School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada.
Bruyere Research Institute, Ottawa, ON, Canada.
Disabil Rehabil. 2020 Nov;42(23):3403-3415. doi: 10.1080/09638288.2019.1592244. Epub 2019 Apr 11.
: Implementation of the Canadian Stroke Best Practice Recommendations has improved inpatient rehabilitation. As attention is turned to the design and allocation of rehabilitation after hospitalization, examination of their implications for post-discharge rehabilitation could help optimize service planning Critical discourse analysis modeled on Alvesson and Sandberg's method of problematization was conducted to determine how the Canadian Stroke Best Practice Recommendations envision and shape post-discharge rehabilitation, and identify any tensions and potential ways to resolve them. Within the Canadian Stroke Best Practice Recommendations post-discharge rehabilitation is implicitly viewed as a continuation of inpatient rehabilitation. Rehabilitation is largely envisioned as a set of biomedical procedures aimed at normalization through correction of impairment. There is potential tension between this implicit goal and the explicit goal of providing patient and family-centered care and promoting reengagement in valued activities and roles. An alternate vision of post-discharge rehabilitation could help resolve this tension. Post-discharge rehabilitation could be envisioned as a self-management intervention. Rather than primarily an expert-driven process of measuring impairment and applying procedures aimed at normalization, rehabilitation would be considered facilitation of self-management with the goal of reengaging in forms of participation that comprise a satisfying life.Implications for RehabilitationImplicit assumptions within best practice guidelines powerfully influence recommendations. These ideas are difficult to examine because they seem self-evident.Implicit assumptions in the Canadian Stroke Best Practice Guidelines envision post-discharge stroke rehabilitation as an expert-driven, impairment-focused biomedical procedure.This biomedical image makes it difficult to provide care that meets the guideline's explicit goals of client- and family-centeredness.Reimagining post-discharge stroke rehabilitation as a chronic self-care management intervention aimed at developing a satisfying life after stroke could improve patient care.
加拿大脑卒中最佳实践推荐的实施改善了住院康复。随着人们对住院后康复的设计和分配的关注，检查其对出院后康复的影响有助于优化服务规划。采用基于 Alvesson 和 Sandberg 的问题化方法的批判性话语分析，确定加拿大脑卒中最佳实践推荐如何设想和塑造出院后康复，并确定任何紧张关系和潜在的解决方法。在加拿大脑卒中最佳实践推荐中，出院后康复被视为住院康复的延续。康复在很大程度上被设想为一组生物医学程序，旨在通过纠正损伤来实现正常化。这种隐含的目标与提供以患者和家庭为中心的护理以及促进重新参与有价值的活动和角色的明确目标之间存在潜在的紧张关系。对出院后康复的另一种设想可以帮助解决这种紧张关系。出院后康复可以被设想为一种自我管理干预。康复不是主要的专家驱动过程，即测量损伤并应用旨在正常化的程序，而是被认为是促进自我管理，目标是重新参与构成满意生活的参与形式。
康复的意义
最佳实践指南中的隐含假设强烈影响推荐。这些想法很难检查，因为它们似乎是不言而喻的。
加拿大脑卒中最佳实践指南中的隐含假设将出院后脑卒中康复设想为一种专家驱动、以损伤为重点的生物医学程序。
这种生物医学形象使得提供符合指南明确以患者和家庭为中心的目标的护理变得困难。
将出院后脑卒中康复重新想象为一种慢性自我护理管理干预，旨在发展脑卒中后的满意生活，可以改善患者护理。
