Occupational therapists' expectations in rehabilitation following stroke: sources of satisfaction and dissatisfaction.

OBJECTIVE: The purpose of this study was to gain understanding of the satisfactions and dissatisfactions in the work of occupational therapists with clients after stroke. METHOD: Data consisted of narrative descriptions by 32 therapists of especially satisfying and dissatisfying experiences in practice. Phenomenology and grounded theory strategies were used for the study design and data analysis. RESULTS: "Expectation" emerged as the core meaning of occupational therapy in stroke rehabilitation. Strong satisfaction was expressed when therapist-informants believed that they had fulfilled their expectations for clients to achieve the following: (a) maximum neuromuscular and functional recovery in affected upper extremities; (b) independence in daily activities; and (c) return to living in the community. Major sources of informants' dissatisfactions were reaching the "plateau" stage of neurological recovery, disagreement between therapist expectations and client and family member expectations, and working with clients perceived as poorly motivated. CONCLUSION: American ideologies about the value of hard work, independence, and self-sufficiency appear to strongly shape therapists' expectations, satisfaction, and dissatisfaction in stroke rehabilitation. For occupational therapists, a tension may exist between the idealism of their therapeutic expectations and the realities of stroke recovery as it is experienced within the context of clients' ongoing lives.