McGlinchey Mark P, Davenport Sally
Guy's and St. Thomas' NHS Foundation Trust , London , UK and.
Disabil Rehabil. 2015;37(14):1277-84. doi: 10.3109/09638288.2014.962106. Epub 2014 Sep 22.
The aim of this study was to explore the decision-making process in the delivery of physiotherapy in a stroke unit.
A focused ethnographical approach involving semi-structured interviews and observations of clinical practice was used. A purposive sample of seven neurophysiotherapists and four patients participated in semi-structured interviews. From this group, three neurophysiotherapists and four patients were involved in observation of practice. Data from interviews and observations were analysed to generate themes.
Three themes were identified: planning the ideal physiotherapy delivery, the reality of physiotherapy delivery and involvement in the decision-making process. Physiotherapists used a variety of clinical reasoning strategies and considered many factors to influence their decision-making in the planning and delivery of physiotherapy post-stroke. These factors included the therapist's clinical experience, patient's presentation and response to therapy, prioritisation, organisational constraints and compliance with organisational practice. All physiotherapists highlighted the importance to involve patients in planning and delivering their physiotherapy. However, there were varying levels of patient involvement observed in this process.
The study has generated insight into the reality of decision-making in the planning and delivery of physiotherapy post-stroke. Further research involving other stroke units is required to gain a greater understanding of this aspect of physiotherapy. Implications for Rehabilitation Physiotherapists need to consider multiple patient, therapist and organisational factors when planning and delivering physiotherapy in a stroke unit. Physiotherapists should continually reflect upon how they provide physiotherapy, with respect to the duration, frequency and time of day sessions are delivered, in order to guide current and future physiotherapy delivery. As patients may demonstrate varying levels of participation in deciding and understanding how physiotherapy is delivered, physiotherapists need to adjust how they engage patients in the decision-making process and manage patient expectations accordingly.
本研究旨在探讨卒中单元中物理治疗实施过程中的决策过程。
采用聚焦民族志方法，包括半结构化访谈和临床实践观察。七名神经物理治疗师和四名患者组成的目的抽样样本参与了半结构化访谈。从这个群体中，三名神经物理治疗师和四名患者参与了实践观察。对访谈和观察数据进行分析以生成主题。
确定了三个主题：规划理想的物理治疗实施、物理治疗实施的现实情况以及参与决策过程。物理治疗师使用多种临床推理策略，并考虑许多因素来影响他们在卒中后物理治疗规划和实施中的决策。这些因素包括治疗师的临床经验、患者的表现和对治疗的反应、优先级、组织限制以及对组织实践的遵守情况。所有物理治疗师都强调让患者参与物理治疗规划和实施的重要性。然而，在此过程中观察到患者参与程度各不相同。
该研究深入了解了卒中后物理治疗规划和实施中决策的实际情况。需要开展涉及其他卒中单元的进一步研究，以更深入地了解物理治疗的这一方面。对康复的启示 物理治疗师在卒中单元规划和实施物理治疗时需要考虑多个患者、治疗师和组织因素。物理治疗师应不断反思他们提供物理治疗的方式，包括治疗的持续时间、频率和每天的治疗时间，以指导当前和未来的物理治疗实施。由于患者在决定和理解物理治疗实施方式方面可能表现出不同程度的参与，物理治疗师需要调整他们让患者参与决策过程的方式，并相应地管理患者的期望。
