Implementing a person-centred model of service delivery and practice in neurological rehabilitation: theoretical and practical considerations

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Published: Sep 30, 2011
DOI: https://doi.org/10.5750/ijpcm.v1i3.121

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Shawab Mir
Neurological Physiotherapist, Walsall Healthcare NHS Trust, Walsall, UK
Christine Carpenter
Reader in Physiotherapy, Faculty of Health Sciences, Coventry University, Coventry, UK

Abstract

The purpose of this paper is to discuss the theoretical and practical implications inherent in the decision, made by the Community Neurological Rehabilitation Service (CNRS) and endorsed by Walsall Community Health, Walsall Healthcare Trust, UK, to adopt a person-centred model of service delivery and clinical practice. The CNRS provides an inter-disciplinary service to patients with a range of long-term neurological conditions in the community. A rigorous review of the previous rehabilitation services was conducted in 2007 and the theoretical influences, namely the biomedical and biopsychosocial models of disability, inherent in aspects of service delivery were critiqued. This review resulted in the adoption, at both client and organisational levels, of a person-centred approach to clinical practice. Cott, Teare, McGilton and Linecker (2006) proposed seven domains as indicators of client-centred rehabilitation and this paper uses these domains to illustrate how person-centred practice has been implemented by the CNRS. The domains are: participation in decision-making and goal setting, client-centred education, evaluation of outcomes from the client’s perspective, family involvement, emotional support, co-ordination and continuity and physical comfort. The challenges experienced by the inter-disciplinary team and future recommendations and research are discussed.

Article Details

Issue
Vol. 1 No. 3 (2011): September
Section
Regular Articles

References

Department of Health. (2005). The National Service Framework for Long-Term Conditions. London: Department of Health.

Merriam-Webster Online Dictionary (2006). Available from: http://www.m-w.com. (last accessed 06 July 2011).

Hammell, K.W. (2003). Changing institutional environments to enable occupation among people with severe physical impairments. In: Using Environments to Enable Occupational Therapy (eds. L. Lett, P. Rigby & D. Stewart), pp. 35-53. Thorofare, NJ: SLACK.

Engel, G. (1977). The need for a new medical model: A challenge for biomedicine. Science 196, 129-136.

Miller, W.L & Crabtree B.F. (2005). Clinical research. In: The Sage Handbook of Qualitative Research. (eds. N.K. Denzin & Y.S. Lincoln), pp. 605-639. Thousand Oaks, CA: Sage.

Carpenter, C. & Suto, M. (2008). Qualitative Research for Occupational and Physical Therapists: A Practical Guide. Oxford: Wiley Blackwell.

Hammell, K.W. (2006). Perspectives on Disability and Rehabilitation: Contesting Assumptions; Challenging Practice. Edinburgh: Churchill Livingstone/Elsevier.

Walsall NHS Teaching Primary Care Trust (2006). Walsall Health and Social Care Economy: Business Case for Rehabilitation Services for People with Long Term Neurological Conditions. Unpublished booklet. Walsall: Lichfield House.

Borrell-Carrio, F., Suchman, A.L. & Epstein, R.M. (2006). The biopsychosocial model 25 years later: Principles, practice, and scientific inquiry. Annals of Family Medicine 2 (6), 576-582.

Jette, A.J. (2006). Towards a common language for function, disability and health. Physical Therapy 86 (5), 726-734.

Barnes, C. (2003). Rehabilitation for Disabled People: a ‘sick’ joke? Scandinavian Journal of Disability Research 5 (1), 7-24.

Hammell, K.W. (2005). The rehabilitation process. In: Physical Management in Neurological Rehabilitation. (ed. M. Stokes) pp. 379-392. Edinburgh: Elsevier Mosby.

World Health Organisation (2003). WHO Definition of Health. Available at:

https://apps.who.int/aboutwho/en/definition.html (last accessed 06 July 2011).

World Health Organization (2002). Towards a common language for functioning, disability and health: ICF Beginners Guide [pdf document] Available at: http://www3.who.int/icf/icftemplate.cfm (last accessed 06 July 2011).

Stucki, G., Cieza, A. & Melvin, J. (2007). The international classification of functioning, disability and health: A unifying model for the conceptual description of the rehabilitation strategy. Journal of Rehabilitation Medicine 39, 279-285.

Lundstrom, L.G. (2008). Further arguments in support of a social humanistic perspective in physiotherapy versus the biomedical model. Physiotherapy Theory and Practice 24 (6), 393-396.

Mead, N. & Bower, P. (2000). Patient-centred: A conceptual framework and review of the empirical literature. Social Science & Medicine 51, 1087-1110.

Picker Institute (2000). Eye on patient: A report by the Picker Institute for the American Hospital Association (pp 1-14). Boston, MA: Picker Institute.

MacLeod, R. & McPherson K.M. (2007). Care and compassion: Part of person-centred rehabilitation, inappropriate response or a forgotten art? Disability and Rehabilitation 29 (20-21), 1589-1595.

Leplege, P.A., Gzil, F., Cammelli, M., Lefeve, C., Pachoud, B. & Ville, I. (2007). Person centeredness: conceptual and historical perspective. Disability and Rehabilitation 29 (20-21), 1555-1565.

Law, M., Baptiste, S., Carswell, A., McColl, M.A., Polatajko, H. & Pollock, N. (2005). Canadian Occupational Performance Measure (4th ed.). Ottawa, ON: CAOT Publications.

Turner-Stokes, L. (2009). Goal attainment scaling in rehabilitation: a practical guide. Clinical Rehabilitation 23, 362-370.

Sumsion, T. & Law, M. (2006). A review of evidence on the conceptual elements informing client-centred practice. Canadian Journal of Occupational Therapy 73 (3), 153-162.

Gzil, F., Lefeve, C., Cammelli, M., Pachoud, B., Ravaud, J.F. & Leplege, A. (2007). Why is rehabilitation not yet fully person-centred and should it be more person centred? Disability and Rehabilitation 29 (20-21), 1616-1624.

Department of Health. (2001). The Expert Patient: A New Approach to Chronic Disease Management in the Twenty-first Century. London: Department of Health.

Department of Health. (2005) Creating a Patient-led NHS: Delivering the NHS Improvement Plan. London: Department of Health.

Cott, C.A., Teare, G., McGilton, K.S. & Lineker, S. (2006). Reliability and construct validity of the client-centred rehabilitation questionnaire. Disability and Rehabilitation 28 (22), 1387-1397.

Cott, C.A. (2004). Client-centred rehabilitation: Client perspectives. Disability and Rehabilitation 26 (24), 1411-1422.

Cott, C.A. (2004). Editorial: Client centred rehabilitation: what is it and how do we measure it. Physiotherapy 94, 89-90.

Turner-Stokes, L., Williams, H. & Johnson, J. (2009). Goal attainment scaling: does it provide added value as a person centred measure for evaluation of outcome in neurorehabilitation following acquired brain injury. Journal of Rehabilitation Medicine 41, 528-535.

Khan, F., Pallant, J.F. & Turner-Stokes, L. (2008). Use of goal attainment scaling in inpatient rehabilitation for person with multiple sclerosis. Archives of Physical Medicine and Rehabilitation 89, 652-659.

Capilouto, G. (2000). Rehabilitation settings. In: Multidisciplinary approach to rehabilitation (ed. S. Kumar). pp. 1-26. Boston: Butterworth Heinemann.

Drinka, T. & Clark, P. (2000). Communicating in teamwork: Understanding professional differences and their implications for working together. In: Health care teamwork. pp. 63-84. Westport, Connecticut: Auburn House.

Suddick, K.T & Souza, L.D. (2006). Therapists experiences and perceptions of teamwork in neurological rehabilitation: reasoning behind the team approach, structure and composition of the team and team working processes. Physiotherapy Research International 11 (2), 72-83.

Barr, O. (1997). Interdisciplinary teamwork: consideration of the challenges. British Journal of Nursing 6 (17), 1005-1010.

Turner-Stokes, L. (2007). Politics, policy and payment – facilitators or barriers to person – centred rehabilitation? Disability and Rehabilitation 29 (20-21), 1575-1582.

McPherson, K.M. & Siegert, R.J. (2007). Person-centred rehabilitation: Rhetoric or reality? Disability and Rehabilitation 29 (20-21), 1551-1554.

Sumsion, T. and Lencucha, R. (2009). Therapists’ perceptions of how teamwork influences client-centred practice. British Journal of Occupational Therapy 72 (2), 48-54.