TY - JOUR
T1 - Factors guiding therapist decision making in the rehabilitation of physical function after severely disabling stroke – an ethnographic study
AU - McGlinchey, Mark P.
AU - Faulkner-Gurstein, Rachel
AU - Sackley, Catherine M.
AU - McKevitt, Christopher
N1 - Funding Information:
The study formed part of the primary researcher’s PhD which was funded by The Dunhill Medical Trust (Grant Number RT62/0116). The authors would like to thank the study participants and stroke services for their involvement in the study.
Publisher Copyright:
© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
PY - 2024
Y1 - 2024
N2 - Purpose: Whilst strong evidence supports rehabilitation to improve outcomes post-stroke, there is limited evidence to guide rehabilitation in the most severely disabled group. In an era of evidence-based practice, the aim of the study was to understand what factors guide physiotherapists (PTs) and occupational therapists (OTs) to select particular interventions in the rehabilitation of physical function after severely disabling stroke. Material and methods: An ethnographic study was undertaken over an 18-month period involving five London, UK stroke services. Seventy-nine primary participants (30 PTs, 22 OTs, and 27 stroke survivors) were recruited to the study. Over 400 h of observation, 52 semi-structured interviews were conducted. Study data were analysed through thematic analysis. Results: Key factors guiding therapist decision making were clinical expertise, professional role, stroke survivors’ clinical presentation, therapist perspectives about stroke recovery, and clinical guidelines. Research evidence, stroke survivors’ treatment preferences, organisational type, and pathway design were less influential factors. Therapy practice did not always address the physical needs of severely disabled stroke survivors. Conclusions: Multiple factors guided therapist decision making after severely disabling stroke. Alternative ways of therapist working should be considered to address the physical needs of severely disabled stroke survivors more fully.
AB - Purpose: Whilst strong evidence supports rehabilitation to improve outcomes post-stroke, there is limited evidence to guide rehabilitation in the most severely disabled group. In an era of evidence-based practice, the aim of the study was to understand what factors guide physiotherapists (PTs) and occupational therapists (OTs) to select particular interventions in the rehabilitation of physical function after severely disabling stroke. Material and methods: An ethnographic study was undertaken over an 18-month period involving five London, UK stroke services. Seventy-nine primary participants (30 PTs, 22 OTs, and 27 stroke survivors) were recruited to the study. Over 400 h of observation, 52 semi-structured interviews were conducted. Study data were analysed through thematic analysis. Results: Key factors guiding therapist decision making were clinical expertise, professional role, stroke survivors’ clinical presentation, therapist perspectives about stroke recovery, and clinical guidelines. Research evidence, stroke survivors’ treatment preferences, organisational type, and pathway design were less influential factors. Therapy practice did not always address the physical needs of severely disabled stroke survivors. Conclusions: Multiple factors guided therapist decision making after severely disabling stroke. Alternative ways of therapist working should be considered to address the physical needs of severely disabled stroke survivors more fully.
KW - decision making
KW - occupational therapy
KW - physiotherapy
KW - rehabilitation
KW - severely disabling stroke
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=85147720284&partnerID=8YFLogxK
U2 - 10.1080/09638288.2023.2172463
DO - 10.1080/09638288.2023.2172463
M3 - Article
AN - SCOPUS:85147720284
SN - 0963-8288
VL - 46
SP - 672
EP - 684
JO - Disability and Rehabilitation
JF - Disability and Rehabilitation
IS - 4
ER -
