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The rehabilitation process for the geriatric stroke patient: an exploratory study of goal setting and intervention
Linköpings universitet, Institutionen för samhälls- och välfärdsstudier. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Geriatriska kliniken.
Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Filosofiska fakulteten. (Landstinget i Östergötland; Centre for Public Health Sciences; Centre for Public Health Sciences; Folkhälsovetenskapligt centrum; Folkhälsovetenskapligt centrum)
Linköpings universitet, Institutionen för samhälls- och välfärdsstudier. Linköpings universitet, Hälsouniversitetet.
1999 (Engelska)Ingår i: Disability and Rehabilitation, ISSN 0963-8288, Vol. 21, nr 2, s. 80-87Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Purpose: The aim was to describe and analyse the rehabilitation process of the geriatric stroke patient from two perspectives; the treatment goals expressed by the staff and the patient and the treatment interventions chosen by the physiotherapist and occupational therapist. A secondary aim was to test whether the process, treatment goals and interventions could be classified according to the International Classification of Impairments, Disabilities and Handicaps (ICIDH).

Method: Qualitative interviews were performed with patients and personnel; diaries were used to register treatment interventions. The 30 interviews were categorized according to the goals expressed by physiotherapists, occupational therapists, physicians and patients. The diaries (n= 22) were analysed to describe how treatment interventions were connected in time, at what levels (impairment, disability and handicap) the interventions were directed, and finally, whether certain decisions were made in order to change the rehabilitation process.

Results: The patients talked more about attaining their prestroke status than about their goals. The therapists set goals according to functional level, whereas the doctors expressed themselves in general terms. Three patterns of rehabilitation processes were found: one with clearly identified decision points, one with a set programme which was not changed through the process, and one where the goal was changed according to changes in medical status.

Conclusions: The patient does not participate in the goalsetting process, and the vaguely expressed goals are not measurable. The rehabilitation process and reason for discharge demonstrate different patterns. Treatment interventions, if related to the ICIDH, give a clear picture of the process, though certain interventions do not fit in the classification.

Ort, förlag, år, upplaga, sidor
1999. Vol. 21, nr 2, s. 80-87
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
URN: urn:nbn:se:liu:diva-14363DOI: 10.1080/096382899298016OAI: oai:DiVA.org:liu-14363DiVA, id: diva2:23337
Tillgänglig från: 2007-03-23 Skapad: 2007-03-23 Senast uppdaterad: 2009-08-21
Ingår i avhandling
1. Client participation in the rehabilitation process
Öppna denna publikation i ny flik eller fönster >>Client participation in the rehabilitation process
2002 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

This thesis evaluates the rehabilitation process with respect to client participation. The Swedish version of a client-centred structure, the Canadian Occupational Performance Measure (COPM), is evaluated from the perspectives of the clients, the occupational therapists and the members of a rehabilitation team. Data have been collected through diaries, the COPM, assessments of ability to perform activities of daily living, mobility, self-assessments of pain and health, interviews with clients, interviews with staff, and focus groups interviews.

The results show that a structured method is needed in order to improve clients’ active participation in goal formulation.

The Swedish version of the COPM has high responsiveness to change over time. The use of the COPM improved client participation in the goal-formulation process, according to the results from a study with experiment and control groups. The clients perceived that treatment goals were identified, they were able to recall the goals and felt that they were active participants. They also perceived they had a higher ability to manage after the rehabilitation period was completed compared to clients in the control group.

The clinical utility of the Swedish version of the COPM was confirmed in focus-group interviews with occupational therapists. The occupational therapists perceived the COPM as helpful in the goal-setting process and planning of treatment interventions. Even though problems are identified, they are directly related to, and formulated as, goals. Clients receive feedback on improvement over time. The COPM ensures a client-centred approach, facilitates communication within the rehabilitation team, and encourages therapists in their professional role. Therapists need knowledge about the theoretical foundation of the instrument and have to develop a personal interview technique.

When the COPM is used in a team setting, it provides the team with broader information on what is purposeful occupation to the client. The focus is on occupational performance rather than function. According to team members the use of the COPM as a team tool increased client participation, was a good outcome measure, resulted in distinct goals, and focused on goals that were meaningful to the client.

Implementation of a client-centred approach is facilitated when a structured method is used, but this is not enough. Involvement and motivation from all team members are required, as well as support during the introduction and implementation period. Support from management, knowledge about the underlying theory, time for discussions and reflections as well as opportunities to develop a personal interview technique are pointed out as important factors for a successful implementation.

Ort, förlag, år, upplaga, sidor
Linköping: Linköping University Electronic Press, 2002. s. 70
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 722
Nyckelord
Occupational therapy, Client-centred practice, https://www.diva-portal.org/liu/webform/form.jsp#paper0COPM, Participation, Rehabilitation, Goal formulation, Outcome
Nationell ämneskategori
Arbetsterapi
Identifikatorer
urn:nbn:se:liu:diva-8594 (URN)91-7373-167-6 (ISBN)
Disputation
2002-04-05, Berzeliussalen, Campus US, Linköpings Universitet, Linköping, 09:00 (Engelska)
Opponent
Handledare
Anmärkning
On the day of the defence date the status on article V was Submitted.Tillgänglig från: 2007-03-23 Skapad: 2007-03-23 Senast uppdaterad: 2012-01-25Bibliografiskt granskad

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Wressle, EwaÖberg, BirgittaHenriksson, Chris

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