A qualitative study of views on disability and expectations from community rehabilitation service users

Conceptualisations of disability influence perspectives in clinical rehabilitation. The individual model and the social model framing of disability offer differing interpretations of the causality of problems and suggested actions to achieve improvement. Current rehabilitation practice centres on a problem-solving goal-oriented approach. How clients and professionals think about disability will invariably influence reasoning and suggestions for action. We explored these issues in a convenience sample of 10 community rehabilitation service users in London, United Kingdom. We took a phenomenological approach, aiming to discover interviewees' individual experiences and conceptualisations of disability, and expectations from community rehabilitation. Semi-structured qualitative interviews were conducted from June to August 2011. Interview transcripts were analysed through open coding, constant comparison and thematic analysis. Participants constituted a group of older adults with acquired impairments and diverse medical background. Participants generally understood disability according to the individual model. There was a lack of self-identification as disabled and of explicit socio-political views on disability. This seemed to correlate with participants' life course and the experience of impairments and increasing vulnerability with old age. However, accounts of interviewees' current difficulties in life provided examples of the applicability and relevance of social model thinking. Participants' expectations from community rehabilitation ranged from those who had no clear expectations and took a passive service user role to those who had concrete wishes and were actively engaged with the service. Our interpretation of these findings is that it may be necessary to raise the public profile of community rehabilitation as a service; and that there is scope for conceptual work to actively develop and incorporate alternative ways of looking at disability into clinical rehabilitation practice.