Discharge from physiotherapy following stroke: the management of disappointment

Stroke tends to result in a range of disabilities which have been shown to benefit from rehabilitation, in particular physiotherapy. Patients tend to have high expectations of the extent of recovery they can achieve through physiotherapy, and subsequently view discharge from physiotherapy before they have achieved that degree of recovery as disappointing and distressing. Current literature suggest that explicit discussion between physiotherapists and patients of the anticipated extent of recovery tends to be avoided during the programme of physiotherapy treatment, making discharge from physiotherapy the point at which potentially differing expectations might be expected to be confronted. This paper explores how the process of discharge is managed and experienced by patients and physiotherapists. It draws on Craib's (1994) ideas about how disappointment is managed in modern society. A qualitative longitudinal study was conducted with 16 stroke patients and their physiotherapists. These data comprise interview and observational material. The study found that the discharge of stroke patients from physiotherapy is not a point when patients' expectations and optimism about recovery are confronted. The notion of natural recovery that was raised with patients by physiotherapists at discharge and the information physiotherapists gave about exercise post-discharge had the effect of maintaining patients' high expectations and hopes about recovery. This has implications for the process of adaptation and adjustment that the patient eventually goes through in order to accommodate their altered abilities and identity. We argue that a number of factors contribute to the denial of disappointment within this interaction and that services need to be developed in ways that enable physiotherapists to engage with the possibility of disappointment about stroke outcome with patients, thereby making a positive contribution to the process of adaptation and adjustment that stroke survivors experience following discharge.