Article

Multi-disciplinary team members predict each patient's
rehabilitation potential to maximise best use of resources. A lack of
underpinning theory about rehabilitation potential makes it difficult to apply
this concept in clinical practice. This study theorises about rehabilitation
potential drawing on everyday decision-making by Health Care Professionals (HCPs)
working in stroke rehabilitation services. METHODS:
A clinical scenario, checked
for face validity, was used in two focus groups to explore meaning and practice
around rehabilitation potential. Participants were 12 HCPs working across the
stroke pathway. Groups were co-facilitated, audio-recorded and fully transcribed.
Analysis paid attention to data grounded in first-hand experience, convergence
within and across groups and constructed a conceptual overview of HCPs'
judgements about rehabilitation potential. RESULTS: Rehabilitation potential is
predicted by observations of "carry-over" and functional gain and managed
differently across recovery trajectories. HCPs' responses to rehabilitation
potential judgements include prioritising workload, working around the system and
balancing optimism and realism. Impacts for patients are streaming of
rehabilitation intensity, rationing access to rehabilitation and a shifting
emphasis between management and active rehabilitation. For staff, the emotional
burden of judging rehabilitation potential is significant. Current service
organisation restricts opportunities for feedback on the accuracy of previous
judgements. CONCLUSION: Patients should have the opportunity to demonstrate
rehabilitation potential by participation in therapy. As therapy resources are
limited and responses to therapy may be context-dependent, early decisions about
a lack of potential should not limit longer-term opportunities for
rehabilitation. Services should develop strategies to enhance the quality of
judgements through feedback to HCPs of longer-term patient outcomes. Implications
for Rehabilitation Rehabilitation potential is judged at the level of individual
patients (rather than population-based predictive models of rehabilitation
outcome), draws on different sources of often experiential knowledge, and may be
less than reliable. Decisions about rehabilitation potential may have far
reaching consequences for individual patients, including the withdrawal of active
rehabilitation in hospital or in the community and eventual care placement. A better understanding of what people mean by rehabilitation potential by all team
members, and by patients and carers, may improve the quality of joint decision
making and communication.

Langue : ANGLAIS