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Eliassen M.1, Henriksen N.O.1, Moe S.1
1UiT The Arctic University of Norway, Department of Health and Care Sciences, Tromsø, Norway
Background: Due to a growing number of old people, political strategies in the western society has led to new work fields and roles for physiotherapists. Reablement is a team based approach consisting of physiotherapists (PT), occupational therapists, nurses and non-professional home trainers (HT). The aim of the intervention is to improve the ability of self-dependency in daily activities[EM1] for people of, or at a risk of, function decline. In the teams the PT is responsible for assessments and development of rehabilitation plans concerning physical function. The training intervention is mainly followed up by the HT. However, there is no clear description of division of labor between team members.
Purpose: The aim of this study is to explore how division of labor in reablement teams affects the practice of assessment and intervention.
Methods: Fieldwork was done in seven Norwegian municipalities with reablement integrated as a health care service. Seven triads of PTs, HTs and users of reablement were included. Observations of work environments, assessments and interventions were conducted and videotaped. Observations were followed by audiotaped individual interviews with PTs and HTs regarding division of labor and clinical judgements. Systematic content analysis was performed and the results where further elaborated by theory of professionalism.
Results: Two main forms of distributions of work emerged. The first was characterized by strictly defined responsibilities where the PTs carried out the assessment at the beginning and the end of the rehabilitation period. In these teams assessment was limited to mainly involve tools often used in reablement (The Canadian Occupational Performance Measure and Short Physical Performance Battery). Training interventions in these teams were often general and standardized exercises. The training intervention was conducted by the HTs, only supported by sporadic instructions and information from PTs. The second form of division of labor was characterized by a stronger influence of interdisciplinary cooperation. In these reablement teams both the PTs and the HTs conducted the tests, and the PTs always carried out additional assessments. The latter assessment included varying extent of specific and general functional analysis and examinations. The PTs were frequently involved in the training interventions, and regularly deliberations involving different members of the team took place. This resulted in interventions where the users individual functional resources and constraints were taken into account.
Conclusion(s): This study revealed that less formal division of labor raised opportunity to thorough assessments, which lead to more individualized and customized training interventions.
Implications: The interdisciplinary cooperation of the reablement team members allows for more professional discussions and a clear focus on individual based assessment and training intervention.
Funding acknowledgements: Norwegian Fund for Post-Graduate Training in Physiotherapy
Topic: Health promotion & wellbeing/healthy ageing
Ethics approval: The study was approved by Norwegian Center for Research Data, November 2015.
All authors, affiliations and abstracts have been published as submitted.
