Advertisement

Person-Centered Rehabilitation Model: Framing the Concept and Practice of Person-Centered Adult Physical Rehabilitation Based on a Scoping Review and Thematic Analysis of the Literature

      Abstract

      Objective

      To develop a cross-professional model framing the concept and practice of person-centered rehabilitation (PCR) in adult populations, based on a scoping review and thematic analysis of the literature.

      Data Sources

      Key databases (PubMed, Scopus, Cumulative Index to Nursing and Allied Health), snowballing searches, and experts’ consultation were the data sources for English-language empirical or conceptual articles published from January 2007-February 2020.

      Study Selection

      Two independent reviewers selected adult-based articles addressing at least 1 of the 6 categories of PCR-related content, a priori specified in the published review protocol. From 6527 unique references, 147 were finally included in the analysis. Of those, 26 were exclusively conceptual articles.

      Data Extraction

      Two independent reviewers extracted textual data on what PCR entails conceptually or as a practice. No quality appraisals were performed as is typical in scoping reviews.

      Data Synthesis

      A thematic analysis produced thematic categories that were combined into an emergent model (the PCR Model), which was reviewed by 5 external experts. PCR was framed as a way of thinking about and providing rehabilitation services “with” the person. PCR is embedded in rehabilitation structures and practice across 3 levels: (1) the person-professional dyad; (2) the microsystem level (typically an interprofessional team, involving significant others); and (3) a macrosystem level (organization within which rehabilitation is delivered). Thematic categories are articulated within each level, detailing both the conceptual and practice attributes of PCR.

      Conclusions

      The PCR Model can inform both clinical and service organization practices. The PCR Model may benefit from further developments including obtaining wider stakeholders’ input, determining relevance in different cultural and linguistic groups, and further operationalization and testing in implementation projects.

      Keywords

      List of abbreviations:

      PCR (person-centered rehabilitation), SDM (shared decision making)
      Person-centered care principles are fundamental for organizing and delivering health services, optimizing care experiences, and achieving meaningful outcomes.

      Health Innovation Network - South London. What is person-centred care and why is it important? London: Health Innovation Network - South London; 2016.

      American Geriatrics Society Expert Panel on Person-Centered Care. Person-centered care: a definition and essential elements. J Am Geriatr Soc 2016;64:15-8.

      Constand MK, MacDermid JC, Dal Bello-Haas V, Law M. Scoping review of patient-centered care approaches in healthcare. BMC Health Serv Res 2014;14:271.

      Cosgrove DM, Fisher M, Gabow P, et al. Ten strategies to lower costs, improve quality, and engage patients: the view from leading health system CEOs. Health Aff (Millwood) 2013;32:321-7.

      Bokhour BG, Fix GM, Mueller NM, et al. How can healthcare organizations implement patient-centered care? Examining a large-scale cultural transformation. BMC Health Serv Res 2018;18:168.

      Therefore, conceptual models that both improve understanding and enhance the practice of person-centered care have proliferated in the broader health care literature

      Sharma T, Bamford M, Dodman D. Person-centred care: an overview of reviews. Contemp Nurse 2015;51:107-20.

      McCormack B, McCance T. Person-centred practice in nursing and health care: theory and practice. 2nd ed. West Sussex, UK: Wiley-Blackwell; 2017.

      Mead N, Bower P. Patient-centredness: a conceptual framework and review of the empirical literature. Soc Sci Med 2000;51:1087-110.

      Entwistle VA, Watt IS. Treating patients as persons: a capabilities approach to support delivery of person-centered care. Am J Bioeth. 2013;13:29-39.

      Ogden K, Barr J, Greenfield D. Determining requirements for patient-centred care: a participatory concept mapping study. BMC Health Serv Res 2017;17:780.

      Santana MJ, Manalili K, Jolley RJ, Zelinsky S, Quan H, Lu M. How to practice person-centred care: a conceptual framework. Health Expect 2018;21:429-40.

      Kitson A, Marshall A, Bassett K, Zeitz K. What are the core elements of patient-centred care? A narrative review and synthesis of the literature from health policy, medicine and nursing. J Adv Nurs 2013;69:4-15.

      Scholl I, Zill JM, Härter M, Dirmaier J. An integrative model of patient-centeredness - a systematic review and concept analysis. PLoS One 2014;9:e107828.

      and in specific fields (eg, dentistry, emergency care, long-term care),

      Constand MK, MacDermid JC, Dal Bello-Haas V, Law M. Scoping review of patient-centered care approaches in healthcare. BMC Health Serv Res 2014;14:271.

      ,

      McCormack B, McCance T. Person-centred practice in nursing and health care: theory and practice. 2nd ed. West Sussex, UK: Wiley-Blackwell; 2017.

      ,

      Kitson A, Marshall A, Bassett K, Zeitz K. What are the core elements of patient-centred care? A narrative review and synthesis of the literature from health policy, medicine and nursing. J Adv Nurs 2013;69:4-15.

      ,

      Lee H, Chalmers NI, Brow A, Boynes S, et al. Person-centered care model in dentistry. BMC Oral Health 2018;18:198.

      McConnell D, McCance T, Melby V. Exploring person-centredness in emergency departments: a literature review. Int Emerg Nurs 2016;26:38-46.

      Kogan AC, Wilber K, Mosqueda L. Person-centered care for older adults with chronic conditions and functional impairment: a systematic literature review. J Am Geriatr Soc 2016;64:e1-7.

      Thompson G, Shindruk CL, Adekoya AA, Demczuk L, McClement S. Meanings of ‘centredness’ in long-term care facilities: a scoping review protocol. BMJ Open 2018;8:e022498.

      Marchand K, Beaumont S, Westfall J, et al. Conceptualizing patient-centered care for substance use disorder treatment: findings from a systematic scoping review. Subst Abuse Treat Prev Policy 2019;14:37.

      some informed by systematic reviews.

      Scholl I, Zill JM, Härter M, Dirmaier J. An integrative model of patient-centeredness - a systematic review and concept analysis. PLoS One 2014;9:e107828.

      ,

      Kogan AC, Wilber K, Mosqueda L. Person-centered care for older adults with chronic conditions and functional impairment: a systematic literature review. J Am Geriatr Soc 2016;64:e1-7.

      However, in rehabilitation, this type of knowledge synthesis and framework is absent,

      Jesus TS, Bright F, Kayes N, Cott CA. Person-centred rehabilitation: what exactly does it mean? Protocol for a scoping review with thematic analysis towards framing the concept and practice of person-centred rehabilitation. BMJ Open 2016;6:e011959.

      even though person-centered rehabilitation (PCR) is widely recommended for guiding rehabilitation services delivery and organization.

      Jesus TS, Bright F, Kayes N, Cott CA. Person-centred rehabilitation: what exactly does it mean? Protocol for a scoping review with thematic analysis towards framing the concept and practice of person-centred rehabilitation. BMJ Open 2016;6:e011959.

      Cheng L, Leon V, Liang A, et al. Patient-centered care in physical therapy: definition, operationalization, and outcome measures. Phys Ther Rev 2016;21:109-23.

      Yun D, Choi J. Person-centered rehabilitation care and outcomes: a systematic literature review. Int J Nurs Stud 2019;93:74-83.

      Terry G, Kayes N. Person centered care in neurorehabilitation: a secondary analysis. Disabil Rehabil 2020;42:2334-43.

      Mroz TM, Pitonyak JS, Fogelberg D, Leland NE. Client centeredness and health reform: key issues for occupational therapy. Am J Occup Ther 2015;69:6905090010p1-8.

      McPherson K, Gibson BE, Leplege A. Rethinking rehabilitation: theory and practice. Boca Raton, FL: Taylor and Francis Group; 2015.

      Heinemann AW, LaVela SL, Etingen B, et al. Perceptions of person-centered care following spinal cord injury. Arch Phys Med Rehabil 2016;97:1338-44.

      Furthermore, PCR remains more rhetoric than standard rehabilitation practice, as identified by recent studies

      van Seben R, Smorenburg SM, Buurman BM. A qualitative study of patient-centered goal-setting in geriatric rehabilitation: patient and professional perspectives. Clin Rehabil 2019;33:128-40.

      ,

      Cameron LJ, Somerville LM, Naismith CE, Watterson D, Maric V, Lannin NA. A qualitative investigation into the patient-centered goal-setting practices of allied health clinicians working in rehabilitation. Clin Rehabil 2018;32:827-40.

      and systematic reviews on goal setting and decision making

      Prescott S, Fleming J, Doig E. Goal setting approaches and principles used in rehabilitation for people with acquired brain injury: a systematic scoping review. Brain Inj 2015;29:1515-29.

      Lloyd A, Bannigan K, Sugavanam T, Freeman J. Experiences of stroke survivors, their families and unpaid carers in goal setting within stroke rehabilitation: a systematic review of qualitative evidence. JBI Database System Rev Implement Rep 2018;16:1418-53.

      Rose A, Rosewilliam S, Soundy A. Shared decision making within goal setting in rehabilitation settings: a systematic review. Patient Educ Couns 2017;100:65-75.

      Rosewilliam S, Roskell CA, Pandyan AD. A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation. Clin Rehabil 2011;25:501-14.

      and evidenced by findings that professionals often perceive their care as being more person-centered than their patients do.

      Cameron LJ, Somerville LM, Naismith CE, Watterson D, Maric V, Lannin NA. A qualitative investigation into the patient-centered goal-setting practices of allied health clinicians working in rehabilitation. Clin Rehabil 2018;32:827-40.

      ,

      Rose A, Rosewilliam S, Soundy A. Shared decision making within goal setting in rehabilitation settings: a systematic review. Patient Educ Couns 2017;100:65-75.

      ,

      Sugavanam T, Mead G, Bulley C, Donaghy M, van Wijck F. The effects and experiences of goal setting in stroke rehabilitation - a systematic review. Disabil Rehabil 2013;35:177-90.

      ,

      Rosewilliam S, Sintler C, Pandyan AD, Skelton J, Roskell CA. Is the practice of goal-setting for patients in acute stroke care patient-centred and what factors influence this? A qualitative study. Clin Rehabil 2016;30:508-19.

      To address these gaps, this article aims to depict what PCR means, in both conceptualization and practice.

      Jesus TS, Bright F, Kayes N, Cott CA. Person-centred rehabilitation: what exactly does it mean? Protocol for a scoping review with thematic analysis towards framing the concept and practice of person-centred rehabilitation. BMJ Open 2016;6:e011959.

      Cheng L, Leon V, Liang A, et al. Patient-centered care in physical therapy: definition, operationalization, and outcome measures. Phys Ther Rev 2016;21:109-23.

      Yun D, Choi J. Person-centered rehabilitation care and outcomes: a systematic literature review. Int J Nurs Stud 2019;93:74-83.

      Terry G, Kayes N. Person centered care in neurorehabilitation: a secondary analysis. Disabil Rehabil 2020;42:2334-43.

      To do so, this article provides the results of a scoping review and thematic analysis of the PCR literature. The thematic analysis gave rise to the Person-Centered Rehabilitation Model, a cross-professional model for the concept and practice of PCR in adult physical rehabilitation settings.

      Methods

      The review protocol

      Jesus TS, Bright F, Kayes N, Cott CA. Person-centred rehabilitation: what exactly does it mean? Protocol for a scoping review with thematic analysis towards framing the concept and practice of person-centred rehabilitation. BMJ Open 2016;6:e011959.

      and initial scoping review results (ie, quantitative map of the literature)

      Jesus TS, Bright FA, Pinho CS, Papadimitriou C, Kayes NM, Cott CA. Scoping review of the person-centered literature in adult physical rehabilitation. Disabil Rehabil 2021;43:1626-36.

      have already been published. This article provides the thematic analysis of that literature. As planned,

      Jesus TS, Bright F, Kayes N, Cott CA. Person-centred rehabilitation: what exactly does it mean? Protocol for a scoping review with thematic analysis towards framing the concept and practice of person-centred rehabilitation. BMJ Open 2016;6:e011959.

      the themes developed from the literature reviewed were organized into a conceptual model, named the PCR Model. The components of the PCR Model, presented throughout the Results, refer to the themes that were developed through our analysis.
      In reporting, we use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

      Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018;169:467-73.

      The PROSPERO database, a prospective register of systematic reviews, does not allow for the registration of scoping reviews.

      Eligibility criteria

      The scoping review included English-language conceptual or empirical articles addressing PCR. Articles were included if they addressed at least 1 PCR topic among 6 predefined categories (table 1) and the rehabilitation of adults (age >18y) with physical impairments (excluding mental health conditions or intellectual impairments).

      Jesus TS, Bright F, Kayes N, Cott CA. Person-centred rehabilitation: what exactly does it mean? Protocol for a scoping review with thematic analysis towards framing the concept and practice of person-centred rehabilitation. BMJ Open 2016;6:e011959.

      Pediatric populations were excluded because the decision-making autonomy of children and the role of parents may imply substantive differences for the conceptualization and practice of PCR compared with adults.

      Jesus TS, Bright F, Kayes N, Cott CA. Person-centred rehabilitation: what exactly does it mean? Protocol for a scoping review with thematic analysis towards framing the concept and practice of person-centred rehabilitation. BMJ Open 2016;6:e011959.

      Table 1Inclusion categories for PCR contents
      No.Inclusion CategoriesClarification Notes on InclusionType of Articles Excluded (Clarification Notes on Exclusion)
      1Conceptual Perspectives

      Full Designation (study protocol): Conceptual, perspective or review articles explicitly (re)defining or reporting a meaning, framing, or dimension(s) relevant to PCR or related concepts (ie, patient-centered, client-centered).
      • Personal/authors’ perspectives on meanings, framing, or dimensions of PCR (not necessarily grounded or supported in the empirical or theoretical literature) were included for the scoping exercise.
      • When concepts other than PCR or client-centered were the ones addressed (eg, patient-focused, patient-driven, patient-led).
      • When PCR concepts were mentioned alongside similar concepts (eg, patient-focused), but the distinction was not made explicit.
      • When related concepts, determinants, dimensions, related concepts, etc, were mentioned but without reporting to an explicit connection to PCR.
      2Novel Approach - Intervention Design

      Full Designation (study protocol): Articles outlining the design or conceptual elements of a novel (self-labeled) approach to a person-centered intervention, addressing either direct patient care or a whole service model.

      • When the model explicitly addressed physical rehabilitation care/settings but also other levels of care within a continuum, the article is included.
      • The approach does not need to have a brand name or acronym for the article to be included provided that a new PCR approach is reported as such and described in its uniqueness or novelty.
      • Articles whose novelty of the intervention was not involved on the person-centered component of that intervention but on a “technical” side of the intervention were excluded.
      • Articles for which there is no report, eg, on the full text, previous protocol, etc, of what does the (novel) PCR component of the intervention entails were excluded.
      3Implementation of PCR approaches, including its effect

      Full Designation (study protocol): Studies reporting on or analyzing the implementation (or lack thereof) of person-centered approaches in rehabilitation.
      • Studies focused on variables affecting implementation (facilitators or barriers) are included.
      • Studies focused on the effect of implementing PCR approaches are included as well.
      • Studies on implementation or effect for interventions that are labeled as PCR approaches but for which there is no specific definition of the patient/person-centered (part of the) approach or intervention
      4Clients’ qualitative perspectives on PCR

      Full Designation (study protocol): Qualitative studies reporting on the perspectives, experiences, or preferences of adults with any physical impairment related to rehabilitation service delivery and its person-centeredness.
      • Studies on experiences with or perspectives of goal setting as long as linked to PCR are included.
      • Single case studies are included for the scoping exercise.
      • Studies on the perspectives or experience with person-centeredness in the access to rehabilitation services are included.
      • Systematic reviews of perspectives or experiences are included as long as the included content/articles at least partly address PCR topics.
      • Studies on the preferences, perspectives, experiences with care approaches, or service delivery but not explicitly addressing PCR.
      • Studies on which patients report needs or preferences for care but not for their person-centeredness.
      • Studies on the lived experience of the health condition or disability.
      • Studies focused on experiences or perspective on goal pursuit, goal planning, goal setting, or goal attainment but with no specific linkage to person-centered goal setting.
      5Providers’ qualitative perspectives on PCR

      Full Designation (study protocol): Qualitative studies on providers’ perspectives of PCR or the person-centeredness of their care.
      • When the study's aim, interview questions, or main category within the results explicitly refers to PCR, the article was included.
      • Studies for students’ perspectives were included whenever from rehabilitation professions (see rehabilitation criteria) and the concept of PCR was addressed.
      • Case studies are included in the scoping exercise as long as reporting to qualitative data or analysis and explicitly address PCR.
      • When PCR issues are mentioned in article's discussion or in a minority part of the results as a by-product yet not as the main aim, study question, interview, question or a main category in the results.
      • Self-provided personal perspectives of providers when not framed as a qualitative study or case study analysis.
      Quantitative measurement of patient experiences and PCR

      Full Designation (study protocol): Quantitative studies on the measurement of person-centered care, patient experiences with service, and care or related patients’ perspectives—including studies on scale development and psychometric validation.
      • Articles directly measuring PCR or experience with care are included provided they have a specific link to PCR or related aspects of care. The link needs to be explicit at least in 1 part of the article from Introduction to Conclusion
      • Articles on the measurement of patient experience with no explicit link in any part of the article to PCR are excluded.
      • Studies whose main construct under measurement are not on patient experience and/or PCR (eg, focus on overall quality of care) even though elements of that measurement can relate to patient experience or PCR.
      • Studies whose measurement (instrument) is labeled with a PCR term, but the main construct actually measured is another one (eg, a client-centered, self-assessment of patient function—because the main construct being measured is patient function).

      Searches and selection of information and evidence sources

      We used key databases (PubMed, Scopus, Cumulative Index to Nursing and Allied Health), snowballing searches, and experts’ consultation as information sources. The full search strategy in PubMed and other search details are available in the open-access review protocol.

      Jesus TS, Bright F, Kayes N, Cott CA. Person-centred rehabilitation: what exactly does it mean? Protocol for a scoping review with thematic analysis towards framing the concept and practice of person-centred rehabilitation. BMJ Open 2016;6:e011959.

      For the initial scoping review, we included articles from any date up to May 1, 2019, which resulted in 170 articles initially included, 35 exclusively conceptual.

      Jesus TS, Bright FA, Pinho CS, Papadimitriou C, Kayes NM, Cott CA. Scoping review of the person-centered literature in adult physical rehabilitation. Disabil Rehabil 2021;43:1626-36.

      For the purpose of this thematic analysis, we updated the search to February 2020 and then applied a temporal cutoff for the oldest articles,

      Jesus TS, Bright F, Kayes N, Cott CA. Person-centred rehabilitation: what exactly does it mean? Protocol for a scoping review with thematic analysis towards framing the concept and practice of person-centred rehabilitation. BMJ Open 2016;6:e011959.

      only including articles published since 2007. This cutoff was selected for 2 reasons: first, to prevent the dilution of recent perspectives and second, in 2007 a special issue that provides key conceptual and historical articles

      Gzil F, Lefeve C, Cammelli M, Pachoud B, Ravaud JF, Leplege A. Why is rehabilitation not yet fully person-centred and should it be more person-centred? Disabil Rehabil 2007;29:1616-24.

      Leplege A, Gzil F, Cammelli M, Lefeve C, Pachoud B, Ville I. Person-centredness: conceptual and historical perspectives. Disabil Rehabil 2007;29:1555-65.

      MacLeod R, McPherson KM. Care and compassion: part of person-centred rehabilitation, inappropriate response or a forgotten art? Disabil Rehabil 2007;29:1589-95.

      Siegert RJ, Ward T, Levack WM, McPherson KM. A Good Lives Model of clinical and community rehabilitation. Disabil Rehabil 2007;29:1604-15.

      regarding PCR was published in Disability and Rehabilitation journal and was included in the analysis. This reduced the risk of neglecting key historical principles.
      In determining if articles met the eligibility criteria, 2 independent reviewers made selection decisions. Any conflicts were taken to a second round of review, and a third, senior author provided arbitration for any remaining disgreements.

      Jesus TS, Bright F, Kayes N, Cott CA. Person-centred rehabilitation: what exactly does it mean? Protocol for a scoping review with thematic analysis towards framing the concept and practice of person-centred rehabilitation. BMJ Open 2016;6:e011959.

      ,

      Jesus TS, Bright FA, Pinho CS, Papadimitriou C, Kayes NM, Cott CA. Scoping review of the person-centered literature in adult physical rehabilitation. Disabil Rehabil 2021;43:1626-36.

      Data charting

      Text quotations for what PCR entails and how was it practiced or implemented (including determinants or perceived facilitators or barriers) were independently extracted by 2 independent reviewers (T.J., C.P.), who have both review and subject matter expertise. The independent extractions were merged afterward. A brief summary of the extractions from each article was also generated. Quality appraisals were not performed per scoping review custom.

      Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018;169:467-73.

      ,

      Colquhoun HL, Jesus TS, O'Brien KK, et al. A scoping review on rehabilitation scoping reviews. Arch Phys Med Rehabil 2020;101:1462-9.

      Synthesis of results

      An inductive thematic analysis was used, following Braun and Clarke's 6-phase guide.

      Jesus TS, Bright F, Kayes N, Cott CA. Person-centred rehabilitation: what exactly does it mean? Protocol for a scoping review with thematic analysis towards framing the concept and practice of person-centred rehabilitation. BMJ Open 2016;6:e011959.

      ,

      Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3:77-101.

      T.J. and C.P., the data extractors, conducted the thematic analysis through the following: (1) further familiarization with the data, which involved rereading the extracted material and developing a topical synthesis of the extracted material per article; (2) generating initial codes (eg, person-professional partnership, shared decision making), manually, out of extracted and synthesized material using both semantic and latent coding on both conceptual attributes and resultant practice behaviors

      Jesus TS, Bright F, Kayes N, Cott CA. Person-centred rehabilitation: what exactly does it mean? Protocol for a scoping review with thematic analysis towards framing the concept and practice of person-centred rehabilitation. BMJ Open 2016;6:e011959.

      ; (3) searching for themes (eg, collaborative, empowering, and enabling coconstructed rehabilitation), through the identification of co-occurring patterns on any salient feature beyond code frequency; (4) reviewing themes for overall congruency, completeness, or any overlap; (5) defining and naming themes, including in a thematic map that illustrates the relationships between themes; and (6) producing the report, that is, drafted the PCR Model. The whole model and its components (ie, the developed themes, thematic map) were revised iteratively also by other authors with PCR expertise (F.B., N.K., C.C.), with reference to the data extracted and any theoretical considerations. This process included reviewing themes as well as their names and definitions, including the thematic map and its figure, which was substantially changed from its initial draft. A final draft manuscript was then sent to 5 external experts (see supplemental appendix S1 for their names and positions, available online only at http://www.archives-pmr.org/) for critique. A “knowledgeable insider” (person experiencing disability and a disability advocate) was included. As planned,

      Jesus TS, Bright F, Kayes N, Cott CA. Person-centred rehabilitation: what exactly does it mean? Protocol for a scoping review with thematic analysis towards framing the concept and practice of person-centred rehabilitation. BMJ Open 2016;6:e011959.

      experts were invited through a snowballing procedure, expanding from the knowledge and professional networks of the research authors who have been publishing extensively on PCR topics. Authors of articles included were also considered. Manuscript revisions in response to the experts’ feedback (detailed in supplemental appendix S2, available online only at http://www.archives-pmr.org/) were returned to these experts who had the opportunity to comment. No further suggested revisions emerged.

      Results

      Figure 1 provides the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart. From 6527 unique references, 174 were initially included, and 147 remained after the temporal cutoff. Of those, 26 were exclusively conceptual articles. The most prevalent inclusion category was on studies of the implementation of PCR approaches, including its effect (category no. 3 in table 1), with 58 articles, 27 exclusively on this inclusion category. Supplemental appendix S3 (available online only at http://www.archives-pmr.org/) provides the list of 147articles included, including the respective inclusion categories. In turn, supplemental appendix S4 (available online only at http://www.archives-pmr.org/) presents the 249-page data extraction table, with a brief synthesis of extractions per included article.
      Fig 1
      Fig 1Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart of the scoping review with thematic analysis.
      Figure 2 displays the PCR Model. After the model overview (ie, synthesis of themes), we elaborate on each theme to elucidate the concept and practice of PCR.
      Fig 2
      Fig 2The PCR Model, a cross-professional model for the concept and practice of adult physical rehabilitation.

      Overview

      PCR is a way of thinking about and providing rehabilitation services “with” the person. The focus is on how rehabilitation services and care are thought about, organized, and delivered by professionals and ultimately experienced by the person, that is, the person in a rehabilitative process, henceforth. The PCR Model articulates that PCR is embedded in rehabilitation structures and practices across (1) the person-professional dyad; (2) the microsystem level (broader unit of care, including interprofessional teams and significant others); and (3) the macrosystem level (organization and structures within which PCR is delivered). Each level has its PCR attributes (see fig 2), which interact across levels.

      Person-professional dyad

      Within the person-professional dyad, we identified 5 attributes characterizing PCR approaches in which interactions are the following:

      Respectful of and tailored to the person beyond individualized interventions for the patient

      PCR refers to a culture of service focused on the needs of the whole person, not merely those arising from patients as objects of biomedical conditions and interventions.

      Terry G, Kayes N. Person centered care in neurorehabilitation: a secondary analysis. Disabil Rehabil 2020;42:2334-43.

      ,

      Enemark Larsen A, Rasmussen B, Christensen JR. Enhancing a client-centred practice with the Canadian Occupational Performance Measure. Occup Ther Int 2018;2018:5956301.

      Stevens A, Koke A, van der Weijden T, Beurskens A. The development of a patient-specific method for physiotherapy goal setting: a user-centered design. Disabil Rehabil 2018;40:2048-55.

      Larsson H, Blomqvist K. From a diagnostic and particular approach to a person-centred approach: a development project. J Clin Nurs 2015;24:465-74.

      Gibson BE, Terry G, Setchell J, Bright FAS, Cummins C, Kayes NM. The micro-politics of caring: tinkering with person-centered rehabilitation. Disabil Rehabil 2020;42:1529-38.

      O'Halloran R, Hersh D, Laplante-Levesque A, Worrall L. Person-centeredness, ethics, and stories of risk. Semin Speech Lang 2010;31:81-9.

      Devan H, Hale L, Hempel D, Saipe B, Perry MA. What works and does not work in a self-management intervention for people with chronic pain? Qualitative systematic review and meta-synthesis. Phys Ther 2018;98:381-97.

      Hence, PCR is respectful of and tailored to the unique characteristics and circumstances of the person (perspectives, preferences, values, experiences, worldview) beyond consisting of individualized interventions addressing the impairments or symptoms of unique patients.

      Yun D, Choi J. Person-centered rehabilitation care and outcomes: a systematic literature review. Int J Nurs Stud 2019;93:74-83.

      ,

      Gzil F, Lefeve C, Cammelli M, Pachoud B, Ravaud JF, Leplege A. Why is rehabilitation not yet fully person-centred and should it be more person-centred? Disabil Rehabil 2007;29:1616-24.

      ,

      Larsson H, Blomqvist K. From a diagnostic and particular approach to a person-centred approach: a development project. J Clin Nurs 2015;24:465-74.

      ,

      Gibson BE, Terry G, Setchell J, Bright FAS, Cummins C, Kayes NM. The micro-politics of caring: tinkering with person-centered rehabilitation. Disabil Rehabil 2020;42:1529-38.

      ,

      Devan H, Hale L, Hempel D, Saipe B, Perry MA. What works and does not work in a self-management intervention for people with chronic pain? Qualitative systematic review and meta-synthesis. Phys Ther 2018;98:381-97.

      Feldthusen C, Dean E, Forsblad-d'Elia H, Mannerkorpi K. Effects of person-centered physical therapy on fatigue-related variables in persons with rheumatoid arthritis: a randomized controlled trial. Arch Phys Med Rehabil 2016;97:26-36.

      Ahlsen B, Engebretsen E, Nicholls D, Mengshoel AM. The singular patient in patient-centred care: physiotherapists' accounts of treatment of patients with chronic muscle pain. Med Humanit 2019;46:226-33

      D'Cruz K, Howie L, Lentin P. Client-centred practice: perspectives of persons with a traumatic brain injury. Scand J Occup Ther 2016;23:30-8.

      Hanga K, DiNitto DM, Wilken JP, Leppik L. A person-centered approach in initial rehabilitation needs assessment: experiences of persons with disabilities. Alter 2017;11:251-66.

      McMurray J, McNeil H, Lafortune C, Black S, Prorok J, Stolee P. Measuring patients' experience of rehabilitation services across the care continuum. Part II: key dimensions. Arch Phys Med Rehabil 2016;97:121-30.

      Hammell KR. Client-centred practice in occupational therapy: critical reflections. Scand J Occup Ther 2013;20:174-81.

      Moore CL, Kaplan SL. A framework and resources for shared decision making: opportunities for improved physical therapy outcomes. Phys Ther 2018;98:1022-36.

      Dorfler E, Kulnik ST. Despite communication and cognitive impairment - person-centred goal-setting after stroke: a qualitative study. Disabil Rehabil 2020;42:3628-37.

      PCR nurtures notions of personhood, the person’s self-determination, and values the singularities (ie, unique characteristics) of each person.

      Leplege A, Gzil F, Cammelli M, Lefeve C, Pachoud B, Ville I. Person-centredness: conceptual and historical perspectives. Disabil Rehabil 2007;29:1555-65.

      ,

      MacLeod R, McPherson KM. Care and compassion: part of person-centred rehabilitation, inappropriate response or a forgotten art? Disabil Rehabil 2007;29:1589-95.

      ,

      Gibson BE, Terry G, Setchell J, Bright FAS, Cummins C, Kayes NM. The micro-politics of caring: tinkering with person-centered rehabilitation. Disabil Rehabil 2020;42:1529-38.

      ,

      Ahlsen B, Engebretsen E, Nicholls D, Mengshoel AM. The singular patient in patient-centred care: physiotherapists' accounts of treatment of patients with chronic muscle pain. Med Humanit 2019;46:226-33

      ,

      Hammell KR. Client-centred practice in occupational therapy: critical reflections. Scand J Occup Ther 2013;20:174-81.

      Persons should be treated with respect, dignity, and valued as persons with needs, resources, and capabilities.

      Yun D, Choi J. Person-centered rehabilitation care and outcomes: a systematic literature review. Int J Nurs Stud 2019;93:74-83.

      ,

      Mroz TM, Pitonyak JS, Fogelberg D, Leland NE. Client centeredness and health reform: key issues for occupational therapy. Am J Occup Ther 2015;69:6905090010p1-8.

      ,

      Leplege A, Gzil F, Cammelli M, Lefeve C, Pachoud B, Ville I. Person-centredness: conceptual and historical perspectives. Disabil Rehabil 2007;29:1555-65.

      ,

      Siegert RJ, Ward T, Levack WM, McPherson KM. A Good Lives Model of clinical and community rehabilitation. Disabil Rehabil 2007;29:1604-15.

      ,

      D'Cruz K, Howie L, Lentin P. Client-centred practice: perspectives of persons with a traumatic brain injury. Scand J Occup Ther 2016;23:30-8.

      ,

      Hanga K, DiNitto DM, Wilken JP, Leppik L. A person-centered approach in initial rehabilitation needs assessment: experiences of persons with disabilities. Alter 2017;11:251-66.

      ,

      Moore CL, Kaplan SL. A framework and resources for shared decision making: opportunities for improved physical therapy outcomes. Phys Ther 2018;98:1022-36.

      ,

      Papadimitriou C, Cott C. Client-centred practices and work in inpatient rehabilitation teams: results from four case studies. Disabil Rehabil 2015;37:1135-43.

      Luker J, Lynch E, Bernhardsson S, Bennett L, Bernhardt J. Stroke survivors' experiences of physical rehabilitation: a systematic review of qualitative studies. Arch Phys Med Rehabil 2015;96:1698-708.

      Fors A, Taft C, Ulin K, Ekman I. Person-centred care improves self-efficacy to control symptoms after acute coronary syndrome: a randomized controlled trial. Eur J Cardiovasc Nurs 2016;15:186-94.

      Bamm EL, Rosenbaum P, Stratford P. Validation of the measure of processes of care for adults: a measure of client-centred care. Int J Qual Health Care 2010;22:302-9.

      Mudge S, Stretton C, Kayes N. Are physiotherapists comfortable with person-centred practice? An autoethnographic insight. Disabil Rehabil 2014;36:457-63.

      Prescott S, Fleming J, Doig E. Refining a clinical practice framework to engage clients with brain injury in goal setting. Aust Occup Ther J 2019;66:313-25.

      Cott CA. Client-centred rehabilitation: what is it and how do we measure it? Physiotherapy 2008;94:89-90.

      Hammell KR. Client-centred occupational therapy in Canada: refocusing on core values. Can J Occup Ther 2013;80:141-9.

      Hedberg-Kristensson E, Iwarsson S. Therapist attitudes and strategies to client-centred approaches in the provision of mobility devices to older clients. Disabil Rehabil Assist Technol 2013;8:381-6.

      Each person has an equal right to experiencing a PCR approach.

      Siegert RJ, Ward T, Levack WM, McPherson KM. A Good Lives Model of clinical and community rehabilitation. Disabil Rehabil 2007;29:1604-15.

      ,

      Hammell KR. Client-centred practice in occupational therapy: critical reflections. Scand J Occup Ther 2013;20:174-81.

      ,

      Larsen AE, Adamsen HN, Boots S, Delkus ECG, Pedersen LL, Christensen JR. A survey on client-centered practice among danish occupational therapists. Scand J Occup Ther 2019;26:356-70.

      Doig E, Prescott S, Fleming J, Cornwell P, Kuipers P. Development and construct validation of the Client-Centredness of Goal Setting (C-COGS) scale. Scand J Occup Ther 2015;22:302-10.

      • Parker DM.
      PCR is accepting, nonjudgmental, embraces individual differences, and aspires to reduce any power differentials exerted by professionals in the person-professionals dyad.

      MacLeod R, McPherson KM. Care and compassion: part of person-centred rehabilitation, inappropriate response or a forgotten art? Disabil Rehabil 2007;29:1589-95.

      ,

      Hammell KR. Client-centred practice in occupational therapy: critical reflections. Scand J Occup Ther 2013;20:174-81.

      ,

      Bamm EL, Rosenbaum P, Stratford P. Validation of the measure of processes of care for adults: a measure of client-centred care. Int J Qual Health Care 2010;22:302-9.

      ,
      • Parker DM.

      Whalley Hammell KR. Client-centred occupational therapy: the importance of critical perspectives. Scand J Occup Ther 2015;22:237-43.

      Njelesani J, Teachman G, Durocher E, Hamdani Y, Phelan SK. Thinking critically about client-centred practice and occupational possibilities across the life-span. Scand J Occup Ther 2015;22:252-9.

      Melin J, Arestedt K. The Patient Participation in Rehabilitation Questionnaire (PPRQ): psychometric evaluation and revision for use in neurological rehabilitation. Disabil Rehabil 2020;42:1454-61.

      Morera-Balaguer J, Botella-Rico JM, Catalan-Matamoros D, Martinez-Segura OR, Leal-Clavel M, Rodriguez-Nogueira O. Patients' experience regarding therapeutic person-centered relationships in physiotherapy services: a qualitative study. Physiother Theory Pract 2021;37:17-27.

      Unger J, Singh H, Mansfield A, Hitzig SL, Lenton E, Musselman KE. The experiences of physical rehabilitation in individuals with spinal cord injuries: a qualitative thematic synthesis. Disabil Rehabil 2019;41:1367-83.

      Baumann M, Peck S, Collins C, Eades G. The meaning and value of taking part in a person-centred arts programme to hospital-based stroke patients: findings from a qualitative study. Disabil Rehabil 2013;35:244-56.

      PCR practices are respectful of personal choices and of persons’ control over their lives.

      Lloyd A, Bannigan K, Sugavanam T, Freeman J. Experiences of stroke survivors, their families and unpaid carers in goal setting within stroke rehabilitation: a systematic review of qualitative evidence. JBI Database System Rev Implement Rep 2018;16:1418-53.

      ,

      Rosewilliam S, Roskell CA, Pandyan AD. A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation. Clin Rehabil 2011;25:501-14.

      ,

      Gibson BE, Terry G, Setchell J, Bright FAS, Cummins C, Kayes NM. The micro-politics of caring: tinkering with person-centered rehabilitation. Disabil Rehabil 2020;42:1529-38.

      ,

      Hammell KR. Client-centred practice in occupational therapy: critical reflections. Scand J Occup Ther 2013;20:174-81.

      ,

      Hammell KR. Client-centred occupational therapy in Canada: refocusing on core values. Can J Occup Ther 2013;80:141-9.

      ,

      Unger J, Singh H, Mansfield A, Hitzig SL, Lenton E, Musselman KE. The experiences of physical rehabilitation in individuals with spinal cord injuries: a qualitative thematic synthesis. Disabil Rehabil 2019;41:1367-83.

      ,

      Gupta J, Taff SD. The illusion of client-centred practice. Scand J Occup Ther 2015;22:244-51.

      Ranner M, Guidetti S, von Koch L, Tham K. Experiences of participating in a client-centred ADL intervention after stroke. Disabil Rehabil 2019;41:3025-33.

      Kneebone, II, Hull SL, McGurk R, Cropley M. Reliability and validity of the neurorehabilitation experience questionnaire for inpatients. Neurorehabil Neural Repair 2012;26:834-41.

      Cott CA, Wiles R, Devitt R. Continuity, transition and participation: preparing clients for life in the community post-stroke. Disabil Rehabil 2007;29:1566-74.

      Professionals must acknowledge persons’ right to participate and ultimately decide about relevant rehabilitation goals, which includes the right to not do so.

      Luker J, Lynch E, Bernhardsson S, Bennett L, Bernhardt J. Stroke survivors' experiences of physical rehabilitation: a systematic review of qualitative studies. Arch Phys Med Rehabil 2015;96:1698-708.

      ,

      Lund A, Michelet M, Kjeken I, Wyller TB, Sveen U. Development of a person-centred lifestyle intervention for older adults following a stroke or transient ischaemic attack. Scand J Occup Ther 2012;19:140-9.

      Peoples H, Satink T, Steultjens E. Stroke survivors' experiences of rehabilitation: a systematic review of qualitative studies. Scand J Occup Ther 2011;18:163-71.

      Bamm EL, Rosenbaum P, Wilkins S, Stratford P, Mahlberg N. Exploring client-centered care experiences in in-patient rehabilitation settings. Glob Qual Nurs Res 2015;2:2333393615582036.

      Indeed, not all persons want active involvement in rehabilitation planning, especially day-to-day decisions,

      Bamm EL, Rosenbaum P, Wilkins S, Stratford P, Mahlberg N. Exploring client-centered care experiences in in-patient rehabilitation settings. Glob Qual Nurs Res 2015;2:2333393615582036.

      ,

      Lloyd A, Roberts AR, Freeman JA. 'Finding a balance' in involving patients in goal setting early after stroke: a physiotherapy perspective. Physiother Res Int 2014;19:147-57.

      yet need to be provided with the means and opportunity to participate in that planning,

      Dorfler E, Kulnik ST. Despite communication and cognitive impairment - person-centred goal-setting after stroke: a qualitative study. Disabil Rehabil 2020;42:3628-37.

      ,

      Melin J, Arestedt K. The Patient Participation in Rehabilitation Questionnaire (PPRQ): psychometric evaluation and revision for use in neurological rehabilitation. Disabil Rehabil 2020;42:1454-61.

      ,

      Hansen AO, Kristensen HK, Cederlund R, Lauridsen HH, Tromborg H. Client-centred practice from the perspective of Danish patients with hand-related disorders. Disabil Rehabil 2018;40:1542-52.

      to the degree they desire.

      Smit EB, Bouwstra H, van der Wouden JC, Wattel LM, Hertogh C. Patient-centred goal setting using functional outcome measures in geriatric rehabilitation: is it feasible? Eur Geriatr Med 2018;9:71-6.

      Persons’ willingness to participate in rehabilitation decisions need to be monitored, revisited, and accounted for,

      Rose A, Rosewilliam S, Soundy A. Shared decision making within goal setting in rehabilitation settings: a systematic review. Patient Educ Couns 2017;100:65-75.

      ,

      Luker J, Lynch E, Bernhardsson S, Bennett L, Bernhardt J. Stroke survivors' experiences of physical rehabilitation: a systematic review of qualitative studies. Arch Phys Med Rehabil 2015;96:1698-708.

      ,

      Smit EB, Bouwstra H, van der Wouden JC, Wattel LM, Hertogh C. Patient-centred goal setting using functional outcome measures in geriatric rehabilitation: is it feasible? Eur Geriatr Med 2018;9:71-6.

      not presumed.

      Pikkarainen A, Vahasantanen K, Paloniemi S, Etelapelto A. Older rehabilitees' life-course agency in Finnish gerontological rehabilitation. Scand J Occup Ther 2015;22:424-34.

      Finally, PCR implies that professionals’ communication is respectful of and tailored to person-specific circumstances. These include persons’ cultural values (for a culturally-competent rehabilitation

      Ross EF, Haidet P. Attitudes of physical therapy students toward patient-centered care, before and after a course in psychosocial aspects of care. Patient Educ Couns 2011;85:529-32.

      ,

      Nguyen T, Baptiste S. Innovative practice: exploring acculturation theory to advance rehabilitation from pediatric to adult “cultures” of care. Disabil Rehabil 2015;37:456-63.

      ), health literacy,

      Moore CL, Kaplan SL. A framework and resources for shared decision making: opportunities for improved physical therapy outcomes. Phys Ther 2018;98:1022-36.

      ,

      Bamm EL, Rosenbaum P, Wilkins S, Stratford P, Mahlberg N. Exploring client-centered care experiences in in-patient rehabilitation settings. Glob Qual Nurs Res 2015;2:2333393615582036.

      educational level,

      Fors A, Gyllensten H, Swedberg K, Ekman I. Effectiveness of person-centred care after acute coronary syndrome in relation to educational level: subgroup analysis of a two-armed randomised controlled trial. Int J Cardiol 2016;221:957-62.

      language needs,

      Martinez J, Leland N. Language discordance and patient- centered care in occupational therapy: a case study. OTJR (Thorofare N J) 2015;35:120-8.

      cognitive or communication impairments,

      Prescott S, Fleming J, Doig E. Goal setting approaches and principles used in rehabilitation for people with acquired brain injury: a systematic scoping review. Brain Inj 2015;29:1515-29.

      ,

      Dorfler E, Kulnik ST. Despite communication and cognitive impairment - person-centred goal-setting after stroke: a qualitative study. Disabil Rehabil 2020;42:3628-37.

      ,

      McGilton KS, Davis AM, Naglie G, et al. Evaluation of patient-centered rehabilitation model targeting older persons with a hip fracture, including those with cognitive impairment. BMC Geriatr 2013;13:136.

      McGilton KS, Davis A, Mahomed N, et al. An inpatient rehabilitation model of care targeting patients with cognitive impairment. BMC Geriatr 2012;12:21.

      Coates R, Irvine C, Sutherland C. Development of an aphasia-friendly Canadian Occupational Performance Measure. Br J Occup Ther 2015;78:196-9.

      Hersh D, Worrall L, Howe T, Sherratt S, Davidson B. SMARTER goal setting in aphasia rehabilitation. Aphasiology 2012;26:220-33.

      Haley KL, Cunningham KT, Barry J, de Riesthal M. Collaborative goals for communicative life participation in aphasia: the FOURC Model. Am J Speech Lang Pathol 2019;28:1-13.

      impaired self-awareness,

      Morera-Balaguer J, Botella-Rico JM, Martinez-Gonzalez MC, Medina-Mirapeix F, Rodriguez-Nogueira O. Physical therapists' perceptions and experiences about barriers and facilitators of therapeutic patient-centred relationships during outpatient rehabilitation: a qualitative study. Braz J Phys Ther 2018;22:484-92.

      visual or hearing impairments,

      Hedberg-Kristensson E, Iwarsson S. Therapist attitudes and strategies to client-centred approaches in the provision of mobility devices to older clients. Disabil Rehabil Assist Technol 2013;8:381-6.

      or spiritual needs.

      Yun D, Choi J. Person-centered rehabilitation care and outcomes: a systematic literature review. Int J Nurs Stud 2019;93:74-83.

      Reflexive and adaptive to the situation at hand, not script-based

      Although PCR is now widely required and accepted as morally appropriate, appraising and developing person-centered interactions remains challenging. Professionals

      Lund A, Michelet M, Kjeken I, Wyller TB, Sveen U. Development of a person-centred lifestyle intervention for older adults following a stroke or transient ischaemic attack. Scand J Occup Ther 2012;19:140-9.

      and PCR experts

      Gibson BE, Terry G, Setchell J, Bright FAS, Cummins C, Kayes NM. The micro-politics of caring: tinkering with person-centered rehabilitation. Disabil Rehabil 2020;42:1529-38.

      often disagree on whether given person-professional interactions are person-centered. In each situation, professionals need to consider a complex net of professional obligations, assigned tasks, organizational imperatives, and safety considerations, along with PCR requirements.

      Gibson BE, Terry G, Setchell J, Bright FAS, Cummins C, Kayes NM. The micro-politics of caring: tinkering with person-centered rehabilitation. Disabil Rehabil 2020;42:1529-38.

      ,

      Moats G. Discharge decision-making, enabling occupations, and client-centred practice. Can J Occup Ther 2007;74:91-101.

      Levack WM, Dean SG, Siegert RJ, McPherson KM. Navigating patient-centered goal setting in inpatient stroke rehabilitation: how clinicians control the process to meet perceived professional responsibilities. Patient Educ Couns 2011;85:206-13.

      Hunt MR, Ells C. A patient-centered care ethics analysis model for rehabilitation. Am J Phys Med Rehabil 2013;92:818-27.

      Leach E, Cornwell P, Fleming J, Haines T. Patient centered goal-setting in a subacute rehabilitation setting. Disabil Rehabil 2010;32:159-72.

      PCR occurs at the interface of a minimum of 2 subjectivities: professionals’ and persons’.

      Gibson BE, Terry G, Setchell J, Bright FAS, Cummins C, Kayes NM. The micro-politics of caring: tinkering with person-centered rehabilitation. Disabil Rehabil 2020;42:1529-38.

      ,

      O'Halloran R, Hersh D, Laplante-Levesque A, Worrall L. Person-centeredness, ethics, and stories of risk. Semin Speech Lang 2010;31:81-9.

      Because situations and persons’ characteristics vary, PCR cannot be fully guided, standardized, or dictated. Rather than merely being protocol-driven or a “1-size-fits-all” approach, it is antireductionist and adaptive to situations at hand.

      Terry G, Kayes N. Person centered care in neurorehabilitation: a secondary analysis. Disabil Rehabil 2020;42:2334-43.

      ,

      Leplege A, Gzil F, Cammelli M, Lefeve C, Pachoud B, Ville I. Person-centredness: conceptual and historical perspectives. Disabil Rehabil 2007;29:1555-65.

      ,

      Gibson BE, Terry G, Setchell J, Bright FAS, Cummins C, Kayes NM. The micro-politics of caring: tinkering with person-centered rehabilitation. Disabil Rehabil 2020;42:1529-38.

      ,

      Whalley Hammell KR. Client-centred occupational therapy: the importance of critical perspectives. Scand J Occup Ther 2015;22:237-43.

      ,

      Amati M, Grignoli N, Rubinelli S, Amann J, Zanini C. The role of hope for health professionals in rehabilitation: a qualitative study on unfavorable prognosis communication. PLoS One 2019;14:e0224394.

      Rigid scripts for PCR curtail the needed personalization and adaptability to persons served, the subjectivities of those involved, and the unique contexts in which rehabilitation takes place.

      Terry G, Kayes N. Person centered care in neurorehabilitation: a secondary analysis. Disabil Rehabil 2020;42:2334-43.

      ,

      Gibson BE, Terry G, Setchell J, Bright FAS, Cummins C, Kayes NM. The micro-politics of caring: tinkering with person-centered rehabilitation. Disabil Rehabil 2020;42:1529-38.

      ,

      O'Halloran R, Hersh D, Laplante-Levesque A, Worrall L. Person-centeredness, ethics, and stories of risk. Semin Speech Lang 2010;31:81-9.

      ,

      Hanga K, DiNitto DM, Wilken JP, Leppik L. A person-centered approach in initial rehabilitation needs assessment: experiences of persons with disabilities. Alter 2017;11:251-66.

      ,

      Van de Velde D, Devisch I, De Vriendt P. The client-centred approach as experienced by male neurological rehabilitation clients in occupational therapy. A qualitative study based on a grounded theory tradition. Disabil Rehabil 2016;38:1567-77.

      Adaptation to the situation requires professionals being continually attentive to persons’ responses (eg, bodily reactions, verbalizations, emotional cues),

      Gibson BE, Terry G, Setchell J, Bright FAS, Cummins C, Kayes NM. The micro-politics of caring: tinkering with person-centered rehabilitation. Disabil Rehabil 2020;42:1529-38.

      reflecting on how their actions come across to that particular person in that context and timing, and adjusting action nimbly.

      Gibson BE, Terry G, Setchell J, Bright FAS, Cummins C, Kayes NM. The micro-politics of caring: tinkering with person-centered rehabilitation. Disabil Rehabil 2020;42:1529-38.

      ,

      Peoples H, Satink T, Steultjens E. Stroke survivors' experiences of rehabilitation: a systematic review of qualitative studies. Scand J Occup Ther 2011;18:163-71.

      ,

      Amati M, Grignoli N, Rubinelli S, Amann J, Zanini C. The role of hope for health professionals in rehabilitation: a qualitative study on unfavorable prognosis communication. PLoS One 2019;14:e0224394.

      Van de Velde D, Devisch I, De Vriendt P. The client-centred approach as experienced by male neurological rehabilitation clients in occupational therapy. A qualitative study based on a grounded theory tradition. Disabil Rehabil 2016;38:1567-77.

      Restall G, Ripat J. Applicability and clinical utility of the Client-Centred Strategies Framework. Can J Occup Ther 2008;75:288-300.

      Similarly, professionals need to understand how and when to push and ease off.

      Gibson BE, Terry G, Setchell J, Bright FAS, Cummins C, Kayes NM. The micro-politics of caring: tinkering with person-centered rehabilitation. Disabil Rehabil 2020;42:1529-38.

      For example, “benevolent manipulations” (encouraging behaviors to support persons in achieving own goals) may fit PCR ideals,

      Gibson BE, Terry G, Setchell J, Bright FAS, Cummins C, Kayes NM. The micro-politics of caring: tinkering with person-centered rehabilitation. Disabil Rehabil 2020;42:1529-38.

      yet professionals cannot coerce or persuade persons to go against stated preferences.

      Gibson BE, Terry G, Setchell J, Bright FAS, Cummins C, Kayes NM. The micro-politics of caring: tinkering with person-centered rehabilitation. Disabil Rehabil 2020;42:1529-38.

      ,

      Moats G. Discharge decision-making, enabling occupations, and client-centred practice. Can J Occup Ther 2007;74:91-101.

      ,

      Wain HR, Kneebone, II, Billings J. Patient experience of neurologic rehabilitation: a qualitative investigation. Arch Phys Med Rehabil 2008;89:1366-71.

      Altogether, PCR is complex, subject to failure, and involves continuous learning and adaptation.

      Whalley Hammell KR. Client-centred occupational therapy: the importance of critical perspectives. Scand J Occup Ther 2015;22:237-43.

      ,

      Njelesani J, Teachman G, Durocher E, Hamdani Y, Phelan SK. Thinking critically about client-centred practice and occupational possibilities across the life-span. Scand J Occup Ther 2015;22:252-9.

      ,
      • Papadimitriou C
      • Carpenter C
      It requires humility,

      Gibson BE, Terry G, Setchell J, Bright FAS, Cummins C, Kayes NM. The micro-politics of caring: tinkering with person-centered rehabilitation. Disabil Rehabil 2020;42:1529-38.

      mindful questioning,
      • Papadimitriou C
      • Carpenter C
      ethical reasoning,

      O'Halloran R, Hersh D, Laplante-Levesque A, Worrall L. Person-centeredness, ethics, and stories of risk. Semin Speech Lang 2010;31:81-9.

      ,

      Hunt MR, Ells C. A patient-centered care ethics analysis model for rehabilitation. Am J Phys Med Rehabil 2013;92:818-27.

      ,

      Rochette A, Racine E, Lefebvre H, Lacombe J, Bastien J, Tellier M. Ethical issues relating to the inclusion of relatives as clients in the post-stroke rehabilitation process as perceived by patients, relatives and health professionals. Patient Educ Couns 2014;94:384-9.

      ,

      Durocher E, Kinsella EA, Ells C, Hunt M. Contradictions in client-centred discharge planning: through the lens of relational autonomy. Scand J Occup Ther 2015;22:293-301.

      and critical reflection in and on one's actions, both at the time services are provided and retrospectively thereafter toward continual improvement.

      Gibson BE, Terry G, Setchell J, Bright FAS, Cummins C, Kayes NM. The micro-politics of caring: tinkering with person-centered rehabilitation. Disabil Rehabil 2020;42:1529-38.

      ,

      Whalley Hammell KR. Client-centred occupational therapy: the importance of critical perspectives. Scand J Occup Ther 2015;22:237-43.

      ,

      Njelesani J, Teachman G, Durocher E, Hamdani Y, Phelan SK. Thinking critically about client-centred practice and occupational possibilities across the life-span. Scand J Occup Ther 2015;22:252-9.

      ,

      Restall G, Ripat J. Applicability and clinical utility of the Client-Centred Strategies Framework. Can J Occup Ther 2008;75:288-300.

      ,
      • Papadimitriou C
      • Carpenter C

      Nurtures a supportive relationship—compassionate, trustful, and caring

      PCR interactions are compassionate, trustful, caring, attentive, and genuinely supportive.

      Terry G, Kayes N. Person centered care in neurorehabilitation: a secondary analysis. Disabil Rehabil 2020;42:2334-43.

      ,

      MacLeod R, McPherson KM. Care and compassion: part of person-centred rehabilitation, inappropriate response or a forgotten art? Disabil Rehabil 2007;29:1589-95.

      ,

      Gibson BE, Terry G, Setchell J, Bright FAS, Cummins C, Kayes NM. The micro-politics of caring: tinkering with person-centered rehabilitation. Disabil Rehabil 2020;42:1529-38.

      ,

      O'Halloran R, Hersh D, Laplante-Levesque A, Worrall L. Person-centeredness, ethics, and stories of risk. Semin Speech Lang 2010;31:81-9.

      ,

      Morera-Balaguer J, Botella-Rico JM, Catalan-Matamoros D, Martinez-Segura OR, Leal-Clavel M, Rodriguez-Nogueira O. Patients' experience regarding therapeutic person-centered relationships in physiotherapy services: a qualitative study. Physiother Theory Pract 2021;37:17-27.

      ,
      • Papadimitriou C
      • Carpenter C
      ,

      Kidd MO, Bond CH, Bell ML. Patients' perspectives of patient-centredness as important in musculoskeletal physiotherapy interactions: a qualitative study. Physiotherapy 2011;97:154-62.

      Wijma AJ, Bletterman AN, Clark JR, et al. Patient-centeredness in physiotherapy: what does it entail? A systematic review of qualitative studies. Physiother Theory Pract 2017;33:825-40.

      Zimmermann L, Konrad A, Muller C, Rundel M, Korner M. Patient perspectives of patient-centeredness in medical rehabilitation. Patient Educ Couns 2014;96:98-105.

      They includes providing emotional support and empathetic reassurance of persons’ suffering or misfortunes

      MacLeod R, McPherson KM. Care and compassion: part of person-centred rehabilitation, inappropriate response or a forgotten art? Disabil Rehabil 2007;29:1589-95.

      ,

      O'Halloran R, Hersh D, Laplante-Levesque A, Worrall L. Person-centeredness, ethics, and stories of risk. Semin Speech Lang 2010;31:81-9.

      ,

      Devan H, Hale L, Hempel D, Saipe B, Perry MA. What works and does not work in a self-management intervention for people with chronic pain? Qualitative systematic review and meta-synthesis. Phys Ther 2018;98:381-97.

      ,

      D'Cruz K, Howie L, Lentin P. Client-centred practice: perspectives of persons with a traumatic brain injury. Scand J Occup Ther 2016;23:30-8.

      ,

      Bamm EL, Rosenbaum P, Stratford P. Validation of the measure of processes of care for adults: a measure of client-centred care. Int J Qual Health Care 2010;22:302-9.

      ,

      Cott CA. Client-centred rehabilitation: what is it and how do we measure it? Physiotherapy 2008;94:89-90.

      ,

      Amati M, Grignoli N, Rubinelli S, Amann J, Zanini C. The role of hope for health professionals in rehabilitation: a qualitative study on unfavorable prognosis communication. PLoS One 2019;14:e0224394.

      ,

      Kidd MO, Bond CH, Bell ML. Patients' perspectives of patient-centredness as important in musculoskeletal physiotherapy interactions: a qualitative study. Physiotherapy 2011;97:154-62.

      ,

      Dockens AL, Bellon-Harn ML, Manchaiah V. Preferences to patient-centeredness in pre-service speech and hearing sciences students: a cross-sectional study. J Audiol Otol 2016;20:73-9.

      Thorarinsdottir K, Bjornsdottir K, Kristjansson K. Development of Hermes, a new person-centered assessment tool in nursing rehabilitation, through action research. ANS Adv Nurs Sci 2017;40:207-21.

      Kontos PC, Miller KL, Gilbert JE, et al. Improving client-centered brain injury rehabilitation through research-based theater. Qual Health Res 2012;22:1612-32.

      Fu VWY, Weatherall M, McNaughton H. The Taking Charge After Stroke (TaCAS) study protocol: a multicentre, investigator-blinded, randomised controlled trial comparing the effect of a single Take Charge session, two Take Charge sessions and control intervention on health-related quality of life 12 months after stroke for non-Maori, non-Pacific adult New Zealanders discharged to community living. BMJ Open 2017;7:e016512.

      Rose A, Soundy A, Rosewilliam S. Shared decision-making within goal-setting in rehabilitation: a mixed-methods study. Clin Rehabil 2019;33:564-74.

      Korner M, Dangel H, Plewnia A, Haller J, Wirtz MA. Psychometric evaluation of the Client-Centered Rehabilitation Questionnaire (CCRQ) in a large sample of German rehabilitation patients. Clin Rehabil 2017;31:926-35.

      Medina-Mirapeix F, Del Bano-Aledo ME, Martinez-Paya JJ, Lillo-Navarro MC, Escolar-Reina P. Development and validity of the questionnaire of patients' experiences in postacute outpatient physical therapy settings. Phys Ther 2015;95:767-77.

      Pidlyskyj K, Roddam H, Rawlinson G, Selfe J. Exploring aspects of physiotherapy care valued by breast cancer patients. Physiotherapy 2014;100:156-61.

      Muller I, Kirby S, Yardley L. The therapeutic relationship in telephone-delivered support for people undertaking rehabilitation: a mixed-methods interaction analysis. Disabil Rehabil 2015;37:1060-5.

      Flink M, Bertilsson AS, Johansson U, Guidetti S, Tham K, von Koch L. Training in client-centeredness enhances occupational therapist documentation on goal setting and client participation in goal setting in the medical records of people with stroke. Clin Rehabil 2016;30:1200-10.

      without condescension, pity, or stigma.

      Leplege A, Gzil F, Cammelli M, Lefeve C, Pachoud B, Ville I. Person-centredness: conceptual and historical perspectives. Disabil Rehabil 2007;29:1555-65.

      These actions require professionals’ willingness to spend time being with the person,

      Bright FA, Boland P, Rutherford SJ, Kayes NM, McPherson KM. Implementing a client-centred approach in rehabilitation: an autoethnography. Disabil Rehabil 2012;34:997-1004.

      undivided attention, and active listening toward the person’s lived experience, as much as persons desire, without rush.

      Terry G, Kayes N. Person centered care in neurorehabilitation: a secondary analysis. Disabil Rehabil 2020;42:2334-43.

      ,

      Cameron LJ, Somerville LM, Naismith CE, Watterson D, Maric V, Lannin NA. A qualitative investigation into the patient-centered goal-setting practices of allied health clinicians working in rehabilitation. Clin Rehabil 2018;32:827-40.

      ,

      Siegert RJ, Ward T, Levack WM, McPherson KM. A Good Lives Model of clinical and community rehabilitation. Disabil Rehabil 2007;29:1604-15.

      ,

      Enemark Larsen A, Rasmussen B, Christensen JR. Enhancing a client-centred practice with the Canadian Occupational Performance Measure. Occup Ther Int 2018;2018:5956301.

      ,

      Hanga K, DiNitto DM, Wilken JP, Leppik L. A person-centered approach in initial rehabilitation needs assessment: experiences of persons with disabilities. Alter 2017;11:251-66.

      ,

      McMurray J, McNeil H, Lafortune C, Black S, Prorok J, Stolee P. Measuring patients' experience of rehabilitation services across the care continuum. Part II: key dimensions. Arch Phys Med Rehabil 2016;97:121-30.

      ,

      Bamm EL, Rosenbaum P, Stratford P. Validation of the measure of processes of care for adults: a measure of client-centred care. Int J Qual Health Care 2010;22:302-9.

      ,

      Cott CA, Wiles R, Devitt R. Continuity, transition and participation: preparing clients for life in the community post-stroke. Disabil Rehabil 2007;29:1566-74.

      ,

      Thorarinsdottir K, Bjornsdottir K, Kristjansson K. Development of Hermes, a new person-centered assessment tool in nursing rehabilitation, through action research. ANS Adv Nurs Sci 2017;40:207-21.

      ,

      Fu VWY, Weatherall M, McNaughton H. The Taking Charge After Stroke (TaCAS) study protocol: a multicentre, investigator-blinded, randomised controlled trial comparing the effect of a single Take Charge session, two Take Charge sessions and control intervention on health-related quality of life 12 months after stroke for non-Maori, non-Pacific adult New Zealanders discharged to community living. BMJ Open 2017;7:e016512.

      ,

      Rose A, Soundy A, Rosewilliam S. Shared decision-making within goal-setting in rehabilitation: a mixed-methods study. Clin Rehabil 2019;33:564-74.

      ,

      Bright FA, Boland P, Rutherford SJ, Kayes NM, McPherson KM. Implementing a client-centred approach in rehabilitation: an autoethnography. Disabil Rehabil 2012;34:997-1004.

      Ranner M, von Koch L, Guidetti S, Tham K. Client-centred ADL intervention after stroke: occupational therapists' experiences. Scand J Occup Ther 2016;23:81-90.

      Cruz EB, Caeiro C, Pereira C. A narrative reasoning course to promote patient-centred practice in a physiotherapy undergraduate programme: a qualitative study of final year students. Physiother Theory Pract 2014;30:254-60.

      Kurz AE, Saint-Louis N, Burke JP, Stineman MG. Exploring the personal reality of disability and recovery: a tool for empowering the rehabilitation process. Qual Health Res 2008;18:90-105.

      Brown M, Levack W, McPherson KM, et al. Survival, momentum, and things that make me “me”: patients’ perceptions of goal setting after stroke. Disabil Rehabil 2014;36:1020-6.

      Walder K, Molineux M. Re-establishing an occupational identity after stroke – a theoretical model based on survivor experience. Br J Occup Ther 2017;80:620-30.

      In the digitalization era, professionals need to look at the person, not only at computer screens, to obtain information firsthand and show presence.

      Burridge L, Foster M, Jones R, Geraghty T, Atresh S. Person-centred care in a digital hospital: observations and perspectives from a specialist rehabilitation setting. Aust Health Rev 2018;42:529-35.

      ,

      Burridge LH, Foster M, Jones R, Geraghty T, Atresh S. Nurses' perspectives of person-centered spinal cord injury rehabilitation in a digital hospital. Rehabil Nurs 2019:45:263-70.

      In doing so, professionals can use communication strategies such as paraphrasing,

      Rose A, Soundy A, Rosewilliam S. Shared decision-making within goal-setting in rehabilitation: a mixed-methods study. Clin Rehabil 2019;33:564-74.

      summarizing,

      Cameron LJ, Somerville LM, Naismith CE, Watterson D, Maric V, Lannin NA. A qualitative investigation into the patient-centered goal-setting practices of allied health clinicians working in rehabilitation. Clin Rehabil 2018;32:827-40.

      interpreting and seeking explanation,

      Rose A, Soundy A, Rosewilliam S. Shared decision-making within goal-setting in rehabilitation: a mixed-methods study. Clin Rehabil 2019;33:564-74.

      and providing gentle reflections on the person’s thoughts, for clarification not for shaping persons’ values.

      Fu VWY, Weatherall M, McNaughton H. The Taking Charge After Stroke (TaCAS) study protocol: a multicentre, investigator-blinded, randomised controlled trial comparing the effect of a single Take Charge session, two Take Charge sessions and control intervention on health-related quality of life 12 months after stroke for non-Maori, non-Pacific adult New Zealanders discharged to community living. BMJ Open 2017;7:e016512.

      In enacting PCR, professionals strive to get to know each person, as much as they want to be known

      Lloyd A, Bannigan K, Sugavanam T, Freeman J. Experiences of stroke survivors, their families and unpaid carers in goal setting within stroke rehabilitation: a systematic review of qualitative evidence. JBI Database System Rev Implement Rep 2018;16:1418-53.

      ,

      Hanga K, DiNitto DM, Wilken JP, Leppik L. A person-centered approach in initial rehabilitation needs assessment: experiences of persons with disabilities. Alter 2017;11:251-66.

      ,

      Prescott S, Fleming J, Doig E. Refining a clinical practice framework to engage clients with brain injury in goal setting. Aust Occup Ther J 2019;66:313-25.

      ,

      Bright FA, Boland P, Rutherford SJ, Kayes NM, McPherson KM. Implementing a client-centred approach in rehabilitation: an autoethnography. Disabil Rehabil 2012;34:997-1004.

      ; understand the person’s struggles, hopes, and priorities

      Mudge S, Stretton C, Kayes N. Are physiotherapists comfortable with person-centred practice? An autoethnographic insight. Disabil Rehabil 2014;36:457-63.

      ,

      Unger J, Singh H, Mansfield A, Hitzig SL, Lenton E, Musselman KE. The experiences of physical rehabilitation in individuals with spinal cord injuries: a qualitative thematic synthesis. Disabil Rehabil 2019;41:1367-83.

      ,

      Fu VWY, Weatherall M, McNaughton H. The Taking Charge After Stroke (TaCAS) study protocol: a multicentre, investigator-blinded, randomised controlled trial comparing the effect of a single Take Charge session, two Take Charge sessions and control intervention on health-related quality of life 12 months after stroke for non-Maori, non-Pacific adult New Zealanders discharged to community living. BMJ Open 2017;7:e016512.

      ,

      Lindahl M, Teljigovic S, Heegaard Jensen L, Hvalsoe B, Juneja H. Importance of a patient-centred approach in ensuring quality of post-fracture rehabilitation for working aged people: a qualitative study of therapists' and patients’ perspectives. Work 2016;55:831-9.

      ; help understand what is meaningful

      Ahlsen B, Engebretsen E, Nicholls D, Mengshoel AM. The singular patient in patient-centred care: physiotherapists' accounts of treatment of patients with chronic muscle pain. Med Humanit 2019;46:226-33

      ,

      Njelesani J, Teachman G, Durocher E, Hamdani Y, Phelan SK. Thinking critically about client-centred practice and occupational possibilities across the life-span. Scand J Occup Ther 2015;22:252-9.

      ,

      Bright FA, Boland P, Rutherford SJ, Kayes NM, McPherson KM. Implementing a client-centred approach in rehabilitation: an autoethnography. Disabil Rehabil 2012;34:997-1004.

      ; and convey that the person is heard, not merely a “number” or object of care.

      Terry G, Kayes N. Person centered care in neurorehabilitation: a secondary analysis. Disabil Rehabil 2020;42:2334-43.

      ,

      D'Cruz K, Howie L, Lentin P. Client-centred practice: perspectives of persons with a traumatic brain injury. Scand J Occup Ther 2016;23:30-8.

      ,

      Hanga K, DiNitto DM, Wilken JP, Leppik L. A person-centered approach in initial rehabilitation needs assessment: experiences of persons with disabilities. Alter 2017;11:251-66.

      ,

      Hammell KR. Client-centred occupational therapy in Canada: refocusing on core values. Can J Occup Ther 2013;80:141-9.

      ,

      Wain HR, Kneebone, II, Billings J. Patient experience of neurologic rehabilitation: a qualitative investigation. Arch Phys Med Rehabil 2008;89:1366-71.

      ,

      Prescott S, Fleming J, Doig E. Rehabilitation goal setting with community dwelling adults with acquired brain injury: a theoretical framework derived from clinicians’ reflections on practice. Disabil Rehabil 2018;40:2388-99.

      ,

      Alanko T, Karhula M, Kroger T, Piirainen A, Nikander R. Rehabilitees perspective on goal setting in rehabilitation - a phenomenological approach. Disabil Rehabil 2019;41:2280-8.

      Information obtained on what is valued or meaningful additionally informs rehabilitation planning.

      McGilton KS, Davis AM, Naglie G, et al. Evaluation of patient-centered rehabilitation model targeting older persons with a hip fracture, including those with cognitive impairment. BMC Geriatr 2013;13:136.

      ,

      Van de Velde D, Devisch I, De Vriendt P. The client-centred approach as experienced by male neurological rehabilitation clients in occupational therapy. A qualitative study based on a grounded theory tradition. Disabil Rehabil 2016;38:1567-77.

      ,

      Fu VWY, Weatherall M, McNaughton H. The Taking Charge After Stroke (TaCAS) study protocol: a multicentre, investigator-blinded, randomised controlled trial comparing the effect of a single Take Charge session, two Take Charge sessions and control intervention on health-related quality of life 12 months after stroke for non-Maori, non-Pacific adult New Zealanders discharged to community living. BMJ Open 2017;7:e016512.

      Caring interactions help to build rapport and trust as well as contribute to developing supportive person-professional relationships, which are all key for PCR.

      Rosewilliam S, Sintler C, Pandyan AD, Skelton J, Roskell CA. Is the practice of goal-setting for patients in acute stroke care patient-centred and what factors influence this? A qualitative study. Clin Rehabil 2016;30:508-19.

      ,

      MacLeod R, McPherson KM. Care and compassion: part of person-centred rehabilitation, inappropriate response or a forgotten art? Disabil Rehabil 2007;29:1589-95.

      ,

      D'Cruz K, Howie L, Lentin P. Client-centred practice: perspectives of persons with a traumatic brain injury. Scand J Occup Ther 2016;23:30-8.

      ,

      Morera-Balaguer J, Botella-Rico JM, Catalan-Matamoros D, Martinez-Segura OR, Leal-Clavel M, Rodriguez-Nogueira O. Patients' experience regarding therapeutic person-centered relationships in physiotherapy services: a qualitative study. Physiother Theory Pract 2021;37:17-27.

      ,

      Hersh D, Worrall L, Howe T, Sherratt S, Davidson B. SMARTER goal setting in aphasia rehabilitation. Aphasiology 2012;26:220-33.

      ,
      • Papadimitriou C
      • Carpenter C
      ,

      Muller I, Kirby S, Yardley L. The therapeutic relationship in telephone-delivered support for people undertaking rehabilitation: a mixed-methods interaction analysis. Disabil Rehabil 2015;37:1060-5.

      ,

      Prescott S, Fleming J, Doig E. Rehabilitation goal setting with community dwelling adults with acquired brain injury: a theoretical framework derived from clinicians’ reflections on practice. Disabil Rehabil 2018;40:2388-99.

      ,

      Schmitt J, Akroyd K, Akroyd L. Perceptions of physiotherapy students of a person-centred approach in rehabilitation. Int J Ther Rehabil 2012;19:23-30.

      ,

      Bertilsson AS, Ranner M, von Koch L, et al. A client-centred ADL intervention: three-month follow-up of a randomized controlled trial. Scand J Occup Ther 2014;21:377-91.

      Supportive, trustful relationships can be engendered from early interactions,

      Muller I, Kirby S, Yardley L. The therapeutic relationship in telephone-delivered support for people undertaking rehabilitation: a mixed-methods interaction analysis. Disabil Rehabil 2015;37:1060-5.

      including in the acute care setting,

      Terry G, Kayes N. Person centered care in neurorehabilitation: a secondary analysis. Disabil Rehabil 2020;42:2334-43.

      taking priority over formal assessments where possible.

      Hersh D, Worrall L, Howe T, Sherratt S, Davidson B. SMARTER goal setting in aphasia rehabilitation. Aphasiology 2012;26:220-33.

      ,

      Haley KL, Cunningham KT, Barry J, de Riesthal M. Collaborative goals for communicative life participation in aphasia: the FOURC Model. Am J Speech Lang Pathol 2019;28:1-13.

      ,

      Bertilsson AS, Ranner M, von Koch L, et al. A client-centred ADL intervention: three-month follow-up of a randomized controlled trial. Scand J Occup Ther 2014;21:377-91.

      These interactions can be reinforced throughout rehabilitation,

      Terry G, Kayes N. Person centered care in neurorehabilitation: a secondary analysis. Disabil Rehabil 2020;42:2334-43.

      ,

      Fors A, Taft C, Ulin K, Ekman I. Person-centred care improves self-efficacy to control symptoms after acute coronary syndrome: a randomized controlled trial. Eur J Cardiovasc Nurs 2016;15:186-94.

      with benefits transferable to others within the rehabilitation teams, and to the next line of professionals in a patient's care.

      Terry G, Kayes N. Person centered care in neurorehabilitation: a secondary analysis. Disabil Rehabil 2020;42:2334-43.

      Professionals can make subtle, tailored use of touch and casual conversations,

      Hiller A, Guillemin M, Delany C. Exploring healthcare communication models in private physiotherapy practice. Patient Educ Couns 2015;98:1222-8.

      closer to informal chat,

      Van de Velde D, Devisch I, De Vriendt P. The client-centred approach as experienced by male neurological rehabilitation clients in occupational therapy. A qualitative study based on a grounded theory tradition. Disabil Rehabil 2016;38:1567-77.

      ,

      Muller I, Kirby S, Yardley L. The therapeutic relationship in telephone-delivered support for people undertaking rehabilitation: a mixed-methods interaction analysis. Disabil Rehabil 2015;37:1060-5.

      ,

      Hiller A, Guillemin M, Delany C. Exploring healthcare communication models in private physiotherapy practice. Patient Educ Couns 2015;98:1222-8.

      conducted alongside or apart from structured care requirements.

      Rosewilliam S, Roskell CA, Pandyan AD. A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation. Clin Rehabil 2011;25:501-14.

      Such acts can put persons at ease

      Terry G, Kayes N. Person centered care in neurorehabilitation: a secondary analysis. Disabil Rehabil 2020;42:2334-43.

      and convey authenticity.

      Morera-Balaguer J, Botella-Rico JM, Catalan-Matamoros D, Martinez-Segura OR, Leal-Clavel M, Rodriguez-Nogueira O. Patients' experience regarding therapeutic person-centered relationships in physiotherapy services: a qualitative study. Physiother Theory Pract 2021;37:17-27.

      Adding to transparency and reciprocity, professionals can share their experiences and perspectives as long as they are relevant for the context and done nonjudgmentally.

      Morera-Balaguer J, Botella-Rico JM, Catalan-Matamoros D, Martinez-Segura OR, Leal-Clavel M, Rodriguez-Nogueira O. Patients' experience regarding therapeutic person-centered relationships in physiotherapy services: a qualitative study. Physiother Theory Pract 2021;37:17-27.

      ,

      Ranner M, Guidetti S, von Koch L, Tham K. Experiences of participating in a client-centred ADL intervention after stroke. Disabil Rehabil 2019;41:3025-33.

      ,

      Ranner M, von Koch L, Guidetti S, Tham K. Client-centred ADL intervention after stroke: occupational therapists' experiences. Scand J Occup Ther 2016;23:81-90.

      That contrasts with “low key,” detached approaches devoid of the personal.

      Terry G, Kayes N. Person centered care in neurorehabilitation: a secondary analysis. Disabil Rehabil 2020;42:2334-43.

      ,

      Gibson BE, Terry G, Setchell J, Bright FAS, Cummins C, Kayes NM. The micro-politics of caring: tinkering with person-centered rehabilitation. Disabil Rehabil 2020;42:1529-38.

      PCR entails time for reciprocal interactions,

      Zimmermann L, Konrad A, Muller C, Rundel M, Korner M. Patient perspectives of patient-centeredness in medical rehabilitation. Patient Educ Couns 2014;96:98-105.

      conveying the professional's personhood.

      Gibson BE, Terry G, Setchell J, Bright FAS, Cummins C, Kayes NM. The micro-politics of caring: tinkering with person-centered rehabilitation. Disabil Rehabil 2020;42:1529-38.

      ,

      O'Halloran R, Hersh D, Laplante-Levesque A, Worrall L. Person-centeredness, ethics, and stories of risk. Semin Speech Lang 2010;31:81-9.

      Professionals use open minds and hearts to understand the person’s perspective, without fearing exposure to personal vulnerabilities.

      Terry G, Kayes N. Person centered care in neurorehabilitation: a secondary analysis. Disabil Rehabil 2020;42:2334-43.

      ,

      Morera-Balaguer J, Botella-Rico JM, Martinez-Gonzalez MC, Medina-Mirapeix F, Rodriguez-Nogueira O. Physical therapists' perceptions and experiences about barriers and facilitators of therapeutic patient-centred relationships during outpatient rehabilitation: a qualitative study. Braz J Phys Ther 2018;22:484-92.

      ,

      Thorarinsdottir K, Bjornsdottir K, Kristjansson K. Development of Hermes, a new person-centered assessment tool in nursing rehabilitation, through action research. ANS Adv Nurs Sci 2017;40:207-21.

      With a trustful relationship established, persons can more likely be supported to reflect on and integrate challenging circumstances.

      Fors A, Gyllensten H, Swedberg K, Ekman I. Effectiveness of person-centred care after acute coronary syndrome in relation to educational level: subgroup analysis of a two-armed randomised controlled trial. Int J Cardiol 2016;221:957-62.

      ,

      Pidlyskyj K, Roddam H, Rawlinson G, Selfe J. Exploring aspects of physiotherapy care valued by breast cancer patients. Physiotherapy 2014;100:156-61.

      This includes issues of grief,

      Ross EF, Haidet P. Attitudes of physical therapy students toward patient-centered care, before and after a course in psychosocial aspects of care. Patient Educ Couns 2011;85:529-32.

      intimacy,

      Ross EF, Haidet P. Attitudes of physical therapy students toward patient-centered care, before and after a course in psychosocial aspects of care. Patient Educ Couns 2011;85:529-32.

      ,

      Kontos PC, Miller KL, Gilbert JE, et al. Improving client-centered brain injury rehabilitation through research-based theater. Qual Health Res 2012;22:1612-32.

      ,

      Freeman C, Cassidy B, Hay-Smith EJC. Couple's experiences of relationship maintenance and intimacy in acute spinal cord injury rehabilitation: an interpretative phenomenological analysis. Sex Disabil 2017;35:433-44.

      social comparisons, comparisons to one's previous self,

      Unger J, Singh H, Mansfield A, Hitzig SL, Lenton E, Musselman KE. The experiences of physical rehabilitation in individuals with spinal cord injuries: a qualitative thematic synthesis. Disabil Rehabil 2019;41:1367-83.

      exploration of occupational alternatives,

      Mroz TM, Pitonyak JS, Fogelberg D, Leland NE. Client centeredness and health reform: key issues for occupational therapy. Am J Occup Ther 2015;69:6905090010p1-8.

      ,

      Njelesani J, Teachman G, Durocher E, Hamdani Y, Phelan SK. Thinking critically about client-centred practice and occupational possibilities across the life-span. Scand J Occup Ther 2015;22:252-9.

      ,

      Lund A, Michelet M, Kjeken I, Wyller TB, Sveen U. Development of a person-centred lifestyle intervention for older adults following a stroke or transient ischaemic attack. Scand J Occup Ther 2012;19:140-9.

      and overall psychosocial struggles, which are acknowledged and taken seriously.

      Hansen AO, Kristensen HK, Cederlund R, Lauridsen HH, Tromborg H. Client-centred practice from the perspective of Danish patients with hand-related disorders. Disabil Rehabil 2018;40:1542-52.

      ,

      Ross EF, Haidet P. Attitudes of physical therapy students toward patient-centered care, before and after a course in psychosocial aspects of care. Patient Educ Couns 2011;85:529-32.

      ,

      Kontos PC, Miller KL, Gilbert JE, et al. Improving client-centered brain injury rehabilitation through research-based theater. Qual Health Res 2012;22:1612-32.

      Fu VWY, Weatherall M, McNaughton H. The Taking Charge After Stroke (TaCAS) study protocol: a multicentre, investigator-blinded, randomised controlled trial comparing the effect of a single Take Charge session, two Take Charge sessions and control intervention on health-related quality of life 12 months after stroke for non-Maori, non-Pacific adult New Zealanders discharged to community living. BMJ Open 2017;7:e016512.

      Rose A, Soundy A, Rosewilliam S. Shared decision-making within goal-setting in rehabilitation: a mixed-methods study. Clin Rehabil 2019;33:564-74.

      Korner M, Dangel H, Plewnia A, Haller J, Wirtz MA. Psychometric evaluation of the Client-Centered Rehabilitation Questionnaire (CCRQ) in a large sample of German rehabilitation patients. Clin Rehabil 2017;31:926-35.

      Medina-Mirapeix F, Del Bano-Aledo ME, Martinez-Paya JJ, Lillo-Navarro MC, Escolar-Reina P. Development and validity of the questionnaire of patients' experiences in postacute outpatient physical therapy settings. Phys Ther 2015;95:767-77.

      ,

      Flink M, Bertilsson AS, Johansson U, Guidetti S, Tham K, von Koch L. Training in client-centeredness enhances occupational therapist documentation on goal setting and client participation in goal setting in the medical records of people with stroke. Clin Rehabil 2016;30:1200-10.

      ,

      Ylvisaker M, McPherson K, Kayes N, Pellett E. Metaphoric identity mapping: facilitating goal setting and engagement in rehabilitation after traumatic brain injury. Neuropsychol Rehabil 2008;18:713-41.

      Open, honest, transparent, and reassuring communication may also securely unfold about interventions, unfavorable prognosis, recovery expectations, or slower progress.

      Hanga K, DiNitto DM, Wilken JP, Leppik L. A person-centered approach in initial rehabilitation needs assessment: experiences of persons with disabilities. Alter 2017;11:251-66.

      ,

      Moore CL, Kaplan SL. A framework and resources for shared decision making: opportunities for improved physical therapy outcomes. Phys Ther 2018;98:1022-36.

      ,

      Fors A, Taft C, Ulin K, Ekman I. Person-centred care improves self-efficacy to control symptoms after acute coronary syndrome: a randomized controlled trial. Eur J Cardiovasc Nurs 2016;15:186-94.

      Bamm EL, Rosenbaum P, Stratford P. Validation of the measure of processes of care for adults: a measure of client-centred care. Int J Qual Health Care 2010;22:302-9.

      Mudge S, Stretton C, Kayes N. Are physiotherapists comfortable with person-centred practice? An autoethnographic insight. Disabil Rehabil 2014;36:457-63.

      ,

      Cott CA. Client-centred rehabilitation: what is it and how do we measure it? Physiotherapy 2008;94:89-90.

      ,

      Unger J, Singh H, Mansfield A, Hitzig SL, Lenton E, Musselman KE. The experiences of physical rehabilitation in individuals with spinal cord injuries: a qualitative thematic synthesis. Disabil Rehabil 2019;41:1367-83.

      ,

      Hansen AO, Kristensen HK, Cederlund R, Lauridsen HH, Tromborg H. Client-centred practice from the perspective of Danish patients with hand-related disorders. Disabil Rehabil 2018;40:1542-52.

      ,

      Amati M, Grignoli N, Rubinelli S, Amann J, Zanini C. The role of hope for health professionals in rehabilitation: a qualitative study on unfavorable prognosis communication. PLoS One 2019;14:e0224394.

      ,

      Kidd MO, Bond CH, Bell ML. Patients' perspectives of patient-centredness as important in musculoskeletal physiotherapy interactions: a qualitative study. Physiotherapy 2011;97:154-62.

      ,

      Pidlyskyj K, Roddam H, Rawlinson G, Selfe J. Exploring aspects of physiotherapy care valued by breast cancer patients. Physiotherapy 2014;100:156-61.

      ,

      Ranner M, von Koch L, Guidetti S, Tham K. Client-centred ADL intervention after stroke: occupational therapists' experiences. Scand J Occup Ther 2016;23:81-90.

      ,

      Brown M, Levack W, McPherson KM, et al. Survival, momentum, and things that make me “me”: patients’ perceptions of goal setting after stroke. Disabil Rehabil 2014;36:1020-6.

      ,

      Korner M, Becker S, Dinius J, Muller C, Zimmermann L, Rundel M. A patient-centred team-coaching concept for medical rehabilitation. J Interprof Care 2018;32:123-6.

      Finally, within holistic principles, professionals are attentive and responsive to the person's physical comfort needs,

      Yun D, Choi J. Person-centered rehabilitation care and outcomes: a systematic literature review. Int J Nurs Stud 2019;93:74-83.

      ,

      Hanga K, DiNitto DM, Wilken JP, Leppik L. A person-centered approach in initial rehabilitation needs assessment: experiences of persons with disabilities. Alter 2017;11:251-66.

      ,

      Cott CA. Client-centred rehabilitation: what is it and how do we measure it? Physiotherapy 2008;94:89-90.

      ,

      Fu VWY, Weatherall M, McNaughton H. The Taking Charge After Stroke (TaCAS) study protocol: a multicentre, investigator-blinded, randomised controlled trial comparing the effect of a single Take Charge session, two Take Charge sessions and control intervention on health-related quality of life 12 months after stroke for non-Maori, non-Pacific adult New Zealanders discharged to community living. BMJ Open 2017;7:e016512.

      ,

      Pidlyskyj K, Roddam H, Rawlinson G, Selfe J. Exploring aspects of physiotherapy care valued by breast cancer patients. Physiotherapy 2014;100:156-61.

      ,

      Muller I, Kirby S, Yardley L. The therapeutic relationship in telephone-delivered support for people undertaking rehabilitation: a mixed-methods interaction analysis. Disabil Rehabil 2015;37:1060-5.

      ,

      Fisher M, Pryor J, Capell J, Alexander T, Simmonds F. The psychometric properties of a modified client-centred rehabilitation questionnaire in an Australian population. Disabil Rehabil 2020;42:122-9.

      including pain issues,

      Cott CA. Client-centred rehabilitation: what is it and how do we measure it? Physiotherapy 2008;94:89-90.

      fatigue or other symptoms,

      Feldthusen C, Dean E, Forsblad-d'Elia H, Mannerkorpi K. Effects of person-centered physical therapy on fatigue-related variables in persons with rheumatoid arthritis: a randomized controlled trial. Arch Phys Med Rehabil 2016;97:26-36.

      and how the person experiences and copes with the symptoms.

      Larsson H, Blomqvist K. From a diagnostic and particular approach to a person-centred approach: a development project. J Clin Nurs 2015;24:465-74.

      Focused on meanings, hope, and strengths—beyond addressing deficits

      With the advent of impairments, persons may not develop or lose occupational roles and functioning and, with that, their sense of self, self-efficacy, and self-worth (ie, sense of being valuable and competent).

      Terry G, Kayes N. Person centered care in neurorehabilitation: a secondary analysis. Disabil Rehabil 2020;42:2334-43.

      ,

      D'Cruz K, Howie L, Lentin P. Client-centred practice: perspectives of persons with a traumatic brain injury. Scand J Occup Ther 2016;23:30-8.

      ,

      Hanga K, DiNitto DM, Wilken JP, Leppik L. A person-centered approach in initial rehabilitation needs assessment: experiences of persons with disabilities. Alter 2017;11:251-66.

      ,

      Cott CA, Wiles R, Devitt R. Continuity, transition and participation: preparing clients for life in the community post-stroke. Disabil Rehabil 2007;29:1566-74.

      ,

      Walder K, Molineux M. Re-establishing an occupational identity after stroke – a theoretical model based on survivor experience. Br J Occup Ther 2017;80:620-30.

      ,

      Fors A, Ekman I, Taft C, et al. Person-centred care after acute coronary syndrome, from hospital to primary care - a randomised controlled trial. Int J Cardiol 2015;187:693-9.

      Persons may struggle to envision a fulfilling life.

      Siegert RJ, Ward T, Levack WM, McPherson KM. A Good Lives Model of clinical and community rehabilitation. Disabil Rehabil 2007;29:1604-15.

      ,

      Ahlsen B, Engebretsen E, Nicholls D, Mengshoel AM. The singular patient in patient-centred care: physiotherapists' accounts of treatment of patients with chronic muscle pain. Med Humanit 2019;46:226-33

      ,

      Unger J, Singh H, Mansfield A, Hitzig SL, Lenton E, Musselman KE. The experiences of physical rehabilitation in individuals with spinal cord injuries: a qualitative thematic synthesis. Disabil Rehabil 2019;41:1367-83.

      ,

      Lund A, Michelet M, Kjeken I, Wyller TB, Sveen U. Development of a person-centred lifestyle intervention for older adults following a stroke or transient ischaemic attack. Scand J Occup Ther 2012;19:140-9.

      ,

      Walder K, Molineux M. Re-establishing an occupational identity after stroke – a theoretical model based on survivor experience. Br J Occup Ther 2017;80:620-30.

      ,

      Prescott S, Fleming J, Doig E. Rehabilitation goal setting with community dwelling adults with acquired brain injury: a theoretical framework derived from clinicians’ reflections on practice. Disabil Rehabil 2018;40:2388-99.

      ,

      Bertilsson AS, Ranner M, von Koch L, et al. A client-centred ADL intervention: three-month follow-up of a randomized controlled trial. Scand J Occup Ther 2014;21:377-91.

      ,

      Ylvisaker M, McPherson K, Kayes N, Pellett E. Metaphoric identity mapping: facilitating goal setting and engagement in rehabilitation after traumatic brain injury. Neuropsychol Rehabil 2008;18:713-41.

      PCR approaches are open to exploring the experiences and perceptions of disability, how meaningful lives can be (re)constructed, and how rehabilitation can be instrumental for that.

      Siegert RJ, Ward T, Levack WM, McPherson KM. A Good Lives Model of clinical and community rehabilitation. Disabil Rehabil 2007;29:1604-15.

      ,

      Prescott S, Doig E, Fleming J, Weir N. Goal statements in brain injury rehabilitation: a cohort study of client-centredness and relationship with goal outcome. Brain Impair 2019;20:1-14.

      PCR interactions provide persons with the opportunities and empathetic encouragement for supported self-explorations, as much as the person wants, to addressing issues such as one's life story, situation, life goals, or occupational choices.

      Mroz TM, Pitonyak JS, Fogelberg D, Leland NE. Client centeredness and health reform: key issues for occupational therapy. Am J Occup Ther 2015;69:6905090010p1-8.

      ,

      Rosewilliam S, Roskell CA, Pandyan AD. A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation. Clin Rehabil 2011;25:501-14.

      ,

      Siegert RJ, Ward T, Levack WM, McPherson KM. A Good Lives Model of clinical and community rehabilitation. Disabil Rehabil 2007;29:1604-15.

      ,

      Devan H, Hale L, Hempel D, Saipe B, Perry MA. What works and does not work in a self-management intervention for people with chronic pain? Qualitative systematic review and meta-synthesis. Phys Ther 2018;98:381-97.

      ,

      Ahlsen B, Engebretsen E, Nicholls D, Mengshoel AM. The singular patient in patient-centred care: physiotherapists' accounts of treatment of patients with chronic muscle pain. Med Humanit 2019;46:226-33

      ,

      Luker J, Lynch E, Bernhardsson S, Bennett L, Bernhardt J. Stroke survivors' experiences of physical rehabilitation: a systematic review of qualitative studies. Arch Phys Med Rehabil 2015;96:1698-708.

      ,

      Unger J, Singh H, Mansfield A, Hitzig SL, Lenton E, Musselman KE. The experiences of physical rehabilitation in individuals with spinal cord injuries: a qualitative thematic synthesis. Disabil Rehabil 2019;41:1367-83.

      ,

      Cott CA, Wiles R, Devitt R. Continuity, transition and participation: preparing clients for life in the community post-stroke. Disabil Rehabil 2007;29:1566-74.

      ,

      Pikkarainen A, Vahasantanen K, Paloniemi S, Etelapelto A. Older rehabilitees' life-course agency in Finnish gerontological rehabilitation. Scand J Occup Ther 2015;22:424-34.

      ,

      Amati M, Grignoli N, Rubinelli S, Amann J, Zanini C. The role of hope for health professionals in rehabilitation: a qualitative study on unfavorable prognosis communication. PLoS One 2019;14:e0224394.

      ,

      Fu VWY, Weatherall M, McNaughton H. The Taking Charge After Stroke (TaCAS) study protocol: a multicentre, investigator-blinded, randomised controlled trial comparing the effect of a single Take Charge session, two Take Charge sessions and control intervention on health-related quality of life 12 months after stroke for non-Maori, non-Pacific adult New Zealanders discharged to community living. BMJ Open 2017;7:e016512.

      ,

      Muller I, Kirby S, Yardley L. The therapeutic relationship in telephone-delivered support for people undertaking rehabilitation: a mixed-methods interaction analysis. Disabil Rehabil 2015;37:1060-5.

      ,

      Flink M, Bertilsson AS, Johansson U, Guidetti S, Tham K, von Koch L. Training in client-centeredness enhances occupational therapist documentation on goal setting and client participation in goal setting in the medical records of people with stroke. Clin Rehabil 2016;30:1200-10.

      ,

      Bertilsson AS, Ranner M, von Koch L, et al. A client-centred ADL intervention: three-month follow-up of a randomized controlled trial. Scand J Occup Ther 2014;21:377-91.

      ,

      Ylvisaker M, McPherson K, Kayes N, Pellett E. Metaphoric identity mapping: facilitating goal setting and engagement in rehabilitation after traumatic brain injury. Neuropsychol Rehabil 2008;18:713-41.

      ,

      Prescott S, Doig E, Fleming J, Weir N. Goal statements in brain injury rehabilitation: a cohort study of client-centredness and relationship with goal outcome. Brain Impair 2019;20:1-14.

      This helps to frame impairments within a continuum of life changes, link one's past and present to hopes for a meaningful future, and foster the person’s capacity to envision relevant life goals and agency-based paths toward their achievement.

      Yun D, Choi J. Person-centered rehabilitation care and outcomes: a systematic literature review. Int J Nurs Stud 2019;93:74-83.

      ,

      Terry G, Kayes N. Person centered care in neurorehabilitation: a secondary analysis. Disabil Rehabil 2020;42:2334-43.

      ,

      Prescott S, Fleming J, Doig E. Goal setting approaches and principles used in rehabilitation for people with acquired brain injury: a systematic scoping review. Brain Inj 2015;29:1515-29.

      ,

      Siegert RJ, Ward T, Levack WM, McPherson KM. A Good Lives Model of clinical and community rehabilitation. Disabil Rehabil 2007;29:1604-15.

      ,

      Hanga K, DiNitto DM, Wilken JP, Leppik L. A person-centered approach in initial rehabilitation needs assessment: experiences of persons with disabilities. Alter 2017;11:251-66.

      ,

      Doig E, Prescott S, Fleming J, Cornwell P, Kuipers P. Development and construct validation of the Client-Centredness of Goal Setting (C-COGS) scale. Scand J Occup Ther 2015;22:302-10.

      ,

      Njelesani J, Teachman G, Durocher E, Hamdani Y, Phelan SK. Thinking critically about client-centred practice and occupational possibilities across the life-span. Scand J Occup Ther 2015;22:252-9.

      ,

      Unger J, Singh H, Mansfield A, Hitzig SL, Lenton E, Musselman KE. The experiences of physical rehabilitation in individuals with spinal cord injuries: a qualitative thematic synthesis. Disabil Rehabil 2019;41:1367-83.

      ,

      Ranner M, Guidetti S, von Koch L, Tham K. Experiences of participating in a client-centred ADL intervention after stroke. Disabil Rehabil 2019;41:3025-33.

      ,

      Cott CA, Wiles R, Devitt R. Continuity, transition and participation: preparing clients for life in the community post-stroke. Disabil Rehabil 2007;29:1566-74.

      ,

      Bamm EL, Rosenbaum P, Wilkins S, Stratford P, Mahlberg N. Exploring client-centered care experiences in in-patient rehabilitation settings. Glob Qual Nurs Res 2015;2:2333393615582036.

      ,

      Pikkarainen A, Vahasantanen K, Paloniemi S, Etelapelto A. Older rehabilitees' life-course agency in Finnish gerontological rehabilitation. Scand J Occup Ther 2015;22:424-34.

      ,

      Hersh D, Worrall L, Howe T, Sherratt S, Davidson B. SMARTER goal setting in aphasia rehabilitation. Aphasiology 2012;26:220-33.

      ,

      Amati M, Grignoli N, Rubinelli S, Amann J, Zanini C. The role of hope for health professionals in rehabilitation: a qualitative study on unfavorable prognosis communication. PLoS One 2019;14:e0224394.

      ,

      Thorarinsdottir K, Bjornsdottir K, Kristjansson K. Development of Hermes, a new person-centered assessment tool in nursing rehabilitation, through action research. ANS Adv Nurs Sci 2017;40:207-21.

      ,

      Pidlyskyj K, Roddam H, Rawlinson G, Selfe J. Exploring aspects of physiotherapy care valued by breast cancer patients. Physiotherapy 2014;100:156-61.

      ,

      Brown M, Levack W, McPherson KM, et al. Survival, momentum, and things that make me “me”: patients’ perceptions of goal setting after stroke. Disabil Rehabil 2014;36:1020-6.

      ,

      Walder K, Molineux M. Re-establishing an occupational identity after stroke – a theoretical model based on survivor experience. Br J Occup Ther 2017;80:620-30.

      ,

      Lindahl M, Teljigovic S, Heegaard Jensen L, Hvalsoe B, Juneja H. Importance of a patient-centred approach in ensuring quality of post-fracture rehabilitation for working aged people: a qualitative study of therapists' and patients’ perspectives. Work 2016;55:831-9.

      ,

      Bertilsson AS, Ranner M, von Koch L, et al. A client-centred ADL intervention: three-month follow-up of a randomized controlled trial. Scand J Occup Ther 2014;21:377-91.

      Self-exploration can be supported by narrative, storytelling approaches,

      Cott CA, Wiles R, Devitt R. Continuity, transition and participation: preparing clients for life in the community post-stroke. Disabil Rehabil 2007;29:1566-74.

      ,

      Ross EF, Haidet P. Attitudes of physical therapy students toward patient-centered care, before and after a course in psychosocial aspects of care. Patient Educ Couns 2011;85:529-32.

      ,

      Cruz EB, Caeiro C, Pereira C. A narrative reasoning course to promote patient-centred practice in a physiotherapy undergraduate programme: a qualitative study of final year students. Physiother Theory Pract 2014;30:254-60.

      ,

      Fors A, Swedberg K, Ulin K, Wolf A, Ekman I. Effects of person-centred care after an event of acute coronary syndrome: two-year follow-up of a randomised controlled trial. Int J Cardiol 2017;249:42-7.

      ,

      Ekman I, Wolf A, Olsson LE, et al. Effects of person-centred care in patients with chronic heart failure: the PCC-HF study. Eur Heart J 2012;33:1112-9.

      including exploration of life in retrospect or teleologically

      Pikkarainen A, Vahasantanen K, Paloniemi S, Etelapelto A. Older rehabilitees' life-course agency in Finnish gerontological rehabilitation. Scand J Occup Ther 2015;22:424-34.

      or by using tools that identify issues of personal relevance (eg, Canadian Occupational Performance Measure),

      Enemark Larsen A, Rasmussen B, Christensen JR. Enhancing a client-centred practice with the Canadian Occupational Performance Measure. Occup Ther Int 2018;2018:5956301.

      ,
      • Parker DM.
      structured workbooks (eg, for the person to describe “my best day”),

      Fu VWY, Weatherall M, McNaughton H. The Taking Charge After Stroke (TaCAS) study protocol: a multicentre, investigator-blinded, randomised controlled trial comparing the effect of a single Take Charge session, two Take Charge sessions and control intervention on health-related quality of life 12 months after stroke for non-Maori, non-Pacific adult New Zealanders discharged to community living. BMJ Open 2017;7:e016512.

      metaphorical approaches or imaginary scenarios (eg, on possible ‘selves’ or alternative outcomes),

      Siegert RJ, Ward T, Levack WM, McPherson KM. A Good Lives Model of clinical and community rehabilitation. Disabil Rehabil 2007;29:1604-15.

      ,

      Kurz AE, Saint-Louis N, Burke JP, Stineman MG. Exploring the personal reality of disability and recovery: a tool for empowering the rehabilitation process. Qual Health Res 2008;18:90-105.

      ,

      Ylvisaker M, McPherson K, Kayes N, Pellett E. Metaphoric identity mapping: facilitating goal setting and engagement in rehabilitation after traumatic brain injury. Neuropsychol Rehabil 2008;18:713-41.

      motivational interviewing approaches (eg, helping identifying and acting on own motivations for change),

      Hanga K, DiNitto DM, Wilken JP, Leppik L. A person-centered approach in initial rehabilitation needs assessment: experiences of persons with disabilities. Alter 2017;11:251-66.

      ,

      Moore CL, Kaplan SL. A framework and resources for shared decision making: opportunities for improved physical therapy outcomes. Phys Ther 2018;98:1022-36.

      ,

      Ross EF, Haidet P. Attitudes of physical therapy students toward patient-centered care, before and after a course in psychosocial aspects of care. Patient Educ Couns 2011;85:529-32.

      or open-ended interviews to understand in which life aspects the person puts energies on.

      Siegert RJ, Ward T, Levack WM, McPherson KM. A Good Lives Model of clinical and community rehabilitation. Disabil Rehabil 2007;29:1604-15.

      PCR approaches foster reflective, interpretive, and supported dialogue, not 1-way reporting.

      Siegert RJ, Ward T, Levack WM, McPherson KM. A Good Lives Model of clinical and community rehabilitation. Disabil Rehabil 2007;29:1604-15.

      ,

      Thorarinsdottir K, Bjornsdottir K, Kristjansson K. Development of Hermes, a new person-centered assessment tool in nursing rehabilitation, through action research. ANS Adv Nurs Sci 2017;40:207-21.

      Additionally, PCR approaches are encouraging, foster belief in self and hope, and try to maximize persons’ engagement in rehabilitation and life situations through reinforcing the person's earlier achievements, enabling a sense of progress, achievement, and outcomes as they occur.

      Terry G, Kayes N. Person centered care in neurorehabilitation: a secondary analysis. Disabil Rehabil 2020;42:2334-43.

      ,

      Lloyd A, Bannigan K, Sugavanam T, Freeman J. Experiences of stroke survivors, their families and unpaid carers in goal setting within stroke rehabilitation: a systematic review of qualitative evidence. JBI Database System Rev Implement Rep 2018;16:1418-53.

      ,

      Bamm EL, Rosenbaum P, Wilkins S, Stratford P, Mahlberg N. Exploring client-centered care experiences in in-patient rehabilitation settings. Glob Qual Nurs Res 2015;2:2333393615582036.

      ,

      Amati M, Grignoli N, Rubinelli S, Amann J, Zanini C. The role of hope for health professionals in rehabilitation: a qualitative study on unfavorable prognosis communication. PLoS One 2019;14:e0224394.

      ,

      Brown M, Levack W, McPherson KM, et al. Survival, momentum, and things that make me “me”: patients’ perceptions of goal setting after stroke. Disabil Rehabil 2014;36:1020-6.

      Finally, PCR approaches are not deficit- or problem-centered (ie, merely listing and addressing problems, limitations, or vulnerabilities)

      Rosewilliam S, Roskell CA, Pandyan AD. A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation. Clin Rehabil 2011;25:501-14.

      ,

      Siegert RJ, Ward T, Levack WM, McPherson KM. A Good Lives Model of clinical and community rehabilitation. Disabil Rehabil 2007;29:1604-15.

      ,

      Haley KL, Cunningham KT, Barry J, de Riesthal M. Collaborative goals for communicative life participation in aphasia: the FOURC Model. Am J Speech Lang Pathol 2019;28:1-13.

      but also identify and build on the person's strengths, abilities, and resources to attain fulfilling lives and relevant rehabilitation outcomes.

      Hammell KR. Client-centred practice in occupational therapy: critical reflections. Scand J Occup Ther 2013;20:174-81.

      ,

      Fors A, Taft C, Ulin K, Ekman I. Person-centred care improves self-efficacy to control symptoms after acute coronary syndrome: a randomized controlled trial. Eur J Cardiovasc Nurs 2016;15:186-94.

      ,

      Mudge S, Stretton C, Kayes N. Are physiotherapists comfortable with person-centred practice? An autoethnographic insight. Disabil Rehabil 2014;36:457-63.

      ,

      Hammell KR. Client-centred occupational therapy in Canada: refocusing on core values. Can J Occup Ther 2013;80:141-9.

      ,

      Ranner M, Guidetti S, von Koch L, Tham K. Experiences of participating in a client-centred ADL intervention after stroke. Disabil Rehabil 2019;41:3025-33.

      ,

      McGilton KS, Davis A, Mahomed N, et al. An inpatient rehabilitation model of care targeting patients with cognitive impairment. BMC Geriatr 2012;12:21.

      ,

      Morera-Balaguer J, Botella-Rico JM, Martinez-Gonzalez MC, Medina-Mirapeix F, Rodriguez-Nogueira O. Physical therapists' perceptions and experiences about barriers and facilitators of therapeutic patient-centred relationships during outpatient rehabilitation: a qualitative study. Braz J Phys Ther 2018;22:484-92.

      ,

      Rochette A, Racine E, Lefebvre H, Lacombe J, Bastien J, Tellier M. Ethical issues relating to the inclusion of relatives as clients in the post-stroke rehabilitation process as perceived by patients, relatives and health professionals. Patient Educ Couns 2014;94:384-9.

      ,

      Brown M, Levack W, McPherson KM, et al. Survival, momentum, and things that make me “me”: patients’ perceptions of goal setting after stroke. Disabil Rehabil 2014;36:1020-6.

      ,

      Ekman I, Wolf A, Olsson LE, et al. Effects of person-centred care in patients with chronic heart failure: the PCC-HF study. Eur Heart J 2012;33:1112-9.

      Collaborative, empowering, and enabling coconstructed rehabilitation

      Applying PCR approaches entail developing a person-professional collaboration (commonly referred to as working alliance or partnership) throughout the rehabilitation process.

      Enemark Larsen A, Rasmussen B, Christensen JR. Enhancing a client-centred practice with the Canadian Occupational Performance Measure. Occup Ther Int 2018;2018:5956301.

      ,

      O'Halloran R, Hersh D, Laplante-Levesque A, Worrall L. Person-centeredness, ethics, and stories of risk. Semin Speech Lang 2010;31:81-9.

      ,

      Feldthusen C, Dean E, Forsblad-d'Elia H, Mannerkorpi K. Effects of person-centered physical therapy on fatigue-related variables in persons with rheumatoid arthritis: a randomized controlled trial. Arch Phys Med Rehabil 2016;97:26-36.

      ,

      D'Cruz K, Howie L, Lentin P. Client-centred practice: perspectives of persons with a traumatic brain injury. Scand J Occup Ther 2016;23:30-8.

      ,

      Hanga K, DiNitto DM, Wilken JP, Leppik L. A person-centered approach in initial rehabilitation needs assessment: experiences of persons with disabilities. Alter 2017;11:251-66.

      ,

      Papadimitriou C, Cott C. Client-centred practices and work in inpatient rehabilitation teams: results from four case studies. Disabil Rehabil 2015;37:1135-43.

      ,
      • Parker DM.
      ,

      Unger J, Singh H, Mansfield A, Hitzig SL, Lenton E, Musselman KE. The experiences of physical rehabilitation in individuals with spinal cord injuries: a qualitative thematic synthesis. Disabil Rehabil 2019;41:1367-83.

      ,

      Baumann M, Peck S, Collins C, Eades G. The meaning and value of taking part in a person-centred arts programme to hospital-based stroke patients: findings from a qualitative study. Disabil Rehabil 2013;35:244-56.

      ,

      Peoples H, Satink T, Steultjens E. Stroke survivors' experiences of rehabilitation: a systematic review of qualitative studies. Scand J Occup Ther 2011;18:163-71.

      ,

      Bamm EL, Rosenbaum P, Wilkins S, Stratford P, Mahlberg N. Exploring client-centered care experiences in in-patient rehabilitation settings. Glob Qual Nurs Res 2015;2:2333393615582036.

      ,

      Pikkarainen A, Vahasantanen K, Paloniemi S, Etelapelto A. Older rehabilitees' life-course agency in Finnish gerontological rehabilitation. Scand J Occup Ther 2015;22:424-34.

      ,

      Muller I, Kirby S, Yardley L. The therapeutic relationship in telephone-delivered support for people undertaking rehabilitation: a mixed-methods interaction analysis. Disabil Rehabil 2015;37:1060-5.

      ,

      Ranner M, von Koch L, Guidetti S, Tham K. Client-centred ADL intervention after stroke: occupational therapists' experiences. Scand J Occup Ther 2016;23:81-90.

      ,

      Kurz AE, Saint-Louis N, Burke JP, Stineman MG. Exploring the personal reality of disability and recovery: a tool for empowering the rehabilitation process. Qual Health Res 2008;18:90-105.

      ,

      Lindahl M, Teljigovic S, Heegaard Jensen L, Hvalsoe B, Juneja H. Importance of a patient-centred approach in ensuring quality of post-fracture rehabilitation for working aged people: a qualitative study of therapists' and patients’ perspectives. Work 2016;55:831-9.

      ,

      Prescott S, Fleming J, Doig E. Rehabilitation goal setting with community dwelling adults with acquired brain injury: a theoretical framework derived from clinicians’ reflections on practice. Disabil Rehabil 2018;40:2388-99.

      ,

      Ylvisaker M, McPherson K, Kayes N, Pellett E. Metaphoric identity mapping: facilitating goal setting and engagement in rehabilitation after traumatic brain injury. Neuropsychol Rehabil 2008;18:713-41.

      ,

      Korner M, Becker S, Dinius J, Muller C, Zimmermann L, Rundel M. A patient-centred team-coaching concept for medical rehabilitation. J Interprof Care 2018;32:123-6.

      ,

      Fors A, Ekman I, Taft C, et al. Person-centred care after acute coronary syndrome, from hospital to primary care - a randomised controlled trial. Int J Cardiol 2015;187:693-9.

      ,

      Ekman I, Wolf A, Olsson LE, et al. Effects of person-centred care in patients with chronic heart failure: the PCC-HF study. Eur Heart J 2012;33:1112-9.

      ,

      Eyssen IC, Steultjens MP, de Groot V, et al. A cluster randomised controlled trial on the efficacy of client-centred occupational therapy in multiple sclerosis: good process, poor outcome. Disabil Rehabil 2013;35:1636-46.

      This means that rehabilitation is seen as coconstructed, that is, the product of a mutually committed person-professional partnership, consisting of shared power, responsibility, and ownership for the rehabilitation process and outcomes.

      Prescott S, Fleming J, Doig E. Goal setting approaches and principles used in rehabilitation for people with acquired brain injury: a systematic scoping review. Brain Inj 2015;29:1515-29.

      ,

      Enemark Larsen A, Rasmussen B, Christensen JR. Enhancing a client-centred practice with the Canadian Occupational Performance Measure. Occup Ther Int 2018;2018:5956301.

      ,

      O'Halloran R, Hersh D, Laplante-Levesque A, Worrall L. Person-centeredness, ethics, and stories of risk. Semin Speech Lang 2010;31:81-9.

      ,

      Mudge S, Stretton C, Kayes N. Are physiotherapists comfortable with person-centred practice? An autoethnographic insight. Disabil Rehabil 2014;36:457-63.

      ,

      Doig E, Prescott S, Fleming J, Cornwell P, Kuipers P. Development and construct validation of the Client-Centredness of Goal Setting (C-COGS) scale. Scand J Occup Ther 2015;22:302-10.

      ,

      Ranner M, Guidetti S, von Koch L, Tham K. Experiences of participating in a client-centred ADL intervention after stroke. Disabil Rehabil 2019;41:3025-33.

      ,

      Pidlyskyj K, Roddam H, Rawlinson G, Selfe J. Exploring aspects of physiotherapy care valued by breast cancer patients. Physiotherapy 2014;100:156-61.

      ,

      Flink M, Bertilsson AS, Johansson U, Guidetti S, Tham K, von Koch L. Training in client-centeredness enhances occupational therapist documentation on goal setting and client participation in goal setting in the medical records of people with stroke. Clin Rehabil 2016;30:1200-10.

      ,

      Teale EA, Young JB. A patient reported experience measure (PREM) for use by older people in community services. Age Ageing 2015;44:667-72.

      Hedman A, Eriksson G, von Koch L, Guidetti S. Five-year follow-up of a cluster-randomized controlled trial of a client-centred activities of daily living intervention for people with stroke. Clin Rehabil 2019;33:262-76.

      Bright FA, Kayes NM, Worrall L, McPherson KM. A conceptual review of engagement in healthcare and rehabilitation. Disabil Rehabil 2015;37:643-54.

      In PCR approaches, the person-professional partnership enables and enacts the person’s autonomy and self-determination through supportive interpersonal relations and mutual dependencies.

      Terry G, Kayes N. Person centered care in neurorehabilitation: a secondary analysis. Disabil Rehabil 2020;42:2334-43.

      ,

      Peoples H, Satink T, Steultjens E. Stroke survivors' experiences of rehabilitation: a systematic review of qualitative studies. Scand J Occup Ther 2011;18:163-71.

      ,

      Durocher E, Kinsella EA, Ells C, Hunt M. Contradictions in client-centred discharge planning: through the lens of relational autonomy. Scand J Occup Ther 2015;22:293-301.

      For example, the person’s autonomy and self-determination can be enabled through information exchange, supported reflection, education, facilitated participation into rehabilitation decisions, and self-management support.

      Yun D, Choi J. Person-centered rehabilitation care and outcomes: a systematic literature review. Int J Nurs Stud 2019;93:74-83.

      ,

      Terry G, Kayes N. Person centered care in neurorehabilitation: a secondary analysis. Disabil Rehabil 2020;42:2334-43.

      ,

      Gibson BE, Terry G, Setchell J, Bright FAS, Cummins C, Kayes NM. The micro-politics of caring: tinkering with person-centered rehabilitation. Disabil Rehabil 2020;42:1529-38.

      ,

      Hanga K, DiNitto DM, Wilken JP, Leppik L. A person-centered approach in initial rehabilitation needs assessment: experiences of persons with disabilities. Alter 2017;11:251-66.

      ,

      Bamm EL, Rosenbaum P, Stratford P. Validation of the measure of processes of care for adults: a measure of client-centred care. Int J Qual Health Care 2010;22:302-9.

      ,

      Melin J, Arestedt K. The Patient Participation in Rehabilitation Questionnaire (PPRQ): psychometric evaluation and revision for use in neurological rehabilitation. Disabil Rehabil 2020;42:1454-61.

      ,

      Ranner M, Guidetti S, von Koch L, Tham K. Experiences of participating in a client-centred ADL intervention after stroke. Disabil Rehabil 2019;41:3025-33.

      ,

      Peoples H, Satink T, Steultjens E. Stroke survivors' experiences of rehabilitation: a systematic review of qualitative studies. Scand J Occup Ther 2011;18:163-71.

      ,

      Hansen AO, Kristensen HK, Cederlund R, Lauridsen HH, Tromborg H. Client-centred practice from the perspective of Danish patients with hand-related disorders. Disabil Rehabil 2018;40:1542-52.

      ,

      Durocher E, Kinsella EA, Ells C, Hunt M. Contradictions in client-centred discharge planning: through the lens of relational autonomy. Scand J Occup Ther 2015;22:293-301.

      ,

      Alanko T, Karhula M, Kroger T, Piirainen A, Nikander R. Rehabilitees perspective on goal setting in rehabilitation - a phenomenological approach. Disabil Rehabil 2019;41:2280-8.

      ,

      Schmitt J, Akroyd K, Akroyd L. Perceptions of physiotherapy students of a person-centred approach in rehabilitation. Int J Ther Rehabil 2012;19:23-30.

      ,

      Teale EA, Young JB. A patient reported experience measure (PREM) for use by older people in community services. Age Ageing 2015;44:667-72.

      These activities can enable persons to (re)exert mastery and control over their lives

      Rosewilliam S, Roskell CA, Pandyan AD. A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation. Clin Rehabil 2011;25:501-14.

      ,

      Unger J, Singh H, Mansfield A, Hitzig SL, Lenton E, Musselman KE. The experiences of physical rehabilitation in individuals with spinal cord injuries: a qualitative thematic synthesis. Disabil Rehabil 2019;41:1367-83.

      ,

      Ranner M, Guidetti S, von Koch L, Tham K. Experiences of participating in a client-centred ADL intervention after stroke. Disabil Rehabil 2019;41:3025-33.

      Kneebone, II, Hull SL, McGurk R, Cropley M. Reliability and validity of the neurorehabilitation experience questionnaire for inpatients. Neurorehabil Neural Repair 2012;26:834-41.

      Cott CA, Wiles R, Devitt R. Continuity, transition and participation: preparing clients for life in the community post-stroke. Disabil Rehabil 2007;29:1566-74.

      and take charge for their own rehabilitation and community (re)engagement as much as they desire.

      Yun D, Choi J. Person-centered rehabilitation care and outcomes: a systematic literature review. Int J Nurs Stud 2019;93:74-83.

      ,

      Devan H, Hale L, Hempel D, Saipe B, Perry MA. What works and does not work in a self-management intervention for people with chronic pain? Qualitative systematic review and meta-synthesis. Phys Ther 2018;98:381-97.

      ,

      Hanga K, DiNitto DM, Wilken JP, Leppik L. A person-centered approach in initial rehabilitation needs assessment: experiences of persons with disabilities. Alter 2017;11:251-66.

      ,

      Wijma AJ, Bletterman AN, Clark JR, et al. Patient-centeredness in physiotherapy: what does it entail? A systematic review of qualitative studies. Physiother Theory Pract 2017;33:825-40.

      ,

      Fu VWY, Weatherall M, McNaughton H. The Taking Charge After Stroke (TaCAS) study protocol: a multicentre, investigator-blinded, randomised controlled trial comparing the effect of a single Take Charge session, two Take Charge sessions and control intervention on health-related quality of life 12 months after stroke for non-Maori, non-Pacific adult New Zealanders discharged to community living. BMJ Open 2017;7:e016512.

      ,

      Pidlyskyj K, Roddam H, Rawlinson G, Selfe J. Exploring aspects of physiotherapy care valued by breast cancer patients. Physiotherapy 2014;100:156-61.

      ,

      Ranner M, von Koch L, Guidetti S, Tham K. Client-centred ADL intervention after stroke: occupational therapists' experiences. Scand J Occup Ther 2016;23:81-90.

      ,

      Lindahl M, Teljigovic S, Heegaard Jensen L, Hvalsoe B, Juneja H. Importance of a patient-centred approach in ensuring quality of post-fracture rehabilitation for working aged people: a qualitative study of therapists' and patients’ perspectives. Work 2016;55:831-9.

      ,

      Jesus TS, Hoenig H. Postacute rehabilitation quality of care: toward a shared conceptual framework. Arch Phys Med Rehabil 2015;96:960-9.

      ,

      Tistad M, Flink M, Ytterberg C, et al. Resource use of healthcare services 1 year after stroke: a secondary analysis of a cluster-randomised controlled trial of a client-centred activities of daily living intervention. BMJ Open 2018;8:e022222.

      In PCR approaches, professionals neither dictate nor are passive caregivers expecting the person “to get rehabilitated.”

      Eyssen IC, Dekker J, de Groot V, et al. Client-centred therapy in multiple sclerosis: more intensive diagnostic evaluation and less intensive treatment. J Rehabil Med 2014;46:527-31.

      Shared decision-making (SDM) approaches are advocated to support the person in decision making (on rehabilitation goals, intervention planning, discharge options).

      Yun D, Choi J. Person-centered rehabilitation care and outcomes: a systematic literature review. Int J Nurs Stud 2019;93:74-83.

      ,

      Mroz TM, Pitonyak JS, Fogelberg D, Leland NE. Client centeredness and health reform: key issues for occupational therapy. Am J Occup Ther 2015;69:6905090010p1-8.

      ,

      Lloyd A, Bannigan K, Sugavanam T, Freeman J. Experiences of stroke survivors, their families and unpaid carers in goal setting within stroke rehabilitation: a systematic review of qualitative evidence. JBI Database System Rev Implement Rep 2018;16:1418-53.

      ,

      Rose A, Rosewilliam S, Soundy A. Shared decision making within goal setting in rehabilitation settings: a systematic review. Patient Educ Couns 2017;100:65-75.

      ,

      Stevens A, Koke A, van der Weijden T, Beurskens A. The development of a patient-specific method for physiotherapy goal setting: a user-centered design. Disabil Rehabil 2018;40:2048-55.

      ,

      Devan H, Hale L, Hempel D, Saipe B, Perry MA. What works and does not work in a self-management intervention for people with chronic pain? Qualitative systematic review and meta-synthesis. Phys Ther 2018;98:381-97.

      ,

      Feldthusen C, Dean E, Forsblad-d'Elia H, Mannerkorpi K. Effects of person-centered physical therapy on fatigue-related variables in persons with rheumatoid arthritis: a randomized controlled trial. Arch Phys Med Rehabil 2016;97:26-36.

      ,

      Moore CL, Kaplan SL. A framework and resources for shared decision making: opportunities for improved physical therapy outcomes. Phys Ther 2018;98:1022-36.

      ,

      Peoples H, Satink T, Steultjens E. Stroke survivors' experiences of rehabilitation: a systematic review of qualitative studies. Scand J Occup Ther 2011;18:163-71.

      ,

      Lloyd A, Roberts AR, Freeman JA. 'Finding a balance' in involving patients in goal setting early after stroke: a physiotherapy perspective. Physiother Res Int 2014;19:147-57.

      ,

      Hansen AO, Kristensen HK, Cederlund R, Lauridsen HH, Tromborg H. Client-centred practice from the perspective of Danish patients with hand-related disorders. Disabil Rehabil 2018;40:1542-52.

      ,

      Haley KL, Cunningham KT, Barry J, de Riesthal M. Collaborative goals for communicative life participation in aphasia: the FOURC Model. Am J Speech Lang Pathol 2019;28:1-13.

      ,

      Hunt MR, Ells C. A patient-centered care ethics analysis model for rehabilitation. Am J Phys Med Rehabil 2013;92:818-27.

      ,

      Zimmermann L, Konrad A, Muller C, Rundel M, Korner M. Patient perspectives of patient-centeredness in medical rehabilitation. Patient Educ Couns 2014;96:98-105.

      ,

      Rose A, Soundy A, Rosewilliam S. Shared decision-making within goal-setting in rehabilitation: a mixed-methods study. Clin Rehabil 2019;33:564-74.

      ,

      Lindahl M, Teljigovic S, Heegaard Jensen L, Hvalsoe B, Juneja H. Importance of a patient-centred approach in ensuring quality of post-fracture rehabilitation for working aged people: a qualitative study of therapists' and patients’ perspectives. Work 2016;55:831-9.

      ,

      Korner M, Becker S, Dinius J, Muller C, Zimmermann L, Rundel M. A patient-centred team-coaching concept for medical rehabilitation. J Interprof Care 2018;32:123-6.

      ,

      Fisher M, Pryor J, Capell J, Alexander T, Simmonds F. The psychometric properties of a modified client-centred rehabilitation questionnaire in an Australian population. Disabil Rehabil 2020;42:122-9.

      ,

      Fors A, Swedberg K, Ulin K, Wolf A, Ekman I. Effects of person-centred care after an event of acute coronary syndrome: two-year follow-up of a randomised controlled trial. Int J Cardiol 2017;249:42-7.

      ,

      Jesus TS, Hoenig H. Postacute rehabilitation quality of care: toward a shared conceptual framework. Arch Phys Med Rehabil 2015;96:960-9.

      SDM first involves sharing information about rights and responsibilities, assessments, intervention options and rationales, community resources, and persons’ preferences.

      Hanga K, DiNitto DM, Wilken JP, Leppik L. A person-centered approach in initial rehabilitation needs assessment: experiences of persons with disabilities. Alter 2017;11:251-66.

      ,

      Moore CL, Kaplan SL. A framework and resources for shared decision making: opportunities for improved physical therapy outcomes. Phys Ther 2018;98:1022-36.

      ,

      Unger J, Singh H, Mansfield A, Hitzig SL, Lenton E, Musselman KE. The experiences of physical rehabilitation in individuals with spinal cord injuries: a qualitative thematic synthesis. Disabil Rehabil 2019;41:1367-83.

      ,

      Hansen AO, Kristensen HK, Cederlund R, Lauridsen HH, Tromborg H. Client-centred practice from the perspective of Danish patients with hand-related disorders. Disabil Rehabil 2018;40:1542-52.

      ,

      Hersh D, Worrall L, Howe T, Sherratt S, Davidson B. SMARTER goal setting in aphasia rehabilitation. Aphasiology 2012;26:220-33.

      ,

      Wain HR, Kneebone, II, Billings J. Patient experience of neurologic rehabilitation: a qualitative investigation. Arch Phys Med Rehabil 2008;89:1366-71.

      ,
      • Papadimitriou C
      • Carpenter C
      ,

      Kontos PC, Miller KL, Gilbert JE, et al. Improving client-centered brain injury rehabilitation through research-based theater. Qual Health Res 2012;22:1612-32.

      ,

      Rose A, Soundy A, Rosewilliam S. Shared decision-making within goal-setting in rehabilitation: a mixed-methods study. Clin Rehabil 2019;33:564-74.

      In doing so, professionals must listen to persons, convey information in an understandable and actionable manner (eg, jargon-free, with links to resources),

      Hunt MR, Ells C. A patient-centered care ethics analysis model for rehabilitation. Am J Phys Med Rehabil 2013;92:818-27.

      ,

      Durocher E, Kinsella EA, Ells C, Hunt M. Contradictions in client-centred discharge planning: through the lens of relational autonomy. Scand J Occup Ther 2015;22:293-301.

      ,

      Kontos PC, Miller KL, Gilbert JE, et al. Improving client-centered brain injury rehabilitation through research-based theater. Qual Health Res 2012;22:1612-32.

      assuring understanding (eg, asking to “teach back”

      Moore CL, Kaplan SL. A framework and resources for shared decision making: opportunities for improved physical therapy outcomes. Phys Ther 2018;98:1022-36.

      ), and clarifying if needed.
      Then, SDM evolves toward shared deliberation, whereby alternatives and their rationales as well as persons’ preferences are openly discussed nonjudgmentally, balancing effectiveness, risks, and uncertainty against what is meaningful or the person prefers.

      Devan H, Hale L, Hempel D, Saipe B, Perry MA. What works and does not work in a self-management intervention for people with chronic pain? Qualitative systematic review and meta-synthesis. Phys Ther 2018;98:381-97.

      ,

      Moore CL, Kaplan SL. A framework and resources for shared decision making: opportunities for improved physical therapy outcomes. Phys Ther 2018;98:1022-36.

      ,

      Kontos PC, Miller KL, Gilbert JE, et al. Improving client-centered brain injury rehabilitation through research-based theater. Qual Health Res 2012;22:1612-32.

      A shared deliberation may include exploration, interpretation, and seeking clarification of the factors (eg, fears, knowledge, beliefs) that drive persons’ preferences or motivations.

      Devan H, Hale L, Hempel D, Saipe B, Perry MA. What works and does not work in a self-management intervention for people with chronic pain? Qualitative systematic review and meta-synthesis. Phys Ther 2018;98:381-97.

      ,

      Dorfler E, Kulnik ST. Despite communication and cognitive impairment - person-centred goal-setting after stroke: a qualitative study. Disabil Rehabil 2020;42:3628-37.

      ,

      Bertilsson AS, Ranner M, von Koch L, et al. A client-centred ADL intervention: three-month follow-up of a randomized controlled trial. Scand J Occup Ther 2014;21:377-91.

      Similarly, it provides opportunities for honest, supported reflections that hopefully lead to a shared understanding of which goals and activities are relevant, have acceptable risks, and are deemed achievable.

      Mroz TM, Pitonyak JS, Fogelberg D, Leland NE. Client centeredness and health reform: key issues for occupational therapy. Am J Occup Ther 2015;69:6905090010p1-8.

      ,

      Gzil F, Lefeve C, Cammelli M, Pachoud B, Ravaud JF, Leplege A. Why is rehabilitation not yet fully person-centred and should it be more person-centred? Disabil Rehabil 2007;29:1616-24.

      ,

      Mudge S, Stretton C, Kayes N. Are physiotherapists comfortable with person-centred practice? An autoethnographic insight. Disabil Rehabil 2014;36:457-63.

      ,

      Njelesani J, Teachman G, Durocher E, Hamdani Y, Phelan SK. Thinking critically about client-centred practice and occupational possibilities across the life-span. Scand J Occup Ther 2015;22:252-9.

      ,

      Lund A, Michelet M, Kjeken I, Wyller TB, Sveen U. Development of a person-centred lifestyle intervention for older adults following a stroke or transient ischaemic attack. Scand J Occup Ther 2012;19:140-9.

      ,

      Hunt MR, Ells C. A patient-centered care ethics analysis model for rehabilitation. Am J Phys Med Rehabil 2013;92:818-27.

      ,

      Amati M, Grignoli N, Rubinelli S, Amann J, Zanini C. The role of hope for health professionals in rehabilitation: a qualitative study on unfavorable prognosis communication. PLoS One 2019;14:e0224394.

      ,
      • Papadimitriou C
      • Carpenter C
      ,

      Fu VWY, Weatherall M, McNaughton H. The Taking Charge After Stroke (TaCAS) study protocol: a multicentre, investigator-blinded, randomised controlled trial comparing the effect of a single Take Charge session, two Take Charge sessions and control intervention on health-related quality of life 12 months after stroke for non-Maori, non-Pacific adult New Zealanders discharged to community living. BMJ Open 2017;7:e016512.

      ,

      Rose A, Soundy A, Rosewilliam S. Shared decision-making within goal-setting in rehabilitation: a mixed-methods study. Clin Rehabil 2019;33:564-74.

      ,

      Lindahl M, Teljigovic S, Heegaard Jensen L, Hvalsoe B, Juneja H. Importance of a patient-centred approach in ensuring quality of post-fracture rehabilitation for working aged people: a qualitative study of therapists' and patients’ perspectives. Work 2016;55:831-9.

      ,

      Bertilsson AS, Ranner M, von Koch L, et al. A client-centred ADL intervention: three-month follow-up of a randomized controlled trial. Scand J Occup Ther 2014;21:377-91.

      ,

      Ylvisaker M, McPherson K, Kayes N, Pellett E. Metaphoric identity mapping: facilitating goal setting and engagement in rehabilitation after traumatic brain injury. Neuropsychol Rehabil 2008;18:713-41.

      ,

      Wallace MA, Kendall MB. Transitional rehabilitation goals for people with spinal cord injury: looking beyond the hospital walls. Disabil Rehabil 2014;36:642-50.

      To be person-centered, shared deliberations evolve from what the person desires, not what professionals perceive is doable.

      Rosewilliam S, Roskell CA, Pandyan AD. A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation. Clin Rehabil 2011;25:501-14.

      ,

      Njelesani J, Teachman G, Durocher E, Hamdani Y, Phelan SK. Thinking critically about client-centred practice and occupational possibilities across the life-span. Scand J Occup Ther 2015;22:252-9.

      ,

      Fu VWY, Weatherall M, McNaughton H. The Taking Charge After Stroke (TaCAS) study protocol: a multicentre, investigator-blinded, randomised controlled trial comparing the effect of a single Take Charge session, two Take Charge sessions and control intervention on health-related quality of life 12 months after stroke for non-Maori, non-Pacific adult New Zealanders discharged to community living. BMJ Open 2017;7:e016512.

      Rehabilitation plans may incorporate goals brought by the person even outside of immediate scopes of practice,
      • Papadimitriou C
      • Carpenter C
      including for psychosocial well-being.

      Rosewilliam S, Roskell CA, Pandyan AD. A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation. Clin Rehabil 2011;25:501-14.

      ,

      Rosewilliam S, Sintler C, Pandyan AD, Skelton J, Roskell CA. Is the practice of goal-setting for patients in acute stroke care patient-centred and what factors influence this? A qualitative study. Clin Rehabil 2016;30:508-19.

      ,

      Hersh D, Worrall L, Howe T, Sherratt S, Davidson B. SMARTER goal setting in aphasia rehabilitation. Aphasiology 2012;26:220-33.

      ,

      Wain HR, Kneebone, II, Billings J. Patient experience of neurologic rehabilitation: a qualitative investigation. Arch Phys Med Rehabil 2008;89:1366-71.

      Finally, a tentative rehabilitation plan can be collaboratively devised,

      Rose A, Rosewilliam S, Soundy A. Shared decision making within goal setting in rehabilitation settings: a systematic review. Patient Educ Couns 2017;100:65-75.

      ,

      Devan H, Hale L, Hempel D, Saipe B, Perry MA. What works and does not work in a self-management intervention for people with chronic pain? Qualitative systematic review and meta-synthesis. Phys Ther 2018;98:381-97.

      ,

      Feldthusen C, Dean E, Forsblad-d'Elia H, Mannerkorpi K. Effects of person-centered physical therapy on fatigue-related variables in persons with rheumatoid arthritis: a randomized controlled trial. Arch Phys Med Rehabil 2016;97:26-36.

      ,

      Moore CL, Kaplan SL. A framework and resources for shared decision making: opportunities for improved physical therapy outcomes. Phys Ther 2018;98:1022-36.

      ,

      Hersh D, Worrall L, Howe T, Sherratt S, Davidson B. SMARTER goal setting in aphasia rehabilitation. Aphasiology 2012;26:220-33.

      ,

      Rose A, Soundy A, Rosewilliam S. Shared decision-making within goal-setting in rehabilitation: a mixed-methods study. Clin Rehabil 2019;33:564-74.

      linking goals to rehabilitation tasks,

      Hersh D, Worrall L, Howe T, Sherratt S, Davidson B. SMARTER goal setting in aphasia rehabilitation. Aphasiology 2012;26:220-33.

      ,

      Flink M, Bertilsson AS, Johansson U, Guidetti S, Tham K, von Koch L. Training in client-centeredness enhances occupational therapist documentation on goal setting and client participation in goal setting in the medical records of people with stroke. Clin Rehabil 2016;30:1200-10.

      and may include short-term goals, resources, possibilities, obstacles, and how support needs can be met.

      Fors A, Gyllensten H, Swedberg K, Ekman I. Effectiveness of person-centred care after acute coronary syndrome in relation to educational level: subgroup analysis of a two-armed randomised controlled trial. Int J Cardiol 2016;221:957-62.

      ,

      Amati M, Grignoli N, Rubinelli S, Amann J, Zanini C. The role of hope for health professionals in rehabilitation: a qualitative study on unfavorable prognosis communication. PLoS One 2019;14:e0224394.

      ,

      Fu VWY, Weatherall M, McNaughton H. The Taking Charge After Stroke (TaCAS) study protocol: a multicentre, investigator-blinded, randomised controlled trial comparing the effect of a single Take Charge session, two Take Charge sessions and control intervention on health-related quality of life 12 months after stroke for non-Maori, non-Pacific adult New Zealanders discharged to community living. BMJ Open 2017;7:e016512.

      ,

      Fors A, Ekman I, Taft C, et al. Person-centred care after acute coronary syndrome, from hospital to primary care - a randomised controlled trial. Int J Cardiol 2015;187:693-9.

      ,

      Fors A, Swedberg K, Ulin K, Wolf A, Ekman I. Effects of person-centred care after an event of acute coronary syndrome: two-year follow-up of a randomised controlled trial. Int J Cardiol 2017;249:42-7.

      SDM and PCR approaches overall are evolving processes (not 1-off or “tick box” exercises) and can be incorporated within rehabilitation activities (eg, an exercise program).

      Gibson BE, Terry G, Setchell J, Bright FAS, Cummins C, Kayes NM. The micro-politics of caring: tinkering with person-centered rehabilitation. Disabil Rehabil 2020;42:1529-38.

      ,

      Haley KL, Cunningham KT, Barry J, de Riesthal M. Collaborative goals for communicative life participation in aphasia: the FOURC Model. Am J Speech Lang Pathol 2019;28:1-13.

      PCR goals and plans are not set in stone.

      Hersh D, Worrall L, Howe T, Sherratt S, Davidson B. SMARTER goal setting in aphasia rehabilitation. Aphasiology 2012;26:220-33.

      They are collaboratively monitored and may need update, expansion, refinement, or renegotiation over time because circumstances and preferences can change.

      van Seben R, Smorenburg SM, Buurman BM. A qualitative study of patient-centered goal-setting in geriatric rehabilitation: patient and professional perspectives. Clin Rehabil 2019;33:128-40.

      ,

      Ahlsen B, Engebretsen E, Nicholls D, Mengshoel AM. The singular patient in patient-centred care: physiotherapists' accounts of treatment of patients with chronic muscle pain. Med Humanit 2019;46:226-33

      ,

      Fors A, Gyllensten H, Swedberg K, Ekman I. Effectiveness of person-centred care after acute coronary syndrome in relation to educational level: subgroup analysis of a two-armed randomised controlled trial. Int J Cardiol 2016;221:957-62.

      ,

      Hersh D, Worrall L, Howe T, Sherratt S, Davidson B. SMARTER goal setting in aphasia rehabilitation. Aphasiology 2012;26:220-33.

      ,

      Van de Velde D, Devisch I, De Vriendt P. The client-centred approach as experienced by male neurological rehabilitation clients in occupational therapy. A qualitative study based on a grounded theory tradition. Disabil Rehabil 2016;38:1567-77.

      ,

      Fu VWY, Weatherall M, McNaughton H. The Taking Charge After Stroke (TaCAS) study protocol: a multicentre, investigator-blinded, randomised controlled trial comparing the effect of a single Take Charge session, two Take Charge sessions and control intervention on health-related quality of life 12 months after stroke for non-Maori, non-Pacific adult New Zealanders discharged to community living. BMJ Open 2017;7:e016512.

      ,

      Medina-Mirapeix F, Del Bano-Aledo ME, Martinez-Paya JJ, Lillo-Navarro MC, Escolar-Reina P. Development and validity of the questionnaire of patients' experiences in postacute outpatient physical therapy settings. Phys Ther 2015;95:767-77.

      ,

      Fors A, Ekman I, Taft C, et al. Person-centred care after acute coronary syndrome, from hospital to primary care - a randomised controlled trial. Int J Cardiol 2015;187:693-9.

      ,

      Plant SE, Tyson SF, Kirk S, Parsons J. What are the barriers and facilitators to goal-setting during rehabilitation for stroke and other acquired brain injuries? A systematic review and meta-synthesis. Clin Rehabil 2016;30:921-30.

      Furthermore, PCR goals, plans, or their development are not necessarily formulaic.

      Smit EB, Bouwstra H, van der Wouden JC, Wattel LM, Hertogh C. Patient-centred goal setting using functional outcome measures in geriatric rehabilitation: is it feasible? Eur Geriatr Med 2018;9:71-6.

      ,

      Van de Velde D, Devisch I, De Vriendt P. The client-centred approach as experienced by male neurological rehabilitation clients in occupational therapy. A qualitative study based on a grounded theory tradition. Disabil Rehabil 2016;38:1567-77.

      ,

      Prescott S, Fleming J, Doig E. Rehabilitation goal setting with community dwelling adults with acquired brain injury: a theoretical framework derived from clinicians’ reflections on practice. Disabil Rehabil 2018;40:2388-99.

      ,

      Prescott S, Doig E, Fleming J, Weir N. Goal statements in brain injury rehabilitation: a cohort study of client-centredness and relationship with goal outcome. Brain Impair 2019;20:1-14.

      Some persons find that far-reaching or general goal statements, worded into “relaxed” or colloquial language,

      Dorfler E, Kulnik ST. Despite communication and cognitive impairment - person-centred goal-setting after stroke: a qualitative study. Disabil Rehabil 2020;42:3628-37.

      are more person-centered than short-term, specific goals designed to be measurable, which are sometimes understood as service-oriented.

      Rosewilliam S, Sintler C, Pandyan AD, Skelton J, Roskell CA. Is the practice of goal-setting for patients in acute stroke care patient-centred and what factors influence this? A qualitative study. Clin Rehabil 2016;30:508-19.

      ,

      Brown M, Levack W, McPherson KM, et al. Survival, momentum, and things that make me “me”: patients’ perceptions of goal setting after stroke. Disabil Rehabil 2014;36:1020-6.

      ,

      Alanko T, Karhula M, Kroger T, Piirainen A, Nikander R. Rehabilitees perspective on goal setting in rehabilitation - a phenomenological approach. Disabil Rehabil 2019;41:2280-8.

      ,

      Prescott S, Doig E, Fleming J, Weir N. Goal statements in brain injury rehabilitation: a cohort study of client-centredness and relationship with goal outcome. Brain Impair 2019;20:1-14.

      ,

      DiLollo A, Favreau C. Person-centered care and speech and language therapy. Semin Speech Lang 2010;31:90-7.

      From a PCR perspective, meaningful changes are not necessarily numerically based but experienced by the person.

      Hersh D, Worrall L, Howe T, Sherratt S, Davidson B. SMARTER goal setting in aphasia rehabilitation. Aphasiology 2012;26:220-33.

      ,

      Wain HR, Kneebone, II, Billings J. Patient experience of neurologic rehabilitation: a qualitative investigation. Arch Phys Med Rehabil 2008;89:1366-71.

      Yet, varying goal-setting approaches work differently for different persons

      Dorfler E, Kulnik ST. Despite communication and cognitive impairment - person-centred goal-setting after stroke: a qualitative study. Disabil Rehabil 2020;42:3628-37.

      ,

      Lloyd A, Roberts AR, Freeman JA. 'Finding a balance' in involving patients in goal setting early after stroke: a physiotherapy perspective. Physiother Res Int 2014;19:147-57.

      ,

      Smit EB, Bouwstra H, van der Wouden JC, Wattel LM, Hertogh C. Patient-centred goal setting using functional outcome measures in geriatric rehabilitation: is it feasible? Eur Geriatr Med 2018;9:71-6.

      ,

      Brown M, Levack W, McPherson KM, et al. Survival, momentum, and things that make me “me”: patients’ perceptions of goal setting after stroke. Disabil Rehabil 2014;36:1020-6.

      ,

      Prescott S, Fleming J, Doig E. Rehabilitation goal setting with community dwelling adults with acquired brain injury: a theoretical framework derived from clinicians’ reflections on practice. Disabil Rehabil 2018;40:2388-99.

      ,

      Plant SE, Tyson SF, Kirk S, Parsons J. What are the barriers and facilitators to goal-setting during rehabilitation for stroke and other acquired brain injuries? A systematic review and meta-synthesis. Clin Rehabil 2016;30:921-30.

      ; the balance between flexible, open-ended approaches and formal, structured ones has to be found for each person.

      Rosewilliam S, Roskell CA, Pandyan AD. A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation. Clin Rehabil 2011;25:501-14.

      Finally, persons with cognitive, communication, or self-awareness impairments should be supported to participate meaningfully in SDM and goal setting.

      Dorfler E, Kulnik ST. Despite communication and cognitive impairment - person-centred goal-setting after stroke: a qualitative study. Disabil Rehabil 2020;42:3628-37.

      Challenges exist

      Haley KL, Cunningham KT, Barry J, de Riesthal M. Collaborative goals for communicative life participation in aphasia: the FOURC Model. Am J Speech Lang Pathol 2019;28:1-13.

      ,

      Leach E, Cornwell P, Fleming J, Haines T. Patient centered goal-setting in a subacute rehabilitation setting. Disabil Rehabil 2010;32:159-72.

      and demand adaptations such as metaphorical approaches,

      Ylvisaker M, McPherson K, Kayes N, Pellett E. Metaphoric identity mapping: facilitating goal setting and engagement in rehabilitation after traumatic brain injury. Neuropsychol Rehabil 2008;18:713-41.

      providing hints rather than detailed instructions,

      Hedberg-Kristensson E, Iwarsson S. Therapist attitudes and strategies to client-centred approaches in the provision of mobility devices to older clients. Disabil Rehabil Assist Technol 2013;8:381-6.

      information in aphasia-friendly formats,

      Dorfler E, Kulnik ST. Despite communication and cognitive impairment - person-centred goal-setting after stroke: a qualitative study. Disabil Rehabil 2020;42:3628-37.

      ,

      Hersh D, Worrall L, Howe T, Sherratt S, Davidson B. SMARTER goal setting in aphasia rehabilitation. Aphasiology 2012;26:220-33.

      ,

      Haley KL, Cunningham KT, Barry J, de Riesthal M. Collaborative goals for communicative life participation in aphasia: the FOURC Model. Am J Speech Lang Pathol 2019;28:1-13.

      and information supplemented with images

      Hanga K, DiNitto DM, Wilken JP, Leppik L. A person-centered approach in initial rehabilitation needs assessment: experiences of persons with disabilities. Alter 2017;11:251-66.

      ,

      Bamm EL, Rosenbaum P, Stratford P. Validation of the measure of processes of care for adults: a measure of client-centred care. Int J Qual Health Care 2010;22:302-9.

      ,

      Unger J, Singh H, Mansfield A, Hitzig SL, Lenton E, Musselman KE. The experiences of physical rehabilitation in individuals with spinal cord injuries: a qualitative thematic synthesis. Disabil Rehabil 2019;41:1367-83.

      ,

      McGilton KS, Davis A, Mahomed N, et al. An inpatient rehabilitation model of care targeting patients with cognitive impairment. BMC Geriatr 2012;12:21.

      ,
      • Papadimitriou C
      • Carpenter C
      to enable collaborative decisions.

      Microsystem

      Person-professional interactions occur within a microsystem, often involving significant others, multiple professionals, and support staff. At this level, PCR approaches are the following:

      Inclusive of significant others

      Engaging significant others (eg, spouse, family, personal caregivers) is seen as germane to PCR.

      Mroz TM, Pitonyak JS, Fogelberg D, Leland NE. Client centeredness and health reform: key issues for occupational therapy. Am J Occup Ther 2015;69:6905090010p1-8.

      ,

      McMurray J, McNeil H, Lafortune C, Black S, Prorok J, Stolee P. Measuring patients' experience of rehabilitation services across the care continuum. Part II: key dimensions. Arch Phys Med Rehabil 2016;97:121-30.

      ,

      Fors A, Taft C, Ulin K, Ekman I. Person-centred care improves self-efficacy to control symptoms after acute coronary syndrome: a randomized controlled trial. Eur J Cardiovasc Nurs 2016;15:186-94.

      ,

      Cott CA. Client-centred rehabilitation: what is it and how do we measure it? Physiotherapy 2008;94:89-90.

      ,
      • Parker DM.
      ,

      Melin J, Arestedt K. The Patient Participation in Rehabilitation Questionnaire (PPRQ): psychometric evaluation and revision for use in neurological rehabilitation. Disabil Rehabil 2020;42:1454-61.

      ,

      Unger J, Singh H, Mansfield A, Hitzig SL, Lenton E, Musselman KE. The experiences of physical rehabilitation in individuals with spinal cord injuries: a qualitative thematic synthesis. Disabil Rehabil 2019;41:1367-83.

      ,

      Bamm EL, Rosenbaum P, Wilkins S, Stratford P, Mahlberg N. Exploring client-centered care experiences in in-patient rehabilitation settings. Glob Qual Nurs Res 2015;2:2333393615582036.

      ,

      Kontos PC, Miller KL, Gilbert JE, et al. Improving client-centered brain injury rehabilitation through research-based theater. Qual Health Res 2012;22:1612-32.

      ,

      Ranner M, von Koch L, Guidetti S, Tham K. Client-centred ADL intervention after stroke: occupational therapists' experiences. Scand J Occup Ther 2016;23:81-90.

      ,

      Fisher M, Pryor J, Capell J, Alexander T, Simmonds F. The psychometric properties of a modified client-centred rehabilitation questionnaire in an Australian population. Disabil Rehabil 2020;42:122-9.

      ,

      Jesus TS, Hoenig H. Postacute rehabilitation quality of care: toward a shared conceptual framework. Arch Phys Med Rehabil 2015;96:960-9.

      ,

      Guidetti S, Ytterberg C. A randomised controlled trial of a client-centred self-care intervention after stroke: a longitudinal pilot study. Disabil Rehabil 2011;33:494-503.

      Caregivers are sometimes care agents; addressing their preferences, informational, and emotional needs can be part of PCR.

      Leplege A, Gzil F, Cammelli M, Lefeve C, Pachoud B, Ville I. Person-centredness: conceptual and historical perspectives. Disabil Rehabil 2007;29:1555-65.

      ,

      McGilton KS, Davis A, Mahomed N, et al. An inpatient rehabilitation model of care targeting patients with cognitive impairment. BMC Geriatr 2012;12:21.

      ,

      Hedman A, Eriksson G, von Koch L, Guidetti S. Five-year follow-up of a cluster-randomized controlled trial of a client-centred activities of daily living intervention for people with stroke. Clin Rehabil 2019;33:262-76.

      Furthermore, when intimate relationship issues are addressed, the couple is the unit for PCR.

      Freeman C, Cassidy B, Hay-Smith EJC. Couple's experiences of relationship maintenance and intimacy in acute spinal cord injury rehabilitation: an interpretative phenomenological analysis. Sex Disabil 2017;35:433-44.

      Significant others may have a role in rehabilitation planning if the person wants them to be involved (which cannot be taken for granted

      Hansen AO, Kristensen HK, Cederlund R, Lauridsen HH, Tromborg H. Client-centred practice from the perspective of Danish patients with hand-related disorders. Disabil Rehabil 2018;40:1542-52.

      ,

      Korner M, Dangel H, Plewnia A, Haller J, Wirtz MA. Psychometric evaluation of the Client-Centered Rehabilitation Questionnaire (CCRQ) in a large sample of German rehabilitation patients. Clin Rehabil 2017;31:926-35.

      ) and if the person is not coerced by any dominating relatives.

      Hedberg-Kristensson E, Iwarsson S. Therapist attitudes and strategies to client-centred approaches in the provision of mobility devices to older clients. Disabil Rehabil Assist Technol 2013;8:381-6.

      ,

      Hunt MR, Ells C. A patient-centered care ethics analysis model for rehabilitation. Am J Phys Med Rehabil 2013;92:818-27.

      ,

      Durocher E, Kinsella EA, Ells C, Hunt M. Contradictions in client-centred discharge planning: through the lens of relational autonomy. Scand J Occup Ther 2015;22:293-301.

      ,

      Fors A, Swedberg K, Ulin K, Wolf A, Ekman I. Effects of person-centred care after an event of acute coronary syndrome: two-year follow-up of a randomised controlled trial. Int J Cardiol 2017;249:42-7.

      ,

      Levack WM, Siegert RJ, Dean SG, McPherson KM. Goal planning for adults with acquired brain injury: how clinicians talk about involving family. Brain Inj 2009;23:192-202.

      Finally, significant others may contribute to rehabilitation decisions when the person has cognitive or communication impairments, especially after attempts to engage and support the person’s involvement have been exhausted.

      Rosewilliam S, Roskell CA, Pandyan AD. A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation. Clin Rehabil 2011;25:501-14.

      ,

      Ylvisaker M, McPherson K, Kayes N, Pellett E. Metaphoric identity mapping: facilitating goal setting and engagement in rehabilitation after traumatic brain injury. Neuropsychol Rehabil 2008;18:713-41.

      Following PCR reasoning, professionals would try to assure that the presumed best interests, expressed desires, or typical person's preferences (eg, inferred from previous life choices) are not overridden by significant others’ conflicting interests.

      Prescott S, Fleming J, Doig E. Goal setting approaches and principles used in rehabilitation for people with acquired brain injury: a systematic scoping review. Brain Inj 2015;29:1515-29.

      ,

      Rosewilliam S, Roskell CA, Pandyan AD. A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation. Clin Rehabil 2011;25:501-14.

      ,

      Dorfler E, Kulnik ST. Despite communication and cognitive impairment - person-centred goal-setting after stroke: a qualitative study. Disabil Rehabil 2020;42:3628-37.

      ,

      Hunt MR, Ells C. A patient-centered care ethics analysis model for rehabilitation. Am J Phys Med Rehabil 2013;92:818-27.

      ,

      Durocher E, Kinsella EA, Ells C, Hunt M. Contradictions in client-centred discharge planning: through the lens of relational autonomy. Scand J Occup Ther 2015;22:293-301.

      ,

      Levack WM, Siegert RJ, Dean SG, McPherson KM. Goal planning for adults with acquired brain injury: how clinicians talk about involving family. Brain Inj 2009;23:192-202.

      With appropriate safeguards, significant others should be integral part of PCR approaches, beyond being mere bystanders,

      Rochette A, Racine E, Lefebvre H, Lacombe J, Bastien J, Tellier M. Ethical issues relating to the inclusion of relatives as clients in the post-stroke rehabilitation process as perceived by patients, relatives and health professionals. Patient Educ Couns 2014;94:384-9.

      ,

      Ward CD. Is patient-centred care a good thing? Clin Rehabil 2012;26:3-9.

      adding a relational, systemic approach to PCR practices.

      Ward CD. Is patient-centred care a good thing? Clin Rehabil 2012;26:3-9.

      ,

      Phelan SK. Constructions of disability: a call for critical reflexivity in occupational therapy. Can J Occup Ther 2011;78:164-72.

      Articulated through a PCR team

      Rehabilitation is often delivered by professionals from multiple disciplines; therefore, PCR approaches (and how the person experiences them) emerge from interactions with rehabilitation teams, not single professionals.

      Ranner M, von Koch L, Guidetti S, Tham K. Client-centred ADL intervention after stroke: occupational therapists' experiences. Scand J Occup Ther 2016;23:81-90.

      ,

      Tistad M, Flink M, Ytterberg C, et al. Resource use of healthcare services 1 year after stroke: a secondary analysis of a cluster-randomised controlled trial of a client-centred activities of daily living intervention. BMJ Open 2018;8:e022222.

      ,

      Körner M, Luzay L, Plewnia A, et al. A cluster-randomized controlled study to evaluate a team coaching concept for improving teamwork and patient-centeredness in rehabilitation teams. PLoS One 2017;12:e0180171.

      As such, PCR is contingent on individual professionals working within person-centered teams and is activated through team members systematically working together to address the persons’ needs.

      Cheng L, Leon V, Liang A, et al. Patient-centered care in physical therapy: definition, operationalization, and outcome measures. Phys Ther Rev 2016;21:109-23.

      Optimally, all professionals who deliver interventions to the person demonstrate a shared commitment to PCR,

      Mroz TM, Pitonyak JS, Fogelberg D, Leland NE. Client centeredness and health reform: key issues for occupational therapy. Am J Occup Ther 2015;69:6905090010p1-8.

      ,

      Larsen AE, Adamsen HN, Boots S, Delkus ECG, Pedersen LL, Christensen JR. A survey on client-centered practice among danish occupational therapists. Scand J Occup Ther 2019;26:356-70.

      ,

      Kontos PC, Miller KL, Gilbert JE, et al. Improving client-centered brain injury rehabilitation through research-based theater. Qual Health Res 2012;22:1612-32.

      listen to the person,

      Hansen AO, Kristensen HK, Cederlund R, Lauridsen HH, Tromborg H. Client-centred practice from the perspective of Danish patients with hand-related disorders. Disabil Rehabil 2018;40:1542-52.

      and work toward common or articulated rehabilitation goals (beyond disciplinary-based agendas).

      Papadimitriou C, Cott C. Client-centred practices and work in inpatient rehabilitation teams: results from four case studies. Disabil Rehabil 2015;37:1135-43.

      ,

      Bamm EL, Rosenbaum P, Wilkins S, Stratford P, Mahlberg N. Exploring client-centered care experiences in in-patient rehabilitation settings. Glob Qual Nurs Res 2015;2:2333393615582036.

      ,

      Flink M, Bertilsson AS, Johansson U, Guidetti S, Tham K, von Koch L. Training in client-centeredness enhances occupational therapist documentation on goal setting and client participation in goal setting in the medical records of people with stroke. Clin Rehabil 2016;30:1200-10.

      ,

      Burau V, Carstensen K, Lou S, Kuhlmann E. Professional groups driving change toward patient-centred care: interprofessional working in stroke rehabilitation in Denmark. BMC Health Serv Res 2017;17:662.

      ,

      Becker S, Korner M, Muller C, Lippenberger C, Rundel M, Zimmermann L. Development and pilot testing of an interprofessional patient-centered team training programme in medical rehabilitation clinics in Germany: a process evaluation. BMC Med Educ 2017;17:120.

      Knowledge exchange and mutual respect among team members, social cohesion, professionalism, and interprofessional teamwork can facilitate team communication, coordination, and ultimately PCR.

      Papadimitriou C, Cott C. Client-centred practices and work in inpatient rehabilitation teams: results from four case studies. Disabil Rehabil 2015;37:1135-43.

      ,

      Korner M, Becker S, Dinius J, Muller C, Zimmermann L, Rundel M. A patient-centred team-coaching concept for medical rehabilitation. J Interprof Care 2018;32:123-6.

      ,

      Ohman A, Keisu BI, Enberg B. Team social cohesion, professionalism, and patient-centeredness: gndered care work, with special reference to elderly care - a mixed methods study. BMC Health Serv Res 2017;17:381.

      Experienced or skilled professionals can support other team members (novice, less skilled) in applying PCR approaches

      Cameron LJ, Somerville LM, Naismith CE, Watterson D, Maric V, Lannin NA. A qualitative investigation into the patient-centered goal-setting practices of allied health clinicians working in rehabilitation. Clin Rehabil 2018;32:827-40.

      ,

      Ylvisaker M, McPherson K, Kayes N, Pellett E. Metaphoric identity mapping: facilitating goal setting and engagement in rehabilitation after traumatic brain injury. Neuropsychol Rehabil 2008;18:713-41.

      or sometimes act on the team's behalf.

      Burau V, Carstensen K, Lou S, Kuhlmann E. Professional groups driving change toward patient-centred care: interprofessional working in stroke rehabilitation in Denmark. BMC Health Serv Res 2017;17:662.

      Finally, a team-based PCR implies that messages delivered to those served are congruent and coordinated among professionals, avoiding contradictory statements that often lead to distrust.

      Morera-Balaguer J, Botella-Rico JM, Catalan-Matamoros D, Martinez-Segura OR, Leal-Clavel M, Rodriguez-Nogueira O. Patients' experience regarding therapeutic person-centered relationships in physiotherapy services: a qualitative study. Physiother Theory Pract 2021;37:17-27.

      ,

      Kontos PC, Miller KL, Gilbert JE, et al. Improving client-centered brain injury rehabilitation through research-based theater. Qual Health Res 2012;22:1612-32.

      Delivered in a welcoming and secure environment

      PCR benefits from a welcoming environment, including physical spaces and affective atmospheres created within those spaces. In inpatient settings, the physical space would provide a sense of a noninstitutionalized environment.

      Wain HR, Kneebone, II, Billings J. Patient experience of neurologic rehabilitation: a qualitative investigation. Arch Phys Med Rehabil 2008;89:1366-71.

      Features can include places to read, watch television, or others for socializing and spending relaxing times (eg, garden, cafe).

      Kneebone, II, Hull SL, McGurk R, Cropley M. Reliability and validity of the neurorehabilitation experience questionnaire for inpatients. Neurorehabil Neural Repair 2012;26:834-41.

      ,

      Wain HR, Kneebone, II, Billings J. Patient experience of neurologic rehabilitation: a qualitative investigation. Arch Phys Med Rehabil 2008;89:1366-71.

      A PCR atmosphere also can be created by staff attentiveness, courtesy, and friendliness.

      McMurray J, McNeil H, Lafortune C, Black S, Prorok J, Stolee P. Measuring patients' experience of rehabilitation services across the care continuum. Part II: key dimensions. Arch Phys Med Rehabil 2016;97:121-30.

      Enjoyable, informal activities, such as weekly barbecues with staff, clients and outsiders, can also signpost and contribute to PCR environments.

      Wain HR, Kneebone, II, Billings J. Patient experience of neurologic rehabilitation: a qualitative investigation. Arch Phys Med Rehabil 2008;89:1366-71.

      PCR also implies the availability of private spaces to address intimate/personal matters

      Hanga K, DiNitto DM, Wilken JP, Leppik L. A person-centered approach in initial rehabilitation needs assessment: experiences of persons with disabilities. Alter 2017;11:251-66.

      ,

      Kneebone, II, Hull SL, McGurk R, Cropley M. Reliability and validity of the neurorehabilitation experience questionnaire for inpatients. Neurorehabil Neural Repair 2012;26:834-41.

      ,

      Morera-Balaguer J, Botella-Rico JM, Martinez-Gonzalez MC, Medina-Mirapeix F, Rodriguez-Nogueira O. Physical therapists' perceptions and experiences about barriers and facilitators of therapeutic patient-centred relationships during outpatient rehabilitation: a qualitative study. Braz J Phys Ther 2018;22:484-92.

      ,

      Rose A, Soundy A, Rosewilliam S. Shared decision-making within goal-setting in rehabilitation: a mixed-methods study. Clin Rehabil 2019;33:564-74.

      ,

      Freeman C, Cassidy B, Hay-Smith EJC. Couple's experiences of relationship maintenance and intimacy in acute spinal cord injury rehabilitation: an interpretative phenomenological analysis. Sex Disabil 2017;35:433-44.

      and to promote both undistracted and uninterrupted attention to the person.

      Morera-Balaguer J, Botella-Rico JM, Catalan-Matamoros D, Martinez-Segura OR, Leal-Clavel M, Rodriguez-Nogueira O. Patients' experience regarding therapeutic person-centered relationships in physiotherapy services: a qualitative study. Physiother Theory Pract 2021;37:17-27.

      Reconfigurations of the layouts of rehabilitation gyms or units may be needed.

      Morera-Balaguer J, Botella-Rico JM, Martinez-Gonzalez MC, Medina-Mirapeix F, Rodriguez-Nogueira O. Physical therapists' perceptions and experiences about barriers and facilitators of therapeutic patient-centred relationships during outpatient rehabilitation: a qualitative study. Braz J Phys Ther 2018;22:484-92.

      ,

      Freeman C, Cassidy B, Hay-Smith EJC. Couple's experiences of relationship maintenance and intimacy in acute spinal cord injury rehabilitation: an interpretative phenomenological analysis. Sex Disabil 2017;35:433-44.

      The person’s home is often where PCR can be best enacted (eg, during home-based therapy); because of its homeliness, personally relevant aspects for rehabilitation can naturally emerge.

      Gupta J, Taff SD. The illusion of client-centred practice. Scand J Occup Ther 2015;22:244-51.

      ,

      Hersh D, Worrall L, Howe T, Sherratt S, Davidson B. SMARTER goal setting in aphasia rehabilitation. Aphasiology 2012;26:220-33.

      ,

      Plant SE, Tyson SF, Kirk S, Parsons J. What are the barriers and facilitators to goal-setting during rehabilitation for stroke and other acquired brain injuries? A systematic review and meta-synthesis. Clin Rehabil 2016;30:921-30.

      ,

      Gustavsson M, Guidetti S, Eriksson G, von Koch L, Ytterberg C. Factors affecting outcome in participation one year after stroke: a secondary analysis of a randomized controlled trial. J Rehabil Med 2019;51:160-6.

      ,

      van der Veen DJ, Dopp CME, Siemonsma PC, Nijhuis-van der Sanden MWG, de Swart BJM, Steultjens EM. Factors influencing the implementation of home-based stroke rehabilitation: professionals' perspective. PLoS One 2019;14:e0220226.

      In the persons’ home, professionals are like guests.

      van der Veen DJ, Dopp CME, Siemonsma PC, Nijhuis-van der Sanden MWG, de Swart BJM, Steultjens EM. Factors influencing the implementation of home-based stroke rehabilitation: professionals' perspective. PLoS One 2019;14:e0220226.

      Finally, home environments often provide a safe place for addressing sensitive topics, such as sexual issues with couples.

      Freeman C, Cassidy B, Hay-Smith EJC. Couple's experiences of relationship maintenance and intimacy in acute spinal cord injury rehabilitation: an interpretative phenomenological analysis. Sex Disabil 2017;35:433-44.

      Macrosystem

      The PCR Model accounts for broader organizational issues at the macrosystem level, such as the attributes described below:

      Inclusive of persons and staff in service design, evaluation, and improvement

      PCR approaches imply that rehabilitation outcomes, services, or care experiences are evaluated from the client perspectives, including significant others’.

      Cott CA. Client-centred rehabilitation: what is it and how do we measure it? Physiotherapy 2008;94:89-90.

      ,

      Unger J, Singh H, Mansfield A, Hitzig SL, Lenton E, Musselman KE. The experiences of physical rehabilitation in individuals with spinal cord injuries: a qualitative thematic synthesis. Disabil Rehabil 2019;41:1367-83.

      ,

      Zimmermann L, Konrad A, Muller C, Rundel M, Korner M. Patient perspectives of patient-centeredness in medical rehabilitation. Patient Educ Couns 2014;96:98-105.

      ,

      Fisher M, Pryor J, Capell J, Alexander T, Simmonds F. The psychometric properties of a modified client-centred rehabilitation questionnaire in an Australian population. Disabil Rehabil 2020;42:122-9.

      ,

      Turner-Stokes L, Ashford S, Esquenazi A, et al. A comprehensive person-centered approach to adult spastic paresis: a consensus-based framework. Eur J Phys Rehabil Med 2018;54:605-17.

      Feedback can be routinely collected via interviews or client-centered assessment questionnaires.

      Cott CA. Client-centred rehabilitation: what is it and how do we measure it? Physiotherapy 2008;94:89-90.

      ,

      Zimmermann L, Konrad A, Muller C, Rundel M, Korner M. Patient perspectives of patient-centeredness in medical rehabilitation. Patient Educ Couns 2014;96:98-105.

      ,

      Fisher M, Pryor J, Capell J, Alexander T, Simmonds F. The psychometric properties of a modified client-centred rehabilitation questionnaire in an Australian population. Disabil Rehabil 2020;42:122-9.

      Experience surveys with focused questions can reveal suboptimal experiences with sensitivity,

      Teale EA, Young JB. A patient reported experience measure (PREM) for use by older people in community services. Age Ageing 2015;44:667-72.

      yet open-ended, qualitative questions may capture unmeasured or unmeasurable aspects of PCR and care experiences for closer inspection and quality-improvement opportunities.

      McMurray J, McNeil H, Lafortune C, Black S, Prorok J, Stolee P. Measuring patients' experience of rehabilitation services across the care continuum. Part II: key dimensions. Arch Phys Med Rehabil 2016;97:121-30.

      Clients or their representatives can be involved in service planning or (re)design

      Cott CA. Client-centred rehabilitation: what is it and how do we measure it? Physiotherapy 2008;94:89-90.

      and participate in quality improvement committees.

      Jesus TS, Hoenig H. Postacute rehabilitation quality of care: toward a shared conceptual framework. Arch Phys Med Rehabil 2015;96:960-9.

      Research teams, experienced facilitators, clients, and staff (health care professionals, middle managers, support staff) can all help design person-centered services and programs.

      Stevens A, Koke A, van der Weijden T, Beurskens A. The development of a patient-specific method for physiotherapy goal setting: a user-centered design. Disabil Rehabil 2018;40:2048-55.

      ,

      McGilton KS, Davis AM, Naglie G, et al. Evaluation of patient-centered rehabilitation model targeting older persons with a hip fracture, including those with cognitive impairment. BMC Geriatr 2013;13:136.

      ,

      Ekman I, Wolf A, Olsson LE, et al. Effects of person-centred care in patients with chronic heart failure: the PCC-HF study. Eur Heart J 2012;33:1112-9.

      ,

      Eriksson C, Eriksson G, Johansson U, Guidetti S. Occupational therapists' perceptions of implementing a client-centered intervention in close collaboration with researchers: a mixed methods study. Scand J Occup Ther 2020;27:142-53.

      In the implementation of PCR programs, professionals’ concerns must be raised and addressed, including in initial debriefings

      McGilton KS, Davis AM, Naglie G, et al. Evaluation of patient-centered rehabilitation model targeting older persons with a hip fracture, including those with cognitive impairment. BMC Geriatr 2013;13:136.

      with room for discussions and reflections,

      Eriksson C, Eriksson G, Johansson U, Guidetti S. Occupational therapists' perceptions of implementing a client-centered intervention in close collaboration with researchers: a mixed methods study. Scand J Occup Ther 2020;27:142-53.

      toward facilitating and safeguarding appropriate implementation.

      Ekman I, Wolf A, Olsson LE, et al. Effects of person-centred care in patients with chronic heart failure: the PCC-HF study. Eur Heart J 2012;33:1112-9.

      Finally, as part of quality improvement initiatives, organizations can use reflective workshops, where clients and staff provide their experiences, stories, and qualitative accounts on PCR issues, including providing deidentified yet personalized, nonjudgmental narratives on different aspects of PCR they experienced.

      Christie J, Macmillan M, Currie C, Matthews-Smith G. Developing person-centred practice in hip fracture care for older people. Nurs Stand 2016;31:47-57.

      Blickem C, Priyadharshini E. Patient narratives: the potential for "patient-centred" interprofessional learning? J Interprof Care 2007;21:619-32.

      Christie J, Macmillan M, Currie C, Matthews-Smith G. Improving the experience of hip fracture care: a multidisciplinary collaborative approach to implementing evidence-based, person-centred practice. Int J Orthop Trauma Nurs 2015;19:24-35.

      Creating the context for person-centeredness

      Organizational approaches are needed toward creating the context for PCR to be delivered for staff to have the means, opportunity, confidence, competencies, and accountability to deliver and improve PCR. Frontline staff need to feel safe, confident, and supported to provide PCR.

      Rosewilliam S, Sintler C, Pandyan AD, Skelton J, Roskell CA. Is the practice of goal-setting for patients in acute stroke care patient-centred and what factors influence this? A qualitative study. Clin Rehabil 2016;30:508-19.

      ,

      Ohman A, Keisu BI, Enberg B. Team social cohesion, professionalism, and patient-centeredness: gndered care work, with special reference to elderly care - a mixed methods study. BMC Health Serv Res 2017;17:381.

      ,

      Lawford BJ, Delany C, Bennell KL, Bills C, Gale J, Hinman RS. Training physical therapists in person-centered practice for people with osteoarthritis: a qualitative case study. Arthritis Care Res (Hoboken) 2018;70:558-70.

      Translating PCR ideals into practice, organizational leaders and managers need to show commitment to PCR approaches, beyond lip service.

      Rosewilliam S, Sintler C, Pandyan AD, Skelton J, Roskell CA. Is the practice of goal-setting for patients in acute stroke care patient-centred and what factors influence this? A qualitative study. Clin Rehabil 2016;30:508-19.

      ,

      Eriksson C, Eriksson G, Johansson U, Guidetti S. Occupational therapists' perceptions of implementing a client-centered intervention in close collaboration with researchers: a mixed methods study. Scand J Occup Ther 2020;27:142-53.

      ,

      Christie J, Macmillan M, Currie C, Matthews-Smith G. Developing person-centred practice in hip fracture care for older people. Nurs Stand 2016;31:47-57.

      ,

      Béliveau J. Middle managers’ role in transferring person-centered management and care. Serv Ind J 2013;33:1345-62.

      This includes proactively identifying and reducing organizational barriers to the uptake of PCR approaches.

      Lloyd A, Bannigan K, Sugavanam T, Freeman J. Experiences of stroke survivors, their families and unpaid carers in goal setting within stroke rehabilitation: a systematic review of qualitative evidence. JBI Database System Rev Implement Rep 2018;16:1418-53.

      ,

      Lloyd A, Roberts AR, Freeman JA. 'Finding a balance' in involving patients in goal setting early after stroke: a physiotherapy perspective. Physiother Res Int 2014;19:147-57.

      ,

      Smit EB, Bouwstra H, van der Wouden JC, Wattel LM, Hertogh C. Patient-centred goal setting using functional outcome measures in geriatric rehabilitation: is it feasible? Eur Geriatr Med 2018;9:71-6.

      ,

      Moats G. Discharge decision-making, enabling occupations, and client-centred practice. Can J Occup Ther 2007;74:91-101.

      ,

      Leach E, Cornwell P, Fleming J, Haines T. Patient centered goal-setting in a subacute rehabilitation setting. Disabil Rehabil 2010;32:159-72.

      ,

      Hiller A, Guillemin M, Delany C. Exploring healthcare communication models in private physiotherapy practice. Patient Educ Couns 2015;98:1222-8.

      ,

      Guidetti S, Ranner M, Tham K, Andersson M, Ytterberg C, von Koch L. A “client-centred activities of daily living” intervention for persons with stroke: one-year follow-up of a randomized controlled trial. J Rehabil Med 2015;47:605-11.

      ,

      Fleming-Castaldy RP. A macro perspective for client-centred practice in curricula: critique and teaching methods. Scand J Occup Ther 2015;22:267-76.

      Health care organizations often operate within a biomedical paradigm

      Rosewilliam S, Sintler C, Pandyan AD, Skelton J, Roskell CA. Is the practice of goal-setting for patients in acute stroke care patient-centred and what factors influence this? A qualitative study. Clin Rehabil 2016;30:508-19.

      ; indicators of success are often service-centered (eg, reduced length of stay), which drives goals and behaviors often inconsistent with PCR (eg, to discharge patients quickly).

      Levack WM, Dean SG, Siegert RJ, McPherson KM. Navigating patient-centered goal setting in inpatient stroke rehabilitation: how clinicians control the process to meet perceived professional responsibilities. Patient Educ Couns 2011;85:206-13.

      Sometimes, it takes whole organizational shifts to move from service-centered, disciplinary-based “treatments” to PCR.

      Prescott S, Fleming J, Doig E. Goal setting approaches and principles used in rehabilitation for people with acquired brain injury: a systematic scoping review. Brain Inj 2015;29:1515-29.

      Organizational redesign can empower professionals to exert accountable, self-directed work that follows the persons’ priorities; for example, professionals would be able to spread out intervention sessions over time for the person to have the chance to practice at home, if desired,

      Zimmermann L, Konrad A, Muller C, Rundel M, Korner M. Patient perspectives of patient-centeredness in medical rehabilitation. Patient Educ Couns 2014;96:98-105.

      ,

      Ranner M, von Koch L, Guidetti S, Tham K. Client-centred ADL intervention after stroke: occupational therapists' experiences. Scand J Occup Ther 2016;23:81-90.

      and could honor person’s preferences in scheduling follow-up visits.

      Feldthusen C, Dean E, Forsblad-d'Elia H, Mannerkorpi K. Effects of person-centered physical therapy on fatigue-related variables in persons with rheumatoid arthritis: a randomized controlled trial. Arch Phys Med Rehabil 2016;97:26-36.

      ,

      Fors A, Gyllensten H, Swedberg K, Ekman I. Effectiveness of person-centred care after acute coronary syndrome in relation to educational level: subgroup analysis of a two-armed randomised controlled trial. Int J Cardiol 2016;221:957-62.

      Organizational challenges for professionals to deliver PCR may include high caseload, understaffing, staff turnover, reimbursement based on procedures/visits, or narrow focuses on self-care activities.

      van Seben R, Smorenburg SM, Buurman BM. A qualitative study of patient-centered goal-setting in geriatric rehabilitation: patient and professional perspectives. Clin Rehabil 2019;33:128-40.

      ,

      Gibson BE, Terry G, Setchell J, Bright FAS, Cummins C, Kayes NM. The micro-politics of caring: tinkering with person-centered rehabilitation. Disabil Rehabil 2020;42:1529-38.

      ,

      Moore CL, Kaplan SL. A framework and resources for shared decision making: opportunities for improved physical therapy outcomes. Phys Ther 2018;98:1022-36.

      ,

      Leach E, Cornwell P, Fleming J, Haines T. Patient centered goal-setting in a subacute rehabilitation setting. Disabil Rehabil 2010;32:159-72.

      Creating the context for PCR also necessitates building staff capacity for PCR, including provision of staff training.

      Prescott S, Fleming J, Doig E. Goal setting approaches and principles used in rehabilitation for people with acquired brain injury: a systematic scoping review. Brain Inj 2015;29:1515-29.

      ,

      Kontos PC, Miller KL, Gilbert JE, et al. Improving client-centered brain injury rehabilitation through research-based theater. Qual Health Res 2012;22:1612-32.

      ,

      Hiller A, Guillemin M, Delany C. Exploring healthcare communication models in private physiotherapy practice. Patient Educ Couns 2015;98:1222-8.

      ,

      Lawford BJ, Delany C, Bennell KL, Bills C, Gale J, Hinman RS. Training physical therapists in person-centered practice for people with osteoarthritis: a qualitative case study. Arthritis Care Res (Hoboken) 2018;70:558-70.

      Without PCR training (on skills, knowledge mindset), professionals may experience difficulty and discomfort with PCR approaches, partly because components (eg, emotional support, SDM) may be perceived as out of their scope.