Current practice of outpatient rehabilitation services in patients with mobility-impaired paralysis due to stroke or spinal cord injury: a qualitative interview study in Germany

Abstract

Purpose

When mobility deficits persist after stroke or spinal cord injury (SCI), outpatient neurorehabilitation services are required. This study aimed to explore the current practice of German outpatient neurorehabilitation services and identify factors associated to this practice.

Methods

This was a qualitative observational study in which semi-structured interviews were conducted with professionals from outpatient neurorehabilitation services and mobility-impaired patients. A qualitative content analysis with a data-driven coding process was used.

Results

Three general practitioners, five physical, five occupational, and one speech therapist, one neuropsychologist, two outpatient nurses, one rehabilitation technician, one social worker, two patient advocates (long-term survivors, each stroke and SCI), and 20 patients (10 after stroke, 10 after SCI, all first-ever affected since approximately one year) participated. The reported experiences ranged from high satisfaction to perceived deficits in participation-oriented, evidence-based, and coordinated care. Identified associated factors were: (a) availability of specialised therapists and professional education, (b) outpatient service catalogue, (c) cost coverage, (d) setting rehabilitation goals, and (e) physician as care coordinator.

Conclusion

Areas of improvement identified focused on: setting rehabilitation goals towards participation, training therapists on evidence-based treatments and shared decision-making, updating the outpatient service catalogue, and implementing coordination actions. Implementation of these recommendations should be evaluated.

IMPLICATIONS FOR REHABILITATION

• Professionals need to be trained in setting rehabilitation goals and treatments. The continuing education should be based on current evidence and address interprofessionalism. Academization and continuing education in scientific work for therapists should be advanced.

• Professionals should educate patients about rehabilitation goals and set rehabilitation goals together, both interprofessional coordinated and with the patient (shared decision-making). Activity and participation should be the central aspects. Rehabilitation clinicians should give instructions to therapists on what to do if rehabilitation goals are not worked on.

• Rehabilitation clinicians should encourage interprofessional collaboration and information exchange where this is not the case. The exchange of information between outpatient professionals should be promoted through appropriate measures, that is, interprofessional meetings could be introduced.

• The outpatient service catalogue should be revised regarding evidence-based and participation-oriented treatments and enable appropriate cost coverage.

Keywords:

• Outpatient rehabilitation
• physiotherapy
• paralysis
• stroke
• spinal cord injury
• qualitative interviews

Acknowledgements

We would like to thank all participants who took part in the interviews. Special thanks go to the patients who, despite sometimes difficult life circumstances, found the courage to report on their impaired life. We are also extremely grateful for the valuable practical experiences of the therapists, physicians, and rehabilitation technicians and their suggestions for improving patient care in the future. Further thanks go to our colleagues at the Research Institute who transcribed the extensive audio data.

Author contributions

This study was part of the larger NeuroMoves study led and coordinated by NW, RR, and TS. TD and MW were responsible for designing the sub-study on current care practices and care coordination, CU advised conceptualising the qualitative study and supported the data analysis. TD, CU, and MW created the interview guide. TD recruited the participants and conducted the data collection, the data analysis, and wrote the first draft of the manuscript. The authors TD, CU, and MW interpreted the results and participated in the revision of the manuscript. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data collected and analysed as part of this study is not publicly available and will not be made available upon request. This is due to our promise to the participants to share the data only in the form of aggregated manuscript data to reach participant privacy.

Additional information

Funding

This work was funded by the fund “Innovations fond” of the Federal Joint Committee (G-BA) and the Deutsche Forschungsgemeinschaft (DFG) under funding number [01VSF18032]. The funding organisation had no influence in the design of the study, the collection, analysis, and interpretation of the data, and in the writing of the associated manuscripts.