Cott CA. Client-centred rehabilitation: client perspectives.
Disabil Rehabil. 2004 Dec 16;26(24):1411-22. [Pub
Med ID 15764361]
Purpose
The purpose of this research is to understand the important components
of client-centred rehabilitation from the perspective of adult
clients with long-term physical disabilities.
[more…]
In the 1990s and to this day, the predominant discourse in health care
and rehabilitation is evidence-based practice in which decision-making
is guided by integrating individual clinical expertise with the best
available external clinical evidence from systematic research.
In this discourse, the person with disabilities is rarely, if
ever, mentioned as having a role it the decision-making. A discourse
about “client-centredness” also emerged around the same time,
that was based on mutuality in which clients were recognized
for their role in decision-making and their increasing power within health
care settings. Although perhaps not adopted with such enthusiasm and vigour
as EBP, client-centredness has increasingly come to the fore
as a basis for health care and rehabilitation service delivery.
Method
Focus groups were conducted with adult clients who had completed at least
one course of rehabilitation in the publicly-funded rehabilitation
system in Ontario. Data were analysed using an iterative inductive
approach.
[more…]
A combination of theoretical and purposive sampling was used. The
boundaries of the data collection encompassed adults with adult-onset
chronic disabling conditions who had completed at least one course
of rehabilitation in the publicly-funded system and who were
able to participate in a 1-2 hour focus group in English. The
conditions chosen (arthritis, total joint replacement, acquired
brain injury, chronic respiratory conditions, spinal cord injury, and
stroke) represent those for which people most commonly receive rehabilitation
in Ontario.
Results
The major theme underlying all of the participants’ comments was
the need for better transitions between rehabilitation programs
and the community. Participants felt ill-prepared for community living
and the emotional challenges of living with a long-term condition
and, once discharged from rehabilitation, felt isolated and had difficulty
finding out about and accessing community services.
[more…]
The main themes that arose from the groups were individualization (i.e.,
rehab programmes being individualized and tailored to their
particular needs), participation in goal setting and decision-making,
client-centred education, preparation for life in the real world,
the need for emotional support, feeling isolated and abandoned,
and the need for ongoing support after discharge. For example,
clients did not feel prepared for life in the real world by
their rehabilitation programmes, once they were discharged they
felt isolated and abandoned. Transitions between services, particularly
from rehabilitation facility to the community, were weak to non-existent
according to most groups. As one participant said: “But that transition
period is not really a transition. You are just sort of dropped like
a rock and then you're out there to fend for yourself and that's
really hard.”
Conclusions
The findings demonstrate that client-centred rehabilitation encompasses
much more than goal-setting and decision-making between individual
clients and professionals. It refers to a philosophy or approach to the
delivery of rehabilitation services that reflects the needs of individuals
and groups of clients. This entails a shift from an acute-illness, curative
model to one that acknowledges the long-term nature of the career of chronic
illness or disability. Definitions of evidence that is deemed credible need
to be broadened beyond expert, “scientific” evidence to include multiple
dimensions of evidence including the expertise of the client.
List of Tables and Figures (in the publication)
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Supplementary Tables (with interpretation)
No supplementary information is available for this paper.
