Posts Tagged Person-Centred

[ARTICLE] What is rehabilitation? An empirical investigation leading to an evidence-based description – Full Text

There is no agreement about or understanding of what rehabilitation is; those who pay for it, those who provide it, and those who receive it all have different interpretations. Furthermore, within each group, there will be a variety of opinions. Definitions based on authority or on theory also vary and do not give a clear description of what someone buying, providing, or receiving rehabilitation can actually expect.

This editorial extracts information from systematic reviews that find rehabilitation to be effective, to discover the key features and to develop an empirical definition.

The evidence shows that rehabilitation may benefit any person with a long-lasting disability, arising from any cause, may do so at any stage of the illness, at any age, and may be delivered in any setting. Effective rehabilitation depends on an expert multidisciplinary team, working within the biopsychosocial model of illness and working collaboratively towards agreed goals. The effective general interventions include exercise, practice of tasks, education of and self-management by the patient, and psychosocial support. In addition, a huge range of other interventions may be needed, making rehabilitation an extremely complex process; specific actions must be tailored to the needs, goals, and wishes of the individual patient, but the consequences of any action are unpredictable and may not even be those anticipated.

Effective rehabilitation is a person-centred process, with treatment tailored to the individual patient’s needs and, importantly, personalized monitoring of changes associated with intervention, with further changes in goals and actions if needed.

What constitutes rehabilitation? Physiotherapy? Exercises? Something you receive ‘to get you better’? Many healthcare staff, when referring someone to rehabilitation, have little idea, maybe saying ‘they’ll sort out your problems for you’, or sometimes ‘they’ll work you really hard’. Commissioners, similarly, rarely understand what they are paying for; at most they expect a certain number of contact hours between a patient and a therapist and/or setting goals. Patients do not know what to expect.

Searching dictionaries or the Internet does not help much because the answers are imprecise and lack detail. Commissioners (for example) still would not know what they are paying for, how to assess its quality, or how to quantify it if depending on published definitions, such as one in a recent commissioning guide1 (Box 1), or others.24 Most definitions are not based on evidence.[…]

Continue —-> What is rehabilitation? An empirical investigation leading to an evidence-based description – Derick T Wade, 2020

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[THESIS] Participation in everyday life after stroke : development and evaluation of f@ce – a team-based, person-centred rehabilitation intervention supported by information and communication technology


AIM: The general aim of this thesis was to generate knowledge about how Information and Communication technology (ICT) could be used in the rehabilitation process after stroke in order to develop and evaluate the feasibility of F@ce- a person-centred, team-based intervention, supported by ICT, to enable performance of daily activities and participation in everyday life for people after stroke. 

METHODS: Studies I and II were qualitative grounded theory studies that were performed to generate knowledge on people after stroke and health care professionals working with rehabilitation after stroke, regarding the experiences of using ICT. The third study was a secondary analysis of a previously performed randomised controlled trial, evaluating a client-centred activities of daily living (CADL) intervention, to analyse factors of importance for a positive outcome in participation after stroke. The knowledge generated in studies I-III combined with previous research was used to develop F@ce, a team-based, person-centred intervention for rehabilitation after stroke, that was supported by ICT. Study IV was an evaluation of the feasibility of using F@ce, and the study design, in terms of the recruitment process, outcome measures used, fidelity, adherence, acceptability and potential harms. 

RESULTS: People after stroke in study I described their drive to integrate ICT in their everyday lives after stroke. They used their mobile phones to feel safe, to stay connected to friends and family, and to improve physical and cognitive functions. They also used their computer for social networks, to manage daily occupations such as paying bills, online shopping and searching for information. The healthcare professionals in study II did not use ICT to any greater extent outside their office, however, they had a vision that ICT could be used as a platform for sharing information and collaboration within the rehabilitation process. The results from study III showed that within the control group (receiving usual ADL interventions) those with mild stroke and home-based rehabilitation had a better outcome in perceived participation compared to the intervention group, however, in the intervention group the difference between stroke severity and context of rehabilitation were not significant. This would indicate that the CADL intervention were specifically useful for those with moderate to severe stroke and those receiving rehabilitation at an in-patient unit. The feasibility testing of the newly developed F@ce intervention in study IV showed that it was feasible to use, and that the fidelity, adherence and acceptability of the intervention were good. The participants had positive outcomes in performance (n=4) and satisfaction with the performance (n=6) of daily activities according to Canadian Occupational Performance measure (COPM) and several participants had clinically significant improvements in different domains in the Stroke Impact Scale (SIS).

CONCLUSION: The studies within this thesis enabled the development and evaluation of a new rehabilitation intervention, F@ce, using ICT which is relevant in this time, with the rapid digitalization in the society, healthcare and rehabilitation. The knowledge from the previously developed CADL study, along with the experiences of people after stroke and healthcare professionals’ use of ICT, and the modelling of F@ce together with stakeholders created a strong foundation for the new intervention. Using a team-based, person-centred intervention with the support of ICT seemed to enable people to perform daily activities and thus increase their participation in everyday life.

List of papers: 
I.Martha Gustavsson, Charlotte Ytterberg, Mille Nabsen Marwaa, Kerstin Tham & Susanne Guidetti. Experiences of using information and communication technology within the first year after stroke – a grounded theory study. Disability and Rehabilitation. 2016 (40) 561-568 

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[Training Package] Person-Centred Rehabilitation. A Learning & Development Package for Rehabilitation Teams – The Hopkins Centre

❖ Person-centred rehabilitation (PCR) means treating each service user undergoing rehabilitation as an individual.
❖ There is a strong and committed drive to provide this type of rehabilitation both nationally and internationally.
❖ To help rehabilitation teams improve their ability to deliver person-centred rehabilitation a training package was developed.

❖ The package is designed to be undertaken in teams.
❖ The sessions will be delivered by a trained facilitator.
❖ Some examples of package content appear below.

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