Person-centred Rehabilitation Research Articles

Experiences of the return to work process after stroke while participating in a person-centred rehabilitation programme

Background: In Sweden, less than 50% of those getting stroke in working age return to work (RTW). Effective rehabilitation programmes need to be developed and therapeutic aspects understood.Aim: To explore and describe how persons with stroke experience their RTW process while participating in a person-centred rehabilitation programme focusing on RTW.Materials and methods: Seven persons with mild or moderate stroke were interviewed twice during the intervention in the vocational training phase using semi-structured interviews. Data were analysed using grounded theory.Results: Having a coordinator by their side gave support and guidance during the RTW process. Knowledge of stroke, strategies and a straightforward communication created a structure for the RTW process. Expressing one’s own wishes increased opportunities to influence and decide which path to follow in order to reach the goal.Conclusion: Straightforward, open and recurring communication facilitated the possibility to adapt to the situation. These aspects increased insight and awareness which facilitated the RTW process.Significance: The findings indicate that a precondition for a fruitful RTW process was that suitable platforms at work were created in which the actors involved could cooperate. This knowledge might also be valuable in the RTW process for people with other diagnosis.

Person-centred rehabilitation: what exactly does it mean? Protocol for a scoping review with thematic analysis towards framing the concept and practice of person-centred rehabilitation

IntroductionPerson-centredness is a philosophy for organising and delivering healthcare based on patients’ needs, preferences and experiences. Although widely endorsed, the concept suffers from a lack of detail and clarification, in...

Impact of a person-centred community rehabilitation service on outcomes for individuals with a neurological condition

Purpose: To evaluate the impact of a person-centred, community rehabilitation service on outcomes for people with a neurological condition, in the first year of service.Method: A prospective, observational, pre-post study was conducted with 206 people who had a neurological condition and attended the rehabilitation service to restore function (e.g., Stroke); maximize recovery in an ongoing situation (e.g., Spina Bifida); or maximize function and independence while preparing for inevitable decline (e.g., Parkinson’s Disease). Outcomes were measured via self-report questionnaires, prior to, and following three months of rehabilitation. The primary outcome was achievement of self-identified goals, measured by the Patient-Specific Functional scale. Secondary outcomes included the Lawton Instrumental Activities of Daily Living (IADL) scale, EQ-5D-5L European Quality of Life scale, and ICECAP-O – Index of Capability for Older Adults and health and medical resource use.Results: Participants demonstrated significant goal achievement and a significant reduction in health and medical resource use. There were small positive changes in the Lawton IADL, EQ-5D-5L, and ICECAP-O however these changes were not significant.Conclusions: In the first year of operation, the community rehabilitation service made a significant impact on outcomes for individuals with a neurological condition. Further research is required to identify appropriate measures of activities of daily living and quality of life that reflect person-centred rehabilitation outcomes for restoring function, maximizing function, or preparing for functional decline.Implications for RehabilitationSelf-identified goals are an important guide for achievement of meaningful outcomes for individuals with a neurological condition.Person-centred outcome measures are required to evaluate the benefits of a person-centred community rehabilitation service for individuals with a neurological condition.

Promoting employment among people with disabilities: Challenges and solutions

This article focuses on difficulties that people with disabilities and reduced work capacity experience in employment and social participation, and on their rehabilitation goals, in order to make recommendations for policy and social and vocational rehabilitation service provision. A semi-structured interview procedure, which included the World Health Organization Disability Assessment Schedule 2.0, was used to conduct initial needs assessments with 85 persons in Estonia. Quantitative and qualitative data were gathered and analysed using descriptive statistics and thematic analysis. Results revealed that participants experienced multiple difficulties, which they mostly ascribed to unstable health conditions, that limited their abilities to participate in employment and social activities. A large number of participants also identified themselves as unemployed for health reasons and linked their rehabilitation goals to health restoration rather than becoming employed. Difficulties such as lack of work skills, unsuitable work tempo, mobility limitations, and emotional problems were also mentioned. To support people with disabilities in obtaining and maintaining employment, services must correspond to the persons´ need; and comprehensive, person-centred rehabilitation assessment, service planning, and budgeting mechanisms are needed. Supportive legislation, flexibility in service provision, and the availability of needs-based rehabilitation and other services, including lifelong learning opportunities, are also necessary to help people learn new work skill

Are physiotherapists comfortable with person-centred practice? An autoethnographic insight

Purpose: This study aimed to understand our shared conflicting response and discomfort to person-centred rehabilitation within the context of our physiotherapy rehabilitation culture by reflecting on our own experiences as research physiotherapists and clinicians. Method: This study used autoethnographical methods to explore the personal and professional experiences of two physiotherapists in neurological rehabilitation. Data were collected through ten written reflections and five joint discussions. The data were analysed collaboratively through focused conversations and writing. We looked for patterns in our data and the literature to triangulate our findings. Joint narratives were structured based on three headings: Where we have come from, Challenges to our position and Where we are now. Results: The four main topics of discussion were goal setting, hope, the physiotherapy paradigm and person-centred practice. Physiotherapy practice is typically underpinned by a biomechanical discourse, which separates the mind and the body. This paradigm limits our ability to manage aspects of person-centred practice, such as valuing patient preferences, fostering hope, managing expectation and building a positive therapeutic relationship. Conclusion: Awareness of existing influences on theory and practice is necessary to move the physiotherapy profession towards a greater degree of understanding and application of the principles of person-centred practice.Implications for RehabilitationPhysiotherapists need to recognise that our clinical practice is currently dominated by a biomechanical perspective, which limits our adoption of person-centred practice.Our usual way of working as an expert focuses on our own perspective that makes it difficult to work in a person-centred way. Strategies to incorporate a more person-centred approach include using communication strategies that help us actively seek patients’ perspectives.

Person-centred rehabilitation for hard-to-reach groups

Nurses play a key role in leading and delivering cardiac rehabilitation within multidisciplinary teams, and continually face new challenges. However, one aspect of service delivery that remains a particular issue and challenge within many cardiac rehabilitation services is poor patient uptake of phase 3 cardiac rehabilitation programmes. Although there are a variety of factors that may affect uptake, it has been identified that despite efforts lack of equal access for sub groups of patients such as women, those from socio-economically deprived groups, ethnic minority groups and the elderly, remains an issue. This article provides a review of the literature exploring the existing issues affecting attendance within these groups, and offers some recommendations for local changes in service delivery to overcome some of the identified barriers to non- engagement or early drop out from programmes. The aim of the article is to discuss ways in which nurses can strengthen the person-centred approach to identify ways of improving uptake further in these hard-to-reach groups.

Politics, policy and payment – facilitators or barriers to person-centred rehabilitation?

Aims. This paper explores the tensions between politics and payment in providing affordable services that satisfy the public demand for patient-centred care.Key findings and implications. The two main approaches taken by the UK Government to curtail the spiralling costs of healthcare have been to focus development in priority areas and to cap spending through the introduction of a fixed-tariff episode-based funding system. The National Service Framework for Long Term Neurological Conditions embraces many laudable principles of person-centred management, but the ‘one-size-fits all’ approach to reimbursement potentially cuts right across these. A series of tools have been developed to determine complexity of rehabilitation needs that will support the development of banded tariffs. A practical approach is also offered to demonstrate the cost-efficiency of rehabilitation services for people with complex needs, and help to ensure that they are not excluded from treatment because of their higher treatment costs.Conclusions. Whilst responding to public demand for person-centred care, we must recognize the current financial pressure on healthcare systems. Clinicians will have greater credibility if they routinely collect and share outcomes that demonstrate the economic benefits of intervention, as well the impact on health, function and quality of life.

Care and compassion: Part of person-centred rehabilitation, inappropriate response or a forgotten art?

Aims of the paper. The nature of healthcare, rehabilitation and indeed even professional practice and discipline roles seems to constantly change. In particular, whilst ‘care’ has an accepted place in much of health service delivery, there is considerable debate about whether the concept has a place in modern rehabilitation. This paper sets out to review the concept and pose questions about the nature of caring in rehabilitation.Key findings and implications. In order to highlight different potential understandings, this paper reviews the origins of healthcare traditions and care. We explore ethical humanistic and political aspects of caring and investigate what facilitates and obstructs adequate care. Finally we examine what the risks of caring (or not caring) are for both health professionals and their clients.Conclusions and recommendations. Whilst the arguments presented here suggest there is value in caring, there are very limited studies that explicitly examine its nature or indeed value, particularly in rehabilitation. As a result, the potential difference in both the experience of, and outcome, from rehabilitation in relation to the nature of care is yet to be clearly established.

Rehabilitation for older people with dementia.

It should not be assumed that living with dementia means a complete loss of abilities. However, people with dementia are not always allowed to realise their full potential. The author suggests that person-centred rehabilitation with this patient group can enhance their abilities and help them to acquire new ones.