Variations in physiotherapy practice in neurological rehabilitation trajectories -an explorative interview and observational study.

Rehabilitation following acquired brain injury requires multidisciplinary efforts, including physiotherapy, across health care levels. Recent changes in the organization of health care services in western societies have led to earlier hospital discharge and increased responsibility for rehabilitation in primary care. The aim of this study was to describe and increase knowledge on the variations in physiotherapy practice for people with acquired brain injury across health care levels in Norway. We performed qualitative interviews with physiotherapists and field observations of physiotherapy treatments for 10 rehabilitation trajectories. We also performed systematic analyses using data from field observations, interviews, and hospital discharge records related to perspectives on social practices. The institutionalized rehabilitation context in hospitals promoted a more uniform approach by physiotherapists, emphasizing quality of movement and reacquisition of function. Physiotherapists in primary health care had to balance between interventions aiming to improve quality of movement versus interventions enabling patients to identify coping strategies. The informants highlighted the relevance of contextual surroundings when patients were discharged earlier from the hospital, as these patients' level of function was perceived to be lower. Moreover, the preconditions for providing rehabilitation in primary care challenged physiotherapists to practice and use their knowledge base in novel ways.