Importance of a patient-centred approach in ensuring quality of post-fracture rehabilitation for working aged people: A qualitative study of therapists' and patients' perspectives.

BACKGROUND: Quality in rehabilitation is important for recovery and return to work for people at working age, who sustain fractures, but there is limited information about what constitutes quality in rehabilitation. OBJECTIVE: To identify factors that therapists and patients define as quality in the rehabilitation process for working population after simple or multiple fractures. METHODS: The study is a qualitative study based on grounded theory approach with semi-structured interviews conducted individually or in focus groups. Seven patients with fractures, 15 physiotherapists and eight occupational therapists from hospitals, municipalities and private practice were included in the study. Grounded theory was used to analyze data and develop a theory about quality in the rehabilitation process. RESULTS: Partnership was identified as the core category with continuity of rehabilitation and patient-centred approach as its dimensions. Themes in the patient-centred approach were Biopsychosocial understanding and Professionalism. The patient's perceived control enhanced when the therapist addressed the whole situation, especially return to work. Therapist's individual considerations and patient's involvement in decisions about the therapeutic methods had the same effect. CONCLUSION: Quality in rehabilitation was enhanced in all its dimensions namely structure, process and outcome when therapists used the patient-centred approach and addressed the patient's overall situation.

Quality in rehabilitation after a working age person has sustained a fracture: partnership contributes to continuity.

OBJECTIVE: Research in quality of rehabilitation has mostly concerned patients with chronic diseases, but the aim of the present study was to investigate what constitutes good quality in rehabilitation after a person has sustained a fracture at working age, from both patients' and therapists' perspectives. PARTICIPANTS: Seven patients with bone fracture, aged 32-60 years, and 23 occupational therapists and physiotherapists from hospitals, municipalities and private practices in Denmark. METHODS: Qualitative study with in-depth semi-structured interviews. Data were analyzed according to grounded theory method. RESULTS: Partnership was a central theme that was constituted by continuity of rehabilitation and therapists' use of a patient-centred approach. Patients' experiences of continuity of rehabilitation was supported, not only by organizational factors, but depended also on values constituting the patient-centred approach. Therapists used their professional network to refine the transition process from hospital into the community, but there was no co-operation between departments in the municipalities about patients' return to work. CONCLUSIONS: The study suggests that patients with acute injuries need partnership, respect, and understanding through the rehabilitation course. Personal relations were important for continuity of rehabilitation (i.e. that organizational quality depended more on therapists' efforts to promote continuity for the patient than organizational tools).