The meaning of rehabilitation: a qualitative study exploring perspectives of occupational therapists and physiotherapists working with older people in acute care

Bradley, Gemma; Baker, Katherine; Bailey, Cathy

doi:10.1080/09638288.2019.1697762

Cited by 4 publications

(3 citation statements)

References 32 publications

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“…Organisational protocols that impede person-centred care have also been reported in hip fracture rehabilitation [17,19]. From a broader rehabilitation perspective, physiotherapists and occupational therapists talk about an ideal for their practice (holistic improvements that return patients back to their pre-fracture functional status) that is inevitable unmet in the reality of the acute setting [39], a conflict attributed in large part to the priority of adhering to organisational standards [39]. Research describing the incompatibility of hip fracture rehabilitation models for hospitalised patients with dementia [24] and those in a less severe state [23], also deem organisational barriers that result in prioritisation of patients based on rehabilitation potential as a main contributor [23,24].…”

Section: Plos Onementioning

confidence: 99%

Multidisciplinary team healthcare professionals’ perceptions of current and optimal acute rehabilitation, a hip fracture example A UK qualitative interview study informed by the Theoretical Domains Framework

et al. 2022

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Objective To understand multidisciplinary team healthcare professionals’ perceptions of current and optimal provision of acute rehabilitation, perceived facilitators and barriers to implementation, and their implications for patient recovery, using hip fracture as an example. Methods A qualitative design was adopted using semi-structured telephone interviews with 20 members of the acute multidisciplinary healthcare team (occupational therapists, physiotherapists, physicians, nurses) working on orthopaedic wards at 15 different hospitals across the UK. Interviews were audio-recorded, transcribed verbatim, anonymised, and then thematically analysed drawing on the Theoretical Domains Framework to enhance our understanding of the findings. Results We identified four themes: conceptualising a model of rehabilitative practice, which reflected the perceived variability of rehabilitation models, along with facilitators and common patient and organisational barriers for optimal rehabilitation; competing professional and organisational goals, which highlighted the reported incompatibility between organisational goals and person-centred care shaping rehabilitation practices, particularly for more vulnerable patients; engaging teams in collaborative practice, which related to the expressed need to work well with all members of the multidisciplinary team to achieve the same person-centred goals and share rehabilitation practices; and engaging patients and their carers, highlighting the importance of their involvement to achieve a holistic and collaborative approach to rehabilitation in the acute setting. Barriers and facilitators within themes were underpinned by the lack or presence of adequate ways of communicating with patients, carers, and multidisciplinary team members; resources (e.g. equipment, staffing, group classes), and support from people in leadership positions such as management and senior staff. Conclusions Cornerstones of optimal acute rehabilitation are effective communication and collaborative practices between the multidisciplinary team, patients and carers. Supportive management and leadership are central to optimise these processes. Organisational constraints are the most commonly perceived barrier to delivering effective rehabilitation in hospital settings, which exacerbate silo working and limited patient engagement.

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Section: Plos Onementioning

confidence: 99%

Multidisciplinary team healthcare professionals’ perceptions of current and optimal acute rehabilitation, a hip fracture example A UK qualitative interview study informed by the Theoretical Domains Framework

et al. 2022

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“…Understanding the context of stroke care gives some insight into why communication occurs as it does. The short-term, impairment-based focus is not uncommon (Bradley et al 2021;Greenway et al 2022). Communication can both reflect the broader context of care practice and reproduce this context of care.…”

Section: Discussionmentioning

confidence: 99%

Limited conversations about constrained futures: exploring clinicians’ conversations about life after stroke in inpatient settings

Bright,

Kayes,

Soundy

et al. 2024

Brain Impairment

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Background. After a stroke, people can find it challenging to look forward to the future. Hope, a critical resource for recovery, can be threatened and can be supported or diminished through interactions with clinicians. As such, understanding how conversations can support people embarking on life after a stroke is critical. Our study explored how clinicians talk about the future with patients and considered what factors shape how these conversations occur. Methods. This study drew on the Interpretive Description methodology, informed by principles of ethnographic inquiry. We conducted 300 hours of observations and 76 interviews with five people with stroke and 37 clinicians. Data were analysed using the reflexive thematic analysis. Results. We constructed three themes that reflect how clinicians talk about the future with people in inpatient stroke services: (1) constrained temporal horizons, (2) limited talk controlled by clinicians, and (3) opening some doors while closing others. Conclusions. Conversations about the future after stroke were constrained and limited: constrained to short-term futures and limited in what aspects of life after stroke were discussed. Creating conversational and relational spaces where people are supported to look to the future with a sense of possibility, hope, and potential is vital for assisting people to move forward in their lives after their stroke. Given its role in supporting people to move forward in their lives, communication must be seen as a core clinical skill and a clinical intervention in its own right.

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“…Significantly, Burton et al (2015) also raise the critical issue that it is therefore the availability, and receipt, of rehabilitation interventions which may influence rehabilitation outcomes adding further complexity to the evaluation of rehabilitation potential. Considering professionals have expressed that they feel they may deliver suboptimal versions of rehabilitation due to systemic constraints in acute care (Bradley et al, 2019), then the final evaluation of potential in stage four is arguably at risk of becoming a forecast of limited potential because of limited rehabilitation opportunities.…”

Section: Discussionmentioning

confidence: 99%

Exploring how occupational therapists and physiotherapists evaluate rehabilitation potential of older people in acute care

Bradley

Baker

Bailey

2021

British Journal of Occupational Therapy

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Introduction Evaluations of rehabilitation potential are an everyday occurrence, yet the concept is poorly understood and there is a lack of understanding about the reasoning process. This study aimed to explore how occupational therapists and physiotherapists evaluated the rehabilitation potential of older people following an acute hospital admission. Method Focused ethnography was utilised, primarily using observation, interviewing and review of records within one acute medical ward in a general hospital in the United Kingdom. Five patient participants gave consent for their episode of care to be studied, for interactions with professionals to be observed and for their clinical records to be reviewed. Three occupational therapists and two physiotherapists then participated in individual interviews. Findings Thematic analysis of data led to the identification of a four-stage reasoning process. The four stages are as follows: gathering baseline information; provision of curative and supportive interventions; provision and monitoring of rehabilitative interventions; the evaluation of rehabilitation potential and decision about the subsequent pathway. Conclusions The reasoning process illustrates the professional reasoning of occupational therapists and physiotherapists when evaluating rehabilitation potential for older adults in acute care. However, it also highlights vulnerabilities to professional reasoning which may contribute to subjectivity, inconsistency or risk to patients.

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The meaning of rehabilitation: a qualitative study exploring perspectives of occupational therapists and physiotherapists working with older people in acute care

Abstract: (2019) The meaning of rehabilitation: a qualitative study exploring perspectives of occupational therapists and physiotherapists working with older people in acute care. Disability and Rehabilitation.

Cited by 4 publications

References 32 publications

Multidisciplinary team healthcare professionals’ perceptions of current and optimal acute rehabilitation, a hip fracture example A UK qualitative interview study informed by the Theoretical Domains Framework

Multidisciplinary team healthcare professionals’ perceptions of current and optimal acute rehabilitation, a hip fracture example A UK qualitative interview study informed by the Theoretical Domains Framework

Limited conversations about constrained futures: exploring clinicians’ conversations about life after stroke in inpatient settings

Exploring how occupational therapists and physiotherapists evaluate rehabilitation potential of older people in acute care

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