization level, PCR approaches are inclusive of clients and staff in service evaluation and improvement, create the context (e.g. provides training opportunities) for PCR to occur, and is organized for coordinated and tailored approaches. <h3>Conclusions</h3> PCR occurs at clinical and service organization practices, which are articulated through the PCR Model. The PCR model offers a conceptualization of PCR applicable in clinical and service settings and may assist in the implementation of PCR principles. <h3>Disclosures</h3> No conflicts of interest declared.

Aging With Cerebral Palsy: A Photovoice Study Into Citizenship.

Background: Adults with cerebral palsy (CP) may experience an increasing impact of their disability on daily life and this may interfere with their citizenship. Citizenship is a layered construct. Next to formal and theoretical significations, and civil rights acts such as the UN Convention on the Rights for Persons with Disabilities (CRPD), the meaning of citizenship is formed by the person themselves. The present study aimed to gain insight into what citizenship means for adults with CP 40 years or older and what is needed to support and pursue their citizenship to improve person-centered rehabilitation which can facilitate this process.Methods: Adults with CP (>40 years) without intellectual disability were recruited from medical records of a large rehabilitation center to participate in a qualitative study using the photovoice method. Participants were asked to take photos of objects or life situations that constituted citizenship for them; these photos were then the prompts for the semi-structured interviews that were held face-to-face at their homes. Background and clinical characteristics were gathered using a short face-to-face questionnaire. Data were analyzed through inductive thematic analysis.Results: Nineteen adults participated [mean age (SD) 57.8 (9.4) years (range 44–79), six men]. From the analysis four themes emerged: (a) Meanings of citizenship; (b) Citizenship: Facilitator and barriers; (c) Paradoxes of support and participation; and (d) Future. Furthermore, next to the ability to participate in society without restrictions, sense of belonging was reported to be an important aspect of “meanings of citizenship.” The physiotherapist was perceived as an important health professional to maintain physical activity and deal with the impact of aging with CP on daily activities. Complex healthcare and support services regulations and aging affected citizenship negatively.Conclusion: Middle-aged and older adults with CP view citizenship as the ability to participate and belong in society. To optimize their citizenship the challenges and individual needs must be seen and supported by person-centered rehabilitation and support services. Simplification of complex healthcare and services regulations can further improve citizenship.

ICF Personal Factors Strengthen Commitment to Person-Centered Rehabilitation - A Scoping Review.

Background: The International Classification of Functioning, Disability and Health (ICF) classification is a biopsychosocial frame of reference that contributes to a holistic understanding of the functioning of a client and the factors involved. Personal factors (PFs) are not currently classified in the ICF due to large societal and cultural diversity and lack of clarity in the scope of such factors.Aims: To ascertain which factors in the ICF classification have been defined as PFs in different studies and what conclusions have been drawn on their role in the ICF classification.Methods: The study was a scoping review. A systematic search for articles published in 2010–2020 was performed on the Cinahl, Pubmed, ScienceDirect, and Sport Discus databases. The PFs specified in the articles were classified according to the seven categories proposed by Geyh et al. socio-demographic factors; position in the immediate social and physical context; personal history and biography; feelings; thoughts and beliefs; motives; and general patterns of experience and behavior.Results: The search yielded 1,988 studies, of which 226 met the inclusion criteria. The studies had addressed a wide variety of PFs that were linked to all seven categories defined by Geyh et al. Some studies had also defined PFs that were linkable to other components of the ICF or that did not describe functioning. Approximately 22% (51) of the studies discussed the role of PFs in rehabilitation.Conclusions: The range of PFs in the ICF classification addressed in the reviewed studies is wide. PFs play an important role in rehabilitation. However, according to the reviewed studies, a more precise coding of PFs is not yet warranted.

A single-case experimental design investigation of collaborative goal setting practices in hospital-based speech-language pathologists when provided supports to use motivational interviewing and goal attainment scaling

ABSTRACT The study investigated the impact of the electronic Goal Attainment Scaling (eGAS) process on medical speech-language pathologists’ (SLPs) interviewing and goal setting. The process was trained via the eGAS app, designed to facilitate motivational interviewing and goal attainment scaling. The study utilized a single-case, nonconcurrent, multiple-baseline design replicated across three clinicians and their 27 respective clients. We observed client-clinician dyads engaged in setting rehabilitation goals pre and post eGAS training. The clients had neurogenic conditions and were being treated for cognitive, communication and/or swallowing challenges in an outpatient setting. Two measures were used to collect data on the clinician’s interviewing and goal-setting behaviors: (1) Assessment of Client-Centeredness when Interviewing and Goal Setting (ACIG) scale, and (2) a task analysis, i.e., the Clinician Interview Behavior scale (CIB). Training with eGAS had a strong effect on clinicians’ collaborative interviewing behaviors, an inconsistent effect on their ability to adhere to a three-phase interview structure, and a strong effect on their ability to generate valid goal attainment scales. This study provides preliminary support that the eGAS process provides a feasible framework for training hospital-based SLPs engaged in neurorehabilitation to use collaborative interviewing behaviors and produce valid person-centered rehabilitation goals.

Comorbidities in Males and Females with TBI: A Population Study from the Department of Social Inclusion of Persons with Disabilities in Cyprus

Comorbidities are common in individuals with traumatic brain injury (TBI) because they can influence the progression and outcomes of rehabilitation. Furthermore, investigating sex differences in this area will provide great understanding in how comorbid disorders can influence rehabilitation contribute to the development of person-centered rehabilitation programs. The main purpose of this study was to investigate specific comorbid disorders in males and females survivors of TBI. This is population study as all individuals with a reported diagnosis of TBI who applied for disability benefits were include in the analyses.

Is Virtual Reality Effective in Orthopedic Rehabilitation? A Systematic Review and Meta-Analysis

Virtual reality (VR) is an interactive technology that allows customized treatment and may help in delivering effective person-centered rehabilitation. The purpose of this review was to systematically review and critically appraise the controlled clinical trials that investigated VR effectiveness in orthopedic rehabilitation. Pubmed, CINAHL, Embase, PEDro, REHABDATA, and Sage publications were searched up to September 2018. In addition, manual searching and snowballing using Scopus and Web of Science were done. Two reviewers screened studies for eligibility first by title and abstract and then full text. Articles were categorized into general or region-specific (upper limbs, lower limbs, and spine) orthopedic disorders. Study quality was assessed using the Evaluation Guidelines for Rating the Quality of an Intervention Study scoring. Meta-analysis quantified VR effectiveness, compared with no treatment, in back pain. Nineteen studies were included in the quality assessment. The majority of the studies were of moderate quality. Fourteen studies showed that VR did not differ compared with exercises. Compared with the no-treatment control, 5 studies favored VR and 3 other studies showed no differences. For low back pain, the meta-analysis revealed no significant difference between VR and no-treatment control (n=116; standardized mean difference=-0.21; 95% confidence interval=-0.58 to 0.15). Limitations included heterogeneity in interventions and the outcome measures of reviewed studies. Only articles in English were included. The evidence of VR effectiveness is promising in chronic neck pain and shoulder impingement syndrome. VR and exercises have similar effects in rheumatoid arthritis, knee arthritis, ankle instability, and post-anterior cruciate reconstruction. For fibromyalgia and back pain, as well as after knee arthroplasty, the evidence of VR effectiveness compared with exercise is absent or inconclusive.

The micro-politics of caring: tinkering with person-centered rehabilitation

Purpose: In this paper, we critically investigate the implementation of person-centered care with the purpose of advancing philosophical debates regarding the overarching aims and delivery of rehabilitation. While general agreement exists regarding person centered care’s core principles, how practitioners reconcile the implementation of these principles with competing practice demands remains an open question.Materials and methods: For the paper, we drew on post-qualitative methods to engage in a process of “diffractive” analysis wherein we analyzed the micro-doings of person-centered care in everyday rehabilitation work. Working from our team members’ diverse experiences, traditions, and epistemological commitments, we engaged with data from nine “care events” generated in previous research to interrogate the multiple forces that co-produce care practices.Results: We map our analyses under three categories: scripts mediate practice, securing compliance through “benevolent manipulations”, and care(ful) tinkering. In the latter, we explore the notion of tinkering as a useful concept for approaching person centered care. Uncertainty, humility, and doubt in one’s expertise are inherent to tinkering, which involves a continual questioning of what to do, what is best, and what is person centered care within each moment of care. The paper concludes with a discussion of the implications for rehabilitation and person-centered care.Implications for rehabilitationDeterminations of what constitutes good, better, or best rehabilitation practices are inevitably questions of ethics.Person-centered care is promoted as good practice in rehabilitation because it provides a framework for attending to the personhood of all engaged in clinical encounters.Post-critical analyses suggest that multiple interacting forces, conditions, assumptions, and actions intersect in shaping each rehabilitation encounter such that what constitutes good care or person-centered care cannot be determined in advance.“Tinkering” is a potentially useful approach that involves a continual questioning of what to do, what is best, and what is person-centered care within each moment of care.

Collaborative Goals for Communicative Life Participation in Aphasia: The FOURC Model.

Purpose Collaborative goal setting is at the heart of person-centered rehabilitation but can be challenging, particularly in the area of aphasia. The purpose of this clinical focus article is to present a step-by-step model for forming a collaborative partnership with clients to develop an intervention plan that follows the client's lead, addresses communicative participation, and integrates multiple treatment strategies. Method We introduce the rationale and core features of a 4-step and 4-pronged process (the FOURC model) and illustrate its application through 3 cases of people with aphasia who were treated in outpatient rehabilitation. Conclusions The model invites client initiative in a clinically feasible manner while supporting the clinician's role in guiding the intervention based on professional expertise and growing familiarity with the case. Outcomes observed in case studies include strengthened motivation and improved real-life communication.

Experiences of Living with Stress-Related Exhaustion Disorder and Participating in a Tailor-Made AntiStress Program in Primary Care

Approximately one million Swedes of working age suffer from stress-related exhaustion disorder (SRED). However, with the current primary care, it is difficult to manage and treat SRED due to the support needs of patients with SRED. To offer more rehabilitation options, a tailor-made 10-week AntiStress program was developed, based on Arvidsdotters thesis, in which complementary medicine was integrated with traditional medicine for persons with SRED. The purpose of the study was to evaluate experiences of participation in traditional versus integrative rehabilitation among persons with SRED during the sick leave process. The study employed a phenomenological-hermeneutic approach. In-depth interviews were conducted individually (n = 12) and in two focus groups (n = 8; n = 10). All interviews were analyzed using a phenomenological-hermeneutic method for text interpretation inspired by Ricoeur. The overall interpretation of the interview text generated five themes: two themes highlighting the internal and external barriers to healing and three themes describing the importance of participation in the AntiStress program through the provision of integrative therapy to process existential problems, a forum for personal growth, and holistic person-centered rehabilitation, during the sick leave process. The participants described that after years of various antistress activities, they finally received the effective support they sought. Through the AntiStress program, the participants experienced increased self-awareness, self-compassion, self-efficacy and harmony in life. The evaluation shows that the AntiStress program gave the participants valuable and effective tools for managing stress in everyday life. To prevent long-term sick leave, this kind of AntiStress program might serve as a model for developing a standardized treatment option to meet the needs of individuals with different stages of SRED.