Moe S1, Pallesen H2, Arntzen C1, Aadal L2
1UiT The Arctic University of Norway, Department of Health and Care Sciences, Tromsoe, Norway, 2Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Åarhus, Hammel, Denmark
Background: Rehabilitation after inpatient stroke differs between European countries. A comparative study of organization of stroke rehabilitation in four European countries revealed inequalities in patients' functional level over time, due to organizational and professional variations between countries (Putman el al, 2009). Comparative studies of stroke rehabilitation in the Scandinavian countries are wanting. There are minor differences in stroke rehabilitation regulations and guidelines between Denmark and Norway. Overall, most Danish municipalities cover smaller geographical areas with higher population density as compared to Norwegian municipalities. Many Norwegian municipalities cover sparsely populated large geographical areas with scattered settlements. Both countries are welfare states with free public rehabilitation.
Purpose: The aim of this study was to explore and compare the content of stroke rehabilitation services in Norwegian and Danish municipalities. In this paper, we explore how municipal service providers perceived and defined their tasks in the rehabilitation process, with particular emphasis on the physiotherapy practice.
Methods: We followed the rehabilitation course for one year after the onset of stroke in six patients with complex needs living in municipalities in Central Denmark and five patients from municipalities in Northern Norway. We performed fieldwork with observation of treatment sessions and focus group interviews with the professionals about their contribution in the municipal rehabilitation process. This paper presents results from the focus group interviews. A socio-cultural perspective framed the study and the categories professional resources and organizational issues informed the content analysis.
Results: The professional practices in the Danish and Norwegian municipalities showed several divergent patterns. The Danish rehabilitation processes consisted of contingent rehabilitation plans and regular collaborative meetings among the professionals. The professionals were organized as teams specialized in rehabilitation after acquired brain injuries, and they carried out their services as individual and group activities, targeting physical, social and cognitive function. In addition, the patient's close family was followed up. Most of the involved professionals in the Norwegian municipalities were generalists, worked in parallel without a common individual rehabilitation plan, and sparse coordination of the services. Only the speech therapist focused on cognitive function. This pattern emerged independent of population density, and could be ascribed to aspects of traditional professional cultures. The physiotherapists and occupational therapists had limited skills in facing complex cognitive problems. In both countries, the physiotherapists were core service providers and their treatment mainly targeted motor function. Physiotherapists in the Norwegian cohort described lack of competence and high workload as reasons to terminate treatment.
Conclusion(s): The professional practice conformed with the guidelines of stroke rehabilitation to a larger degree in the included Danish municipalities as compared to the Norwegian ones. The included Norwegian physiotherapists had insufficient competence to support complex functional problems due to stroke, and the included municipalities in Norway lacked team organization and competencies to meet the complexity of rehabilitation challenges.
Implications: The Norwegian municipalities with a low volume of stroke rehabilitation need to strengthen the competences of their rehabilitation services, get access to more resources to meet cognitive problems and social challenges, as well as to create organizational structures to facilitate team work.
Keywords: Professional practice, Organization, Competence
Funding acknowledgements: This study was funded by Hammel Neurocenter, Denmark and UiT The Arctic University of Norway
Purpose: The aim of this study was to explore and compare the content of stroke rehabilitation services in Norwegian and Danish municipalities. In this paper, we explore how municipal service providers perceived and defined their tasks in the rehabilitation process, with particular emphasis on the physiotherapy practice.
Methods: We followed the rehabilitation course for one year after the onset of stroke in six patients with complex needs living in municipalities in Central Denmark and five patients from municipalities in Northern Norway. We performed fieldwork with observation of treatment sessions and focus group interviews with the professionals about their contribution in the municipal rehabilitation process. This paper presents results from the focus group interviews. A socio-cultural perspective framed the study and the categories professional resources and organizational issues informed the content analysis.
Results: The professional practices in the Danish and Norwegian municipalities showed several divergent patterns. The Danish rehabilitation processes consisted of contingent rehabilitation plans and regular collaborative meetings among the professionals. The professionals were organized as teams specialized in rehabilitation after acquired brain injuries, and they carried out their services as individual and group activities, targeting physical, social and cognitive function. In addition, the patient's close family was followed up. Most of the involved professionals in the Norwegian municipalities were generalists, worked in parallel without a common individual rehabilitation plan, and sparse coordination of the services. Only the speech therapist focused on cognitive function. This pattern emerged independent of population density, and could be ascribed to aspects of traditional professional cultures. The physiotherapists and occupational therapists had limited skills in facing complex cognitive problems. In both countries, the physiotherapists were core service providers and their treatment mainly targeted motor function. Physiotherapists in the Norwegian cohort described lack of competence and high workload as reasons to terminate treatment.
Conclusion(s): The professional practice conformed with the guidelines of stroke rehabilitation to a larger degree in the included Danish municipalities as compared to the Norwegian ones. The included Norwegian physiotherapists had insufficient competence to support complex functional problems due to stroke, and the included municipalities in Norway lacked team organization and competencies to meet the complexity of rehabilitation challenges.
Implications: The Norwegian municipalities with a low volume of stroke rehabilitation need to strengthen the competences of their rehabilitation services, get access to more resources to meet cognitive problems and social challenges, as well as to create organizational structures to facilitate team work.
Keywords: Professional practice, Organization, Competence
Funding acknowledgements: This study was funded by Hammel Neurocenter, Denmark and UiT The Arctic University of Norway
Topic: Disability & rehabilitation; Professional issues; Neurology: stroke
Ethics approval required: Yes
Institution: The Danish Data Protection Agency, Denmark
Ethics committee: The Regional Committee for Medical and Health Research Ethics, Norway
Ethics number: Denmark: 1-16-02-66-14, Norway 2013/1920
All authors, affiliations and abstracts have been published as submitted.
