File
Irgens EL1,2, Henriksen N1,2, Moe S1,2
1UiT The Arctic University of Norway, Department of Health and Care Sciences, Tromso, Norway, 2Center for Care Research, North, Tromso, Norway
Background: Acquired brain injury (ABI) is a major cause of disability and mortality both in Western countries and worldwide. Rehabilitation following ABI implies complex interventions across health care levels, and physiotherapy is considered important in neurological rehabilitation. Reformative work within health and care services in Western societies currently focus on both the improvement of service provision quality, and economic rationalization. This has led to earlier hospital discharge and an increased responsibility for health and care services in the municipalities, including rehabilitation services. There is a need for increased capacity, increased competence, new services and better organization of primary health and care services. In this regard, the transitions and collaborative work between health care levels in neurological rehabilitation trajectories is an important arena for improving and adapting rehabilitation practices to shifting contexts.
Purpose: To explore physiotherapists' experiences regarding clinical collaboration and physiotherapy practice development in ABI rehabilitation trajectories across health care levels.
Methods: This study was part of a larger project in which we explored physiotherapists' perceptions of neurological rehabilitation across health care levels in the post-reform era in Norway. We recruited 19 physiotherapists involved in the rehabilitation trajectories of ten persons with acquired brain injury. We conducted individual interviews with PTs in both specialist and primary health care, including a 3-month follow-up interview of PTs at the primary care level, as we followed the rehabilitation trajectories from in-hospital rehabilitation to further community rehabilitation. We analyzed the empirical material using an interpretive approach and systematic text condensation.
Results: The physiotherapists from both health care levels highlighted aspects of inter-professional collaboration and communication of information important for practice knowledge development, as patients were discharged from hospitals. They pointed to the shortcomings of written and verbal communication of information in rehabilitation trajectories in terms of professional development and patient follow-up. To further transfer and develop practice knowledge, the physiotherapists placed emphasis on patient-oriented collaboration within the context of clinical practice and work place environments. They highlighted clinical guidance and colloquial collaboration between primary and specialist health care physiotherapists, both prior to hospital discharge and in the patients' home communities. To increase clinical competence and optimize patient follow-up, several of the physiotherapists in the primary health care appreciated the opportunity to participate in out-patient consultations at specialist health care level. Furthermore, the primary health care physiotherapists accentuated that information and knowledge regarding the patients' home context may be beneficial for the initial phase of hospital rehabilitation. In the physiotherapists' opinions, clinical collaborative practices in patient transitions across health care levels may enhance a bilateral development of physiotherapy practices tailored to meet individual needs in ABI rehabilitation.
Conclusion(s): The results of this study point direction to the importance of clinical collaboration across health care levels in ABI rehabilitation trajectories. Clinical collaboration in patient transitions may facilitate both neurological physiotherapy practice development and improve patient care following ABI.
Implications: Increased emphasis on clinical patient-oriented collaboration in patient transitions from hospital to primary health care may facilitate further development of physiotherapy practice and knowledge in ABI rehabilitation, and enhance tailored and individualized interventions.
Keywords: Neurological physiotherapy, Clinical collaboration, Practice knowledge
Funding acknowledgements: The Norwegian Fund for Post-Graduate Training in Physiotherapy, and Center for Care Research, North Norway
Purpose: To explore physiotherapists' experiences regarding clinical collaboration and physiotherapy practice development in ABI rehabilitation trajectories across health care levels.
Methods: This study was part of a larger project in which we explored physiotherapists' perceptions of neurological rehabilitation across health care levels in the post-reform era in Norway. We recruited 19 physiotherapists involved in the rehabilitation trajectories of ten persons with acquired brain injury. We conducted individual interviews with PTs in both specialist and primary health care, including a 3-month follow-up interview of PTs at the primary care level, as we followed the rehabilitation trajectories from in-hospital rehabilitation to further community rehabilitation. We analyzed the empirical material using an interpretive approach and systematic text condensation.
Results: The physiotherapists from both health care levels highlighted aspects of inter-professional collaboration and communication of information important for practice knowledge development, as patients were discharged from hospitals. They pointed to the shortcomings of written and verbal communication of information in rehabilitation trajectories in terms of professional development and patient follow-up. To further transfer and develop practice knowledge, the physiotherapists placed emphasis on patient-oriented collaboration within the context of clinical practice and work place environments. They highlighted clinical guidance and colloquial collaboration between primary and specialist health care physiotherapists, both prior to hospital discharge and in the patients' home communities. To increase clinical competence and optimize patient follow-up, several of the physiotherapists in the primary health care appreciated the opportunity to participate in out-patient consultations at specialist health care level. Furthermore, the primary health care physiotherapists accentuated that information and knowledge regarding the patients' home context may be beneficial for the initial phase of hospital rehabilitation. In the physiotherapists' opinions, clinical collaborative practices in patient transitions across health care levels may enhance a bilateral development of physiotherapy practices tailored to meet individual needs in ABI rehabilitation.
Conclusion(s): The results of this study point direction to the importance of clinical collaboration across health care levels in ABI rehabilitation trajectories. Clinical collaboration in patient transitions may facilitate both neurological physiotherapy practice development and improve patient care following ABI.
Implications: Increased emphasis on clinical patient-oriented collaboration in patient transitions from hospital to primary health care may facilitate further development of physiotherapy practice and knowledge in ABI rehabilitation, and enhance tailored and individualized interventions.
Keywords: Neurological physiotherapy, Clinical collaboration, Practice knowledge
Funding acknowledgements: The Norwegian Fund for Post-Graduate Training in Physiotherapy, and Center for Care Research, North Norway
Topic: Neurology; Neurology; Education: continuing professional development
Ethics approval required: No
Institution: Regional Committees for Medical and Health Research Ethics
Ethics committee: REK North
Reason not required: The study addresses new developments in physiotherapy practice. The Regional Committee for Medical and Health Research Ethics, REK North, evaluated the study protocol and stated that the study did not require ethics approval, as the study purpose focused on cooperation and collabration across health care levels and not new knowledge of health and disease.
All authors, affiliations and abstracts have been published as submitted.
