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Original research| Volume 97, ISSUE 8, P1262-1268.e1, August 2016

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Adherence of Individuals in Upper Extremity Rehabilitation: A Qualitative Study

Published:December 16, 2015DOI:https://doi.org/10.1016/j.apmr.2015.11.008

      Abstract

      Objective

      To describe the rehabilitation experiences, expectations, and treatment adherence of patients receiving upper extremity (UE) rehabilitation who demonstrated discrepancy between functional gains and overall improvement.

      Design

      Qualitative (phenomenologic) interviews and analysis.

      Setting

      Outpatient UE rehabilitation.

      Participants

      Patients with acute UE injuries (N=10).

      Interventions

      Not applicable.

      Main Outcome Measure

      Concerns related to UE rehabilitation patients demonstrating discrepancy between outcome measures.

      Results

      Five key themes emerged from the interviews of patients demonstrating discrepancy in their self-reported patient outcomes: (1) desire to return to normal, (2) initial anticipation of brief recovery, (3) trust of therapist, (4) cannot stop living, and (5) feelings of ambivalence. Challenges included living with the desire to move back into life. Multiple factors affected patient adherence: cost of treatment, patient-provider relation (difference between therapist and patient understanding on what is important for treatment), and patients expecting the treating therapists to be an expert and fix their problem.

      Conclusions

      Patient adherence to UE rehabilitation presents many challenges. Patients view themselves as laypersons and seek the knowledge of a dedicated therapist who they trust to spend time with them to understand what they value as important and clarify their injury, collaboratively make goals, and explain the intervention to get them in essence, back into life, in the minimal required time. When categorized according to the World Health Organization's multidimensional adherence model, domains identified in this model include social and economic, health care team and system, condition-related, therapy-related, and patient-related dimensions. Assessing factors identified to improve efficiency and effectiveness of clinical management can enhance patient adherence.

      Keywords

      List of abbreviations:

      GROC (Global Rating of Change Scale), QDASH (Quick Disabilities of the Arm, Shoulder, and Hand), UE (upper extremity)
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      References

        • Martin C.
        • Perfect T.
        • Mantle G.
        Non-attendance in primary care: the views of patients and practices on its causes, impact and solutions.
        Fam Pract. 2005; 22: 638-643
        • Meichenbaum D.
        • Turk D.
        Facilitating treatment adherence.
        Plenum Pr, New York1987
        • O'Brien L.
        The evidence on ways to improve patient's adherence in hand therapy.
        J Hand Ther. 2012; 25: 247-250
        • World Health Organization
        Adherence to long-term therapies: evidence for action.
        World Health Organization, Geneva2003
        • Groth G.N.
        • Wulf M.B.
        Compliance with hand rehabilitation: health beliefs and strategies.
        J Hand Ther. 1995; 8: 18-22
        • Winthrop Rose B.
        • Kasch M.C.
        • Aaron D.H.
        • Stegink-Jansen C.W.
        Does hand therapy literature incorporate the holistic view of health and function promoted by the World Health Organization?.
        J Hand Ther. 2011; 24 (quiz 88): 84-87
        • Beaton D.E.
        • Wright J.G.
        • Katz J.N.
        Development of the QuickDASH: comparison of three item-reduction approaches.
        J Hand Surg [Am]. 2005; 87: 1038-1046
        • Kamper S.J.
        • Maher C.G.
        • Mackay G.
        Global rating of change scales: a review of strengths and weaknesses and considerations for design.
        J Man Manip Ther. 2009; 17: 163-170
        • Gummesson C.
        • Ward M.M.
        • Atroshi I.
        The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH.
        BMC Musculoskelet Disord. 2006; 7: 44
        • Stucki G.
        • Daltroy L.
        • Katz J.N.
        • Johannesson M.
        • Liang M.H.
        Interpretation of change scores in ordinal clinical scales and health status measures: the whole may not equal the sum of the parts.
        J Clin Epidemiol. 1996; 49: 711-717
        • Creswell J.W.
        Qualitative inquiry & research design: choosing among five approaches.
        3rd ed. SAGE, Lincoln2013
        • Colaizzi P.F.
        Psychological research as the phenomenologist views it.
        in: Valle R. King M. Existential phenomenological alternatives in psychology. Oxford Univ Pr, New York1978: 48-71
        • O'Brien L.
        • Presnell S.
        Patient experience of distraction splinting for complex finger fracture dislocations.
        J Hand Ther. 2010; 23 (quiz 260): 249-259
        • Miller W.
        • Rollnick S.
        Motivational interviewing.
        Guilford Pr, New York1999
        • Sluijs E.M.
        • Kok G.J.
        • van der Zee J.
        Correlates of exercise compliance in physical therapy.
        Phys Ther. 1993; 73 (discussion 778-81): 771-782
        • Schofield N.G.
        • Green C.
        • Creed F.
        Communication skills of health-care professionals working in oncology–can they be improved?.
        Eur J Oncol Nurs. 2008; 12: 4-13
        • Martyn C.
        Field guide to the difficult patient interview.
        BMJ. 1999; 319: 792
        • Vranceanu A.M.
        • Cooper C.
        • Ring D.
        Integrating patient values into evidence-based practice: effective communication for shared decision-making.
        Hand Clin. 2009; 25 (vii): 83-96