Pauline Boland

Implementing a client-centred approach in rehabilitation: an autoethnography

Purpose: Client-centred practice is widely considered a key element of rehabilitation. However, there is limited discussion of how it should be implemented. This study explored how client-centred practice was operationalized during a clinical trial of innovative goal-setting techniques. Method: This study drew on principles of co-autoethnography. The personal experiences of three clinical researchers were explored to identify insights into client-centred practice, and seek understanding of this within the broader socio-cultural context. Data were collected through group discussions and written reflections. Thematic analysis and coding were used to identify the dominant themes from the data. Results: The primary way that client-centred practice was operationalized was through listening in order to get to know, to uncover and to understand what was meaningful. Four strategies were identified: utilizing mindful listening, allowing time, supporting clients to prioritize what is meaningful and viewing the therapists’ role differently. Conclusion: While technical competence in rehabilitation is important, our study suggested a starting point of ‘being with’ rather than ‘doing to’ may be beneficial for engaging people in their rehabilitation. We have highlighted a number of practical strategies that can be used to facilitate more client-centred practice. These approaches are consistent with what clients report they want and need from rehabilitation services. Implications for Rehabilitation At face value, clinical practice may appear to be client-centred. However, critical reflection of existing practice suggests that in reality, it is not well operationalized. Prioritizing getting to know the client, their story and what is meaningful to them appears fundamental to client-centred practice. A number of strategies may facilitate this process, including mindful listening on the part of the clinician and allowing time. Structures and processes need to be instituted to support implementation of client-centred practice. Autoethnography is an approach that may support clinicians’ to reflect on their practice.

Coping with multiple sclerosis as a couple: 'peaks and troughs' - an interpretative phenomenological exploration.

Purpose: Multiple Sclerosis (MS) is a chronic degenerative condition where illness uncertainty is a key difficulty that people with MS and their significant others have to cope with. Clinicians acknowledge that people with MS need to be seen in the context of their families, however there is little knowledge on what to expect about how people cope as a couple, which this study set out to explore. Method: Interpretative Phenomenological Analysis (IPA) exploring, through semi-structured interviews, how seven couples, where one had MS, experienced coping with their situation. Results: Two overarching themes pertaining to coping as a couple emerged from the data: Coping Together: “Peaks and Troughs” and Coping Over the Long Haul, with each overarching theme relating to sub-themes. Two integrative themes emerged also, which were called Faith in Self and Faith in Each Other. Conclusions: These results will assist clinicians better comprehend how those with MS and their spouses cope in an interconnected way and this in turn affects their experience of rehabilitation. Results from this research indicated that clinicians need to be sensitive to the individual coping strategies of both members of a couple where one has MS, and address the changing needs of their relationship. Implications for Rehabilitation It is important to consider how people with MS and their significant others cope as a couple when planning rehabilitation intervention Health professionals need to be mindful that the coping strategies of people with MS and their partners’ is reliant on concentrating on the present Health professionals could take a greater role in considering couples’ relationships and the role of optimism as part of rehabilitation

Establishing a person-centred framework of self-identity after traumatic brain injury: a grounded theory study to inform measure development

Objective To develop a theoretically sound, client-derived framework to underpin development of a measure reflecting the impact of traumatic brain injury (TBI) on a persons self-identity. Design Grounded theory, based on transcription of audio recordings from focus group meetings with people who have experienced TBI, analysed with constant comparative methods. Setting 8 different urban and rural communities in New Zealand. Participants 49 people (34 men, 15 women), 6 months to 36 years after mild-to-severe TBI. Results The central concept emerging from the data was that of desiring to be or having lost a sense of being an integrated and valued person. The three main subthemes were: (1) having a coherent, satisfying and complete sense of oneself, (2) respect, validation and acceptance by others and (3) having a valued place in the world. Conclusions This study reinforces the notion that change in self-identity is an important aspect of life after TBI, and provides information on what this concept means to people with TBI. In order to scientifically evaluate relationships between self-identity and other aspects of health (eg, depression, quality of life), and to test the effect of interventions to address problems with self-identity after TBI, a quantitative tool for evaluation of this construct is required. Themes from this research provide a foundation for the development of a measure of self-identity grounded in the language and experience of people with TBI.

Whakawhanaungatanga: the importance of culturally meaningful connections to improve uptake of pulmonary rehabilitation by Māori with COPD – a qualitative study

Background Pulmonary rehabilitation is known to improve function and quality of life for people with chronic obstructive pulmonary disease (COPD). However, little research has been conducted on the influence of culture on experiences of pulmonary rehabilitation. This study examined factors influencing uptake of pulmonary rehabilitation by Māori with COPD in New Zealand. Method Grounded theory nested within kaupapa Māori methodology. Transcripts were analyzed from interviews and focus groups with 15 Māori and ten New Zealand non-Māori invited to attend pulmonary rehabilitation for COPD. Māori participants had either attended a mainstream hospital-based program, a community-based program designed “by Māori, for Māori”, or had experienced both. Results Several factors influencing uptake of pulmonary rehabilitation were common to all participants regardless of ethnicity: 1) participants’ past experiences (eg, of exercise; of health care systems), 2) attitudes and expectations, 3) access issues (eg, time, transport, and conflicting responsibilities), and 4) initial program experiences. These factors were moderated by the involvement of family and peers, interactions with health professionals, the way information on programs was presented, and by new illness events. For Māori, however, several additional factors were also identified relating to cultural experiences of pulmonary rehabilitation. In particular, Māori participants placed high value on whakawhanaungatanga: the making of culturally meaningful connections with others. Culturally appropriate communication and relationship building was deemed so important by some Māori participants that when it was absent, they felt strongly discouraged to attend pulmonary rehabilitation. Only the more holistic services offered a program in which they felt culturally safe and to which they were willing to return for ongoing rehabilitation. Conclusion Lack of attention to cultural factors in the delivery of pulmonary rehabilitation may be a barrier to its uptake by indigenous, minority ethnic groups, such as New Zealand Māori. Indigenous-led or culturally responsive health care interventions for COPD may provide a solution to this issue.

Equipment provision after stroke: A scoping review of the use of personal care and mobility aids in rehabilitation

Introduction The aim of this scoping review was to examine and synthesise literature on adaptive equipment use for personal care and mobility after stroke. Method We searched databases including Medline, EMBASE, AMED, CINAHL and Scopus to February 2016. Two authors independently screened 789 titles, identifying 28 studies for inclusion in the review. Results Findings were grouped into four themes: (1) stroke-specific impairments and consequences for equipment use and training; (2) meaning of equipment for people with stroke; (3) cost of equipment after stroke; and (4) conflicts between equipment provision and models of stroke rehabilitation. Conclusion The wide range of impairments after stroke increases complexity of how people use equipment. Nonetheless, training needs and the relationship between social context, identity and equipment use are increasingly better understood,. The findings highlight a tension between practice that seeks to re-train function by ‘normal’ movement without equipment and restoration of function by using compensation strategies involving use of equipment. However, there is no evidence that compensation strategies impede recovery of physical abilities. High-quality evidence about costs of equipment after stroke, which could inform policy decisions, is urgently needed.

Occupational therapists??? and physiotherapists??? perceptions of implementing Occupational Performance Coaching

Abstract Purpose: Occupational Performance Coaching (OPC) has been proposed as an intervention for working with caregivers towards achievement of goals for themselves and their children. Preliminary studies indicate the effectiveness of OPC; however, translation into practice requires an understanding of therapists’ perceptions of applying OPC in their service delivery settings. This study explored physio- and occupational-therapists’ experiences of using OPC and their perceptions of the contextual factors which influence its implementation. Method: Interviews and a focus group were used to gather physio- (n = 4) and occupational- (n = 12) therapists’ perspectives of applying OPC in their work with caregivers of children with disabilities. Data were analysed thematically. Results: One overarching theme and three major themes emerged. The overarching theme, “Listening better” pervaded all other themes. Three major themes, each with subthemes, were: (1) Sharing power, (2) Reprioritising processes, and (3) Liberating but challenging. Implementing OPC drew on skills that were familiar to therapists and aligned with existing values when working with families but challenged some aspects of their practice. Conclusions: From physio- and occupational-therapists’ perspectives, OPC is applicable in a range of paediatric service environments. However, therapist and service-level flexibility appeared to be key contextual factors in adhering to intervention principles. Implications for Rehabilitation Occupational Performance Coaching (OPC) is a strengths-focused intervention in which caregiver engagement and active involvement is prioritised. Therapists reported distinct changes to the process of therapy and outcomes achieved following OPC training and implementation. Most therapists indicated that OPC enabled them to operationalisation person-centred principles to a greater extent which they perceived enhanced the way therapy was delivered and the benefit to services users. Some flexibility in service structures may be needed to implement OPC in the way it was intended.

Park-based physical activity interventions for persons with disabilities: A mixed-methods systematic review

BACKGROUND Park-based physical activity (PA) interventions improve health in the general population, but it is unknown if the evidence can be translated to persons with disabilities. OBJECTIVES To conduct a mixed-methods systematic synthesis of the evidence for park-based physical activity interventions for persons with disabilities and secondarily, to consider the health benefits across the lifespan (children and adolescents, young, middle, and older adults). METHODS All major electronic databases were searched from inception until 30th November 2016. Studies were eligible if the PA intervention was conducted in an urban park environment with people reporting a disability (e.g. physical, psychological and developmental impairments) and health outcomes were evaluated with biopsychosocial measures. Methodological quality was assessed using Crowes Critical Appraisal Tool (CCAT) and key findings extracted. RESULTS Six quantitative and four qualitative papers, comprising of 446 participants (age range seven to ninety-one years), were included for qualitative synthesis; five in children/adolescents, none in adults, and five in older adults. There was limited, low level, preliminary evidence for short-term improvements in physical, psychological, and social health outcomes in children and older adults with disabilities as well as improvements in disability-related impairments. When accessible, parks fostered societal inclusion. CONCLUSIONS Health benefits from park use in persons with disabilities were identified. Parks may provide an alternative environment for rehabilitation and management of disabilities. Further randomized controlled trials evaluating the long-term effectiveness of park-based interventions is necessary to corroborate our findings. Legislative commitment ensuring urban parks are accessible may mitigate some health disparities in persons with disabilities.