Exploring the Personal Reality of Disability and Recovery: A Tool for Empowering the Rehabilitation Process

Abstract

People experiencing disability and chronic disease often feel powerless, relinquishing medical control to "more knowledgeable" professionals. This article presents qualitative and quantitative results from three individual patients experiencing an emerging procedure called Recovery Preference Exploration (RPE). To inspire greater patient involvement, self-direction, and individual choice, we instructed participants to create an imagined recovery path, exposing recovery preferences while learning about clinical rehabilitation concepts. Results uncovered important values and feelings about disability, providing a richer context for patient evaluation and treatment goal modification. Applying mixed methods, RPE is presented as an explanatory process for quantifying recovery preferences in a way that stimulates rich narrative of how people see different types of disabilities. RPE shows promise for increasing depth of discussions among patients, family, and clinicians. RPE may promote greater quality of life through patient empowerment by directed learning, increased communication, and enhanced self-knowledge.

Through the Clinician's Lens: Objective and Subjective Views of Disability

“…RPE yields quantitative and qualitative data about a single individual’s recovery preferences (Kurz, Saint-Louis, Burke, & Stineman, 2008; Stineman et al, 2007). The clinician is asked to imagine that he or she is completely dependent in all 18 activities of the FIM (Functional Independence Measure; Hamilton, Granger, Sherwin, Zielezny, & Tashman, 1987).…”

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

“…Differences in subjective appraisals [13, 19, 28, 32, 33] highlight the ideographic and nonontological nature of meaning, where the QoL implications of activity limitation are driven in part through each person’s internal explanations of external life contexts as they understand them [31]. Various individuals and groups of people logically judge the relative importance of recovering through different objective frames of reference, subjective standards of comparison, and personal reference points [21].…”

“…Early applications to clinical practice suggest that RPE empowers patients, enhances the depth of patient–practitioner dialogue, and inspires clinicians to change therapeutic goals to be more patient focused [13]. Future research might further develop therapeutic applications, explore the influence of culture, education, or other life contexts on recovery preferences, and apply alternative symptom or functional status inventories.…”

“…In an effort to understand the perceived importance of being able to perform particular activities, we apply recovery preference exploration (RPE) [13, 14], a phenomenologically based tool designed to break down disabilities into elements of meaning. This uses partial decentering to help relinquish personal perspectives [15], guiding patients to look at meanings outside their current status and clinicians outside scientific knowledge.…”

Trauma rehabilitation outcome scoring

“…A recent article [35 ] uses the Recovery Preference Exploration [36] approach to explore alternative states of disability and individual recovery preferences. The article concludes that meaningfulness of a function to a patient differs conceptually from the patient's measured functional performance.…”