Barriers and facilitators to implementing self-directed therapy activities in inpatient rehabilitation settings.

Autor: Brusco NK; Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia., Walpole B; Safer Care Victoria, Victorian Government, Melbourne, Australia., Kugler H; Allied Health Services, Cabrini Health, Malvern, Victoria, Australia., Tilley L; Allied Health Services, Cabrini Health, Malvern, Victoria, Australia., Thwaites C; The Victorian Rehabilitation Centre and La Trobe University ARCH and CERI, Bundoora, Victoria, Australia., Devlin A; Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia., Dorward E; Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia., Dulfer F; Allied Health Services, Cabrini Health, Malvern, Victoria, Australia., Lee AL; Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia., Morris ME; The Victorian Rehabilitation Centre and La Trobe University ARCH and CERI, Bundoora, Victoria, Australia., Taylor NF; Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia.; School of Allied Health Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia., Dawes H; Clinical Rehabilitation, University of Exeter, Exeter, UK., Whittaker SL; Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia., Ekegren CL; Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia.
Jazyk: angličtina
Zdroj: Australian occupational therapy journal [Aust Occup Ther J] 2023 Oct; Vol. 70 (5), pp. 617-626. Date of Electronic Publication: 2023 Jun 08.
DOI: 10.1111/1440-1630.12891
Abstrakt: Background: Self-directed therapy activities are not currently part of routine care during inpatient rehabilitation. Understanding patient and clinician perspectives on self-directed therapy is key to increasing implementation. The aim of this study was to investigate barriers and facilitators to implementing a self-directed therapy programme ("My Therapy") in adult inpatient rehabilitation settings.
Methods: My Therapy was recommended by physiotherapists and occupational therapists and completed by rehabilitation inpatients independently, outside of supervised therapy sessions. Physiotherapists, occupational therapists, and patients were invited to complete an online questionnaire comprising open-ended questions on barriers and facilitators to prescribing and participating in My Therapy. A directed content analysis of free-text responses was undertaken, with data coded using categories of the Capability, Opportunity, and Motivation Model of Behaviour (COM-B model).
Results: Eleven patients and 20 clinicians completed the questionnaire. Patient capability was reported to be facilitated by comprehensive education by clinicians, with mixed attitudes towards the format of the programme booklet. Clinician capability was facilitated by staff collaboration. One benefit was the better use of downtime between the supervised therapy sessions, but opportunities for patients to engage in self-directed therapy were compromised by the lack of space to complete the programme. Clinician opportunity was reported to be provided via organisational support but workload was a reported barrier. Patient motivation to engage in self-directed therapy was reported to be fostered by feeling empowered, engaged, and encouraged to participate. Clinician motivation was associated with belief in the value of the programme.
Conclusion: Despite some barriers to rehabilitation patients independently practicing therapeutic exercises and activities outside of supervised sessions, both clinicians and patients agreed it should be considered as routine practice. To do this, patient time, ward space, and staff collaboration are required. Further research is needed to scale-up the implementation of the My Therapy programme and evaluate its effectiveness.
(© 2023 The Authors. Australian Occupational Therapy Journal published by John Wiley & Sons Australia, Ltd on behalf of Occupational Therapy Australia.)
Databáze: MEDLINE
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