Disability meanings according to patients and clinicians: imagined recovery choice pathways

Abstract

Objective The purpose of this study was to explore how the meaning of disability varies between patients with acute-onset activity limitations and clinicians, and between males and females. Methods Seventy-nine patients undergoing inpatient rehabilitation and 93 practicing rehabilitation clinicians in the USA developed personal recovery choice pathways through recovery preference exploration (RPE). Imagining complete dependence in 18 activities as diverse as eating and expression, each individual determined an optimal sequence of recovery. This sequence was used to determine the relative value of each activity compared with the other 17. Three comparisons were made by calculating the mean absolute difference (MAD) in median utilities, including patients versus clinicians, male versus female patients, and male versus female clinicians. The MAD shows the relative magnitude of disparity between each pair. Results The MAD value between patients and clinicians was 3.4 times larger and 4.8 times larger than the MAD values between male and female patients and male and female clinicians, respectively. Conclusions The much larger difference in recovery preferences between patients and clinicians compared with differences between genders suggests that life contexts of being a patient with disabilities versus a clinician are more potent determinants of activity limitation perspectives than being a man or woman.

Needs of Stroke Survivors as Perceived by Their Caregivers

“…The outcome preferences differs among patients, caregivers, and clinicians and across rehabilitation settings; 99 none of these studies compared the caregivers outcome preferences across post-acute settings. Information, rehabilitation, and heath care needs may vary at different time points of recovery; future studies must investigate the caregivers’ perceived needs by various type of stroke (ischemic, hemorrhagic, and transient ischemic attack) and across settings (acute hospitalization, inpatient rehabilitation, skilled nursing rehabilitation, and community).…”

Indicators of injury recovery identified by patients, family members and clinicians

“…Differences in the meaning of disability and optimal recovery have been identified between patients with acute onset activity limitations and clinicians 11 , and between care recipients, relatives and nurses in relation to the quality of care of older people 17 . In a related area, patients and caregivers considered different factors than clinicians when making decisions about the most appropriate procedure for treatment of abdominal aneurysms 18 .…”

“…There are a few examples of groups consulting with patients or their families to determine what aspects of recovery are a priority or should be measured to indicate success, as well as to identify concerns in recovery 8 . When examined, significant differences in recovery preferences and perceptions have been identified, with patients placing greater value on activities of daily living such as eating, bathing and toileting while clinicians valued cognitive activities such as expression, comprehension and memory 11 or with patients and relatives perceiving greater compromise than clinicians 12 . Further, there is evidence that indicators of successful recovery change over time with the number of concerns being greatest 1 to 4 weeks after hospital discharge, and focusing on practical issues at this time 13,14 .…”

“…Although sometimes consulted on an individual basis, recipients of care -both patients and their families -are rarely asked to identify the indicators of successful recovery to inform activity at the healthcare system or national level 1,11,13 or to determine the salient outcomes included in research studies to test newly developed interventions and therefore influence improvements in healthcare. The scant evidence outlined above suggests that prioritization of care and assessment of recovery based on clinician preference may not meet the most pressing needs of patients and their families.…”

Patient-centered mobility outcome preferences according to individuals with stroke and caregivers: a qualitative analysis

“…For instance, for individuals with stroke; rehabilitation in skilled nursing facilities is known to increase the rates of institutionalizations than those who received rehabilitation in inpatient facilities or were discharged home [13]. In addition, patients with acute-onset of disabilities undergoing inpatient rehabilitation have different preferences to prioritize the functional recovery compared to their clinicians caring for them [14]. The patients were more concerned to be independent in their physical functional recovery, including eating, grooming, and toileting activities; whereas their rehabilitation clinicians were focused on improving patient’s comprehension and expression.…”