Combining scoping review and concept analysis methodologies to clarify the meaning of rehabilitation potential after acquired brain injury

Abstract

Purpose

Clinicians make judgments about patients’ rehabilitation potential because it is considered by many as a prerequisite for referral to rehabilitation. However, the concept is rarely defined. This research aimed to clarify the concept of rehabilitation potential in the context of acquired brain injury patient referral to post-acute rehabilitation.

Method

Literature search (conducted in Medline, CINAHL and Embase) and article selection followed a scoping review methodology while a concept analysis methodology guided data extraction and analysis.

Results

Eighteen documents met inclusion criteria. Findings suggest four defining attributes of the concept. Rehabilitation potential (1) emerges from clinicians’ interpretation of patient characteristics and is influenced by the health care environment, (2) involves the prediction of how a patient might improve with rehabilitation interventions, (3) is a multi-level concept and (4) can change over time. The most critical consequence to assessing a patient’s rehabilitation potential is the impact on the patient’s opportunity to access post-acute rehabilitation services.

Conclusion

Rehabilitation potential is a concept rooted in clinical reasoning. We propose an operational definition and a conceptual model to provide a solid foundation for future research to advance policy and clinical decision-making regarding equitable access to post-acute rehabilitation.

IMPLICATIONS FOR REHABILITATION

• Rehabilitation potential is a concept rooted in clinical reasoning and emerges from clinicians’ prediction of how a patient might improve with rehabilitation interventions.

• Rehabilitation potential is not a dichotomous concept but a multi-level concept with each level falling along a continuum.

• It may be inaccurate/inappropriate to definitively state that a patient has or does not have rehabilitation potential, as patients may demonstrate varying levels of rehabilitation potential.

• Rehabilitation potential can change with time requiring re-assessment to readjust recommendations accordingly with regards to appropriate rehabilitation interventions at any given time.

Keywords:

• Brain injuries
• stroke
• clinical decision-making
• referral and consultation
• health services accessibility

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

This work is part of Priscilla Lam Wai Shun‘s doctoral studies for which she has received scholarships from the “Fonds de Recherche Santé Québec” (#31896), the Canadian Occupational Therapy Foundation, the “Ordre des ergothérapeutes du Québec’’, the Centre for interdisciplinary research in rehabilitation of Greater Montreal, the Faculty of Graduate and Postdoctoral studies at “Université de Montréal” and the School of Rehabilitation at “Université de Montréal”.