Transitioning from hospitals to the community: perspectives of rehabilitation patients with neurological disorders and their service providers

Abstract

Purpose: To identify the contextual factors that influence community participation in rehabilitation outpatients from the perspectives of patients and their service providers.

Method: Five focus groups with rehabilitation outpatients (n = 22) and three focus groups with occupational and physical therapists (n = 17) were conducted. Two independent coders thematically analyzed the transcribed data.

Results: Patients and their providers identified three common personal factors (personal interests, personal values, and finances) and four major categories of environmental factors (products and technology; support and relationships; attitudes; and services, systems, and policies) that have great influence on patients’ participation in the community. Additionally, some patients perceived the impacts of fear of falling and climate on their participation, whereas some service providers reported that age, adaptability, and successful experiences could determine the patients’ participation in the community.

Conclusions: This study synthesized and contrasted perspectives from both rehabilitation outpatients and their service providers to identify the contextual factors that enable or restrict patients from participating in the community. Both patients and service providers identified numerous personal and environmental factors associated with participation, thus highlighting areas that can be addressed in rehabilitation outpatient programs and considered in policy development.

Implications for Rehabilitation

• Community participation is an outcome of dynamic interactions among multiple factors and is highly environmentally and culturally sensitive.

• Both personal and environmental factors have substantial impacts on rehabilitation patients’ participation outcomes.

• Rehabilitation practitioners and policy-makers need to incorporate perspectives from both patients and providers when developing interventions targeting to improve patients’ community participation.

Keywords:

• Community participation
• outpatients
• central nervous system diseases
• qualitative research
• rehabilitation

Acknowledgements

We thank all the participating therapists and patients and the collaborating hospitals: Taipei Medical University Hospital, Wan Fang Hospital, Shuang Ho Hospital, and Buddhist Tzu Chi General Hospital. We would particularly like to acknowledge Jui-chi Lin, OT (Shuang Ho Hospital), Ting-Fang Chang, PT (Wan Fang Hospital), Hsien-Lin Cheng, OT (Taipei Medical University Hospital), and Chi-Tzu Feng, OT (Buddhist Tzu Chi General Hospital) for providing great support for subject recruitment. Project team members included Yi-Cian Lai, BS and Yi-An Lien, BS (Taipei Medical University).

Disclosure statement

The authors declare no conflicts of interest. The funding sources had no influence on the study design or findings.