STRENGTH and the Health Care Team: Changing Interprofessional and Client-Centered Practices

Abstract

Background: Client-centered practice in stroke rehabilitation is strongly infl uenced by interprofessional team functioning and collaborative goal setting. The hospital context is problematic for client-centered practice and reduces the ability of the health care team and client with stroke to appreciate the impact of stroke on functioning within the home environment. Objective: The purpose of this study was to trial Stroke Rehabilitation Enhancing and Guiding Transition Home (STRENGTH), an approach to rehabilitation that provides clients, carers, and hospital-based therapists with weekly opportunities to develop goals and undertake therapy sessions in the home and community before hospital discharge. Methods: Nine participants, comprising 3 occupational therapists, 4 physiotherapists, and 2 speech pathologists, completed a custom-made survey and participated in a semi-structured focus group at the completion of the 6-month trial of STRENGTH. The survey and focus group questioned the participants on their experiences and impressions of STRENGTH. Results: Inductive thematic analysis of the focus group identifi ed 2 themes: "infl uences of context on team functioning" and "experiences of the program." The quantitative data supported the value of STRENGTH for team functioning and client outcomes. Conclusions: The fi ndings provide an overall endorsement for STRENGTH from the therapists' perspectives and highlight the positive impact of environmental context on team functioning, collaborative goal setting, and ultimately client-centered practice.

Listening to the client voice – A constructivist grounded theory study of the experiences of client‐centred practice after stroke

“…Collaborative goal setting has also been explored within the context of client-centred practice in stroke care (Almborg, Ulander, Thulin, & Berg, 2009;Gustafsson et al, 2014;Gustafsson & McLaughlin, 2009;Laver, Halbert, Stewart, & Crotty, 2010). This study sheds further light on the survivor experience of goal setting.…”

“…As goal setting practices in stroke rehabilitation are linked to client motivation (Koh, Barr, & George, 2014;Sugavanam, Mead, Bulley, Donaghy, & van Wijck, 2013), continued exploration of the survivor perspective of goal setting is required. Studies have highlighted some barriers to collaboration (Gustafsson et al, 2014;Sugavanam et al, 2013), and differing perceptions between stroke survivors and health professionals in relation to the degree of collaboration that occurred (Holliday, Ballinger, & Playford, 2007;Salter, Hellings, Foley, & Teasell, 2008).…”

“…A collaborative partnership with a therapist, active involvement in decision making and ability to exercise choice are important as individuals navigate their often complex and emotional adjustment following a stroke. Provision of client-centred stroke care is widely reported and advocated (Stroke Foundation, 2019;Gustafsson, Fleming, Cornwell, Worrall, & Brauer, 2014). However, evidence of unmet survivor needs (Andrew et al, 2014;Kristensen, Tistad, von Koch, & Ytterberg, 2016;National Stroke Foundation, 2013) suggests the level of client choice, collaboration, and empowerment in their care may not always be optimal.…”

Let’s Get Real about Person- and Family-Centred Geriatric Home Care: A Realist Synthesis

“…OTs actively assess individuals performing daily activities within the full scope of their environment rather than just focusing on the physical environment in isolation (Comunale, 1992; Szanton et al, 2015). For example, in the Stroke Rehabilitation Enhancing and Guiding Transition Home (STRENGTH) program for stroke rehabilitation, an OT completes home visits with the patient prior to the patient’s discharge from hospital to ensure they are able to assess the full range of the patient’s environment (Gustafsson, Fleming, Cornwell, Worrall, & Brauer, 2014). The idea that occupational therapy is linked to the PFCC core concept of Participation in the preliminary evaluative framework was confirmed by the data; however, it became clear that OTs specifically focus on the outcome of patient participation within the context of the patient’s day-to-day life activities (occupations) in addition to providing care.…”

Healthcare teams and patient‐related terminology: a review of concepts and uses

“…Some authors include an explanation of the terminology they decided to use for recipients of care (6); however, a number of studies addressing healthcare teams do not show consistency in the use of patient-related terminology. While various studies prefer the term patient when referring to recipients of care in interprofessional (7)(8)(9) or interdisciplinary teams (10,11), others prefer the term user (12,13) or client (14,15).…”