Karolinska Institutet
Browse

File(s) not publicly available

On aspects of context in rehabilitation after stroke : views of patients and therapeutists

thesis
posted on 2024-09-02, 22:42 authored by Annica Wohlin Wottrich

Contextual factors have lately come more into focus contributing to the individual's health condition. Previous research indicates that contextual factors are poorly accounted for in stroke rehabilitation and that the patient's participation in planning and decision making in the rehabilitation process is very limited. Professionals working with stroke rehabilitation need to develop an understanding of the contextual aspects and incorporate them in their rehabilitation strategies. The overall aim of this thesis was to explore and describe rehabilitation after stroke in different contexts.

Data for Study I were collected from participant observation of therapy sessions in hospital and at home and from semi-structured interviews and documents. Three patients and two therapists participated. In Study II, data were collected by participant observations in hospital and semi-structured interviews with nine patients and ten physiotherapists. A descriptive, comparative approach for data analysis was applied in Studies I and II. In Study III data were collected from therapeutic stories told by 13 therapists working in the patient's home. The transcribed data were analysed with a phenomenological approach.

The present thesis describes differences in rehabilitation after stroke in the hospital and in the home. It has put words on tacit knowledge of the meaning of working with rehabilitation after stroke in the patient's home.

The findings in Study I indicate clear differences between a rehabilitation session in the patient's home versus one in the hospital. Both the therapists and the patients assumed different roles in the different contexts and at home the patient took initiative and expressed his goals, which was not the case for the patients in the hospital. In Study II differences between the patients' and the therapists' descriptions of what characterises a physiotherapy session in the hospital was revealed. In the theme Facilitating active patient involvement the physiotherapists reported an interest for taking the patients personal experiences into account. This was not recognised by the patients. One of them explicitly expressed how the personal interest was not included in the rehabilitation process. In Study III one of the characteristics was Supporting continuity, where the patient as an individual with his/her life-story was in focus.

The findings in the three studies support and confirm each other by giving descriptions on aspects of context involving both environmental and personal factors. In addition, the findings describe contextual aspects in relation to experiences of the body after stroke. Contextual factors were considered of great importance for the rehabilitation after stroke by both the therapists and the patients, but only in rehabilitation at borne they were clearly included in the therapy sessions or the rehabilitation process. Ways to include contextual factors in the rehabilitation in hospital needs to be developed e.g. to encourage the patients' participation in the rehabilitation process. Contextual factors in the hospital in general were not regarded as conducive to activities neither by the patients nor the therapists. Hence, this is an area open for improvements.

List of scientific papers

I. von Koch L, Wottrich AW, Holmqvist LW (1998). Rehabilitation in the home versus the hospital: the importance of context. Disabil Rehabil. 20(10): 367-72.
https://pubmed.ncbi.nlm.nih.gov/9793750

II. Wohlin Wottrich A, Stenstrom CH, Engardt M, Tham K, von Koch L (2004). Characteristics of physiotherapy sessions from the patient's and therapist's perspective. Disabil Rehabil. 26(20): 1198-205.
https://doi.org/10.1080/09638280410001724889

III. Wohlin Wottrich A, von Koch L, Tham K (2006). Charcteristics of rehabilitation in the home environment after stroke. The therapist´s perspective. [Submitted]

History

Defence date

2006-10-06

Department

  • Department of Neurobiology, Care Sciences and Society

Publication year

2006

Thesis type

  • Licentiate thesis

ISBN-10

91-7140-866-5

Number of supporting papers

3

Language

  • eng

Original publication date

2006-09-15

Author name in thesis

Wohlin Wottrich, Annica

Original department name

Department of Neurobiology, Care Sciences and Society

Place of publication

Stockholm

Usage metrics

    Theses

    Categories

    No categories selected

    Keywords

    Exports

    RefWorks
    BibTeX
    Ref. manager
    Endnote
    DataCite
    NLM
    DC