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Adherence of Individuals in Upper Extremity Rehabilitation: A Qualitative Study
Enrique V Smith-Forbes1, Dana M Howell2, Jason Willoughby3
1Department of Rehabilitation Sciences, College of Health Sciences, University of Kentucky, Lexington, KY; Graduate Medical Education, U.S. Army, Fort Sam Houston, TX.
Objective:
To describe the rehabilitation experiences, expectations, and treatment adherence of patients receiving upper extremity (UE) rehabilitation who demonstrated discrepancy between functional gains and overall improvement.
Design:
Qualitative (phenomenologic) interviews and analysis.
Setting:
Outpatient UE rehabilitation.
Participants:
Patients with acute UE injuries (N=10).
Interventions:
Not applicable.
Main Outcome Measure:
Concerns related to UE rehabilitation patients demonstrating discrepancy between outcome measures.
Results:
Five key themes emerged from the interviews of patients demonstrating discrepancy in their self-reported patient outcomes: (1) desire to return to normal, (2) initial anticipation of brief recovery, (3) trust of therapist, (4) cannot stop living, and (5) feelings of ambivalence. Challenges included living with the desire to move back into life. Multiple factors affected patient adherence: cost of treatment, patient-provider relation (difference between therapist and patient understanding on what is important for treatment), and patients expecting the treating therapists to be an expert and fix their problem.
Conclusions:
Patient adherence to UE rehabilitation presents many challenges. Patients view themselves as laypersons and seek the knowledge of a dedicated therapist who they trust to spend time with them to understand what they value as important and clarify their injury, collaboratively make goals, and explain the intervention to get them in essence, back into life, in the minimal required time. When categorized according to the World Health Organization's multidimensional adherence model, domains identified in this model include social and economic, health care team and system, condition-related, therapy-related, and patient-related dimensions. Assessing factors identified to improve efficiency and effectiveness of clinical management can enhance patient adherence.
