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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 16, 2015
Footnotes
This study fulfilled part of the degree requirements for Smith-Forbes.
The views expressed herein are those of the authors and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, the Department of Defense, or the U.S. Government.
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
