Lam Wai Shun Priscilla, Bottari Carolina, Ogourtsova Tatiana, Swaine Bonnie
Occupational Therapy, School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada.
Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Lucie-Bruneau Rehabilitation Centre, Montréal, Québec, Canada.
Aust Occup Ther J. 2017 Apr;64(2):149-158. doi: 10.1111/1440-1630.12327. Epub 2016 Sep 21.
BACKGROUND/AIM: Clinical practice guidelines advocate for early involvement of rehabilitation professionals in screening acquired brain injury patients' rehabilitation needs and determining the required rehabilitation services. Little is yet known about the nature of occupational therapists' role in this context. This exploratory study sought to identify factors influencing occupational therapists' perception of acquired brain injury patients' rehabilitation potential for inpatient rehabilitation.
A qualitative approach was used to analyse data from a focus group involving 12 occupational therapists working in acute care and inpatient rehabilitation. A consensus-seeking technique was used to identify patient-related factors participants perceived as most important to consider when assessing rehabilitation potential. The transcription of the group discussion was analysed using an interpretive description approach to identify additional factors influencing occupational therapists' perception.
Participants agreed on 11 patient-related factors most important to consider: age, behaviour, cognitive abilities, endurance, home environment, medical status, observed improvement in acute care post-injury, physical abilities, post-injury functional status, pre-injury functional status, patient and family expectations. Additional factors included the influence of the organisational context (i.e. acute care and broader health care context) as well as occupational therapists' professional expertise, knowledge of scientific evidence, concerns for ethical decisions and interpretive activities (i.e. clinician's interpretation of patients' characteristics in light of all other factors).
Findings suggest that assessing rehabilitation potential is a complex process that goes beyond strictly appraising patients' characteristics. Additional factors influence clinicians' perception of patients' rehabilitation potential. Clinicians should pay more attention to these factors when making evidence-based decisions regarding patients' potential to benefit from rehabilitation.
背景/目的：临床实践指南提倡康复专业人员尽早参与筛查获得性脑损伤患者的康复需求并确定所需的康复服务。目前对于职业治疗师在此背景下的角色性质了解尚少。这项探索性研究旨在确定影响职业治疗师对获得性脑损伤患者住院康复康复潜力认知的因素。
采用定性方法分析来自一个焦点小组的数据，该小组由12名在急性护理和住院康复领域工作的职业治疗师组成。使用一种寻求共识的技术来确定参与者认为在评估康复潜力时最重要的与患者相关的因素。使用解释性描述方法分析小组讨论的文字记录，以确定影响职业治疗师认知的其他因素。
参与者就11个最重要的与患者相关的因素达成了一致：年龄、行为、认知能力、耐力、家庭环境、医疗状况、伤后急性护理中的观察到的改善、身体能力、伤后功能状态、伤前功能状态、患者及家属期望。其他因素包括组织背景（即急性护理和更广泛的医疗保健背景）的影响，以及职业治疗师的专业知识、科学证据知识、对伦理决策的关注和解释活动（即临床医生根据所有其他因素对患者特征的解释）。
研究结果表明，评估康复潜力是一个复杂的过程，不仅仅是严格评估患者的特征。其他因素会影响临床医生对患者康复潜力的认知。临床医生在基于证据就患者从康复中获益的潜力做出决策时应更加关注这些因素。
