Socialization to the culture of a rehabilitation hospital: an ethnographic study

Using Qualitative Research to Inform the Client-Centred Evidence-Based Practice of Occupational Therapy

Demands for increased accountability for health care expenditure, and recognition of clients' rights to interventions and methods of service delivery that are grounded in sound evidence, are compelling occupational therapists to use research findings to inform their clinical decision making. Occupational therapists also state that they embrace a client-centred orientation to practice, yet this espoused ethic seems rarely to influence decisions concerning what research is undertaken and how it is undertaken or what counts as evidence for practice. Given the widely divergent perspectives, priorities and values between health care professionals and their clients, practice based upon therapist-centred research may be neither relevant nor valid.

This paper explores the philosophical underpinning of methods used to develop theory, proposing that occupational therapy's evidence-based practice must be ethically consistent with its espoused client-centred philosophy to avoid a tendency towards hypocrisy. It explores issues concerning client-centred practice and evidence-based practice and suggests that qualitative research methods may be the most appropriate tools to identify and address client priorities. While traditional quantitative research approaches render client voices silent, qualitative methods may enable occupational therapists to explore the complexities of clinical practice and of living with a disability, thereby informing a more client-centred, evidence-based practice of occupational therapy.

Toward a Cultural Anthropology of Disability and Rehabilitation

The author reviewed both the anthropology literature and the literature of disability and rehabilitation, examining the extent to which the concepts, theories, and methods of cultural anthropology have been applied to the conceptualization and understanding of "disability and rehabilitation" as a cultural phenomenon. Future directions for investigation are suggested, with particular reference to its application in rehabilitation counseling practice and research.

Experience of rehabilitation following spinal cord injury: a meta-synthesis of qualitative findings

STUDY DESIGN

Meta-synthesis of qualitative research.

OBJECTIVES

To identify, compare and synthesize published qualitative evidence concerning the experience of rehabilitation following spinal cord injury (SCI).

METHODS

Published articles were identified from the Medline, CINAHL and Sociological abstracts databases, a hand search through selected journals published since 1990, and from reference lists. These were assessed for their relevance to the focus of interest and appraised for rigour. The key themes that emerged from the data were summarized, compared and synthesized.

RESULTS

The search located 64 papers and four books, of which eight papers (describing seven studies) met the review criteria for relevance and rigour. Thematic comparison and synthesis resulted in the identification of seven concepts that encapsulate the important dimensions of rehabilitation from participants' perspectives: (1) the importance of specific staff qualities; (2) the need for a vision of future life possibilities; (3) the importance of peers; (4) the relevance of programme content; (5) the institutional context of rehabilitation; (6) the importance of reconnecting the past to the future; (7) the importance of meeting the needs of the real world.

CONCLUSIONS

If rehabilitation services are to be evidence-based, relevant and effective in meeting the needs of people with SCI they must be informed by the perspectives of people with SCI. The findings of this review suggest that the most important dimension of rehabilitation for people with SCI is the calibre and vision of the rehabilitation staff.

Quality of life after spinal cord injury: a meta-synthesis of qualitative findings

STUDY DESIGN

Meta-synthesis of qualitative research.

OBJECTIVES

To identify, compare and synthesize the factors found to contribute to, or detract from the experience of a life worth living following spinal cord injury (SCI).

METHODS

Published articles were identified from the Medline, CINAHL and Sociological Abstracts databases, a hand search through selected journals published since 1990, and from reference lists. These were assessed for their relevance to the focus of interest and appraised for rigour and quality. The key themes that emerged from the data were summarized, compared and synthesized.

RESULTS

The search located 64 papers and four books, of which seven papers met the review criteria for relevance and rigour, and in which 10 main concepts were identified: (1) body problems, (2) loss, (3) relationships, (4) responsibility for, and control of one's life, (5) occupation, and ability to contribute, (6) environmental context, (7) new values/perspective transformation, (8) good and bad days, (9) self-worth, (10) self-continuity.

CONCLUSIONS

This study demonstrates the utility of synthesizing qualitative research to provide a greater depth of insight into the factors that contribute to, and detract from, quality of life (QOL) after SCI. It also provides a more nuanced understanding of the experience of QOL following SCI than is achievable by quantitative methods. Future qualitative research is required to probe further the concepts and connections identified in this study, and to identify how rehabilitation services might best address these issues.

Spinal cord injury and outdoor experiences

Anecdotal evidence from spinal cord injury (SCI) rehabilitation clients suggests that nature experiences and outdoor pursuits are valued ingredients in a SCI rehabilitation program, in particular for those individuals who were outdoor enthusiasts pre-injury and/or who sustained their injury during outdoor pursuits. Model SCI centres in North America offer outdoor activities as components of SCI rehabilitation. A literature review on the effects and dynamics of nature experiences and outdoor pursuits in SCI rehabilitation and adjustment reveals a lacuna of empirical research in this area. Studies on leisure and recreation following SCI offer insights into how non-vocational rehabilitation activities assist functional independence, quality of life, and community re-integration. Systematic research is needed to ascertain the value and contribution of outdoor experiences in SCI rehabilitation; further, research is needed to document how contact with 'blue-green nature' may assist in the identity reconstruction process and in adjustment to life with a physical disability.

Spinal cord injury rehabilitation. 4. Individual experience, personal adaptation, and social perspectives

This learner-directed module highlights contemporary perspectives on personal success in the adjustment and adaptation of patients with spinal cord injury (SCI). It is the fourth in a series of five modules within the chapter on spinal cord injury rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This module explores models of the multisystem effects on a person after SCI, disablement, theories of adjustment, patient autonomy, quality of life, community experience, adaptations enhancing sexuality, and minimization of pain after SCI. Perspectives of the patient's experience in disablement, interdisciplinary person-centered rehabilitation, and success of the individual in chosen life roles are emphasized. The module is designed to update SCI issues reviewed in past syllabi.