The how’s and why’s in judging rehabilitation potential (Abstract)

Abstract

Background: Predicting recovery and benefit of neuro-rehabilitation has huge implications in today’s National Health Service. Anecdotal clinical experience suggests variability and subjectivity in clinicians’ decision making. Method: Five participants were recruited, via email, using a convenience sampling method of experienced neurological physiotherapists in the Specialist Interest Group in Neurological Therapy (SIGNeT) group based at Keele University. An inductive qualitative phenomenological approach was adopted using semi-structured interviews, lasting approximately 45?minutes. Coventry University Ethics Committee granted ethical approval. Results/Findings: Thematic analysis highlighted dependency on information such as age, pre-morbid health, social history, motor, sensory and functional abilities when making decisions about rehabilitation. Patients with neglect, ataxia, and incontinence were found to have limited benefit from further rehabilitation. Discussion: Multidisciplinary working to share ideas and discuss quality of life were strong factors in decision making. Bed pressures and time constraints were detrimental to decision making, while junior clinicians were found to lack the knowledge and skills required to make some clinical decisions. Conclusion: Although rehabilitation potential had various meanings to the participants, quality of life was of paramount importance in decisions made. This study demonstrates that a detailed physiotherapy assessment with specialty experience is essential to judging rehabilitation potential. It also concludes that certain complex patient characteristics were indicative of a poor outcome following rehabilitation.