Unmet needs in long-term outpatient rehabilitative care: a qualitative and multi-perspective study in Japan

Abstract

Purpose

This study explores the experiences and unmet needs related to post-discharge long-term rehabilitation from triadic perspective of male patients with stroke, caregivers, and rehabilitation professionals.

Methods

This is an exploratory qualitative study using in-depth interviews conducted in two outpatient rehabilitation facilities in Japan. Nine male patients with stroke, ten caregivers, and five rehabilitation professionals participated in this study. The data were coded, followed by thematic analysis.

Results

Patients who did not achieve further physical recovery regardless of their efforts experienced a loss of motivation and lost sight of their goals. Moreover, caregivers regarded such patients as lazy and reported feeling frustrated with them. Furthermore, patients and caregivers had unmet needs regarding communication with professionals and psychological and emotional care. In contrast, professionals perceived time constraints on outpatient rehabilitation service provision and sometimes narrowed the scope of the care approach to physical function aspects for providing services efficiently. They also expressed difficulties in identifying patients’ needs, values, and meaningful goals.

Conclusions

These findings suggest that in Japanese post-stroke outpatient rehabilitation, there is a need to adopt a comprehensive care approach, enhance the quality of communication, and involve caregivers in the rehabilitation process in limited-resource situations.

IMPLICATIONS FOR REHABILITATION

• In long-term outpatient rehabilitation services in the community, stroke patients and their caregivers often face a physical recovery plateau.

• A comprehensive approach such as enhancing the quality of communication and providing psychological and emotional care —other than physical rehabilitation— is needed, particularly once the patient physical recovery stagnates.

• Involving caregivers in the rehabilitation process may be helpful for rehabilitation professionals to understand a potential problem that the patient cannot express but the caregiver can.

• It can be crucial to develop strategies that enable the rehabilitation professionals to provide a comprehensive care approach and prevent too much reliance on physical rehabilitation under the time-constraint situation in outpatient rehabilitation services.

Keywords:

• Qualitative research
• Japan
• outpatient rehabilitation
• post-stroke rehabilitation
• patient-family-centred care
• unmet needs

Acknowledgments

The authors thank all study participants. The authors are very grateful to Dr. Masayuki Kaji, Director General for Public Health Centre, Shizuoka city, for his valuable contributions to data collection in this study. Additionally, the authors thank Miki Takashi, OTR, for their special contribution to data analysis and interpretation of data. The authors also thank Editage (www.editage.com) for English language editing and translating.

Author contributions

NT is the principal author of this manuscript in all phases from the conception to the submission, data collection, data analysis and manuscript writing. NT, PMM, TT, SPS, MOK, and MK conceived and designed the study. NT conducted data analysis and interpretation of data with support from MK, PMM, TT, SPS, MOK, MK, TN. All authors revised and approved the final manuscript.

Disclosure statement

All authors declare that they do not have conflict of interest.

Data availability statement

No individual participant data will be shared as participants and the facilities that cooperated in this study did not provide approval for this.

Additional information

Funding

The study was supported by research funding of Graduate School of Medicine, School of Public Health, Department of Global Health and Socio-Epidemiology, Kyoto University, where NT previously belonged to.