Client’s role and participation in stroke physiotherapy encounters: an observational study

Abstract

Client participation is a basic principle in rehabilitation encounters. Coping at home after stroke requires self-confidence and autonomy, which can be enhanced by active collaboration and knowledge sharing. Earlier studies show, however, that clients are not always offered the role of an active participant in physiotherapy practice. A contradiction remains between official rhetoric and clinical practice. The purpose of this study was to investigate the interaction between the client and the physiotherapist in stroke rehabilitation sessions. Eight video-recorded treatment sessions were observed after an educational intervention that focused on client participation. Discourse analysis was used to examine the client’s involvement in the sessions. Four discourses were identified: taking on expert talk, inviting the client to participate in self-guided planning, neglecting emotional talk and supporting reflection. The client’s active participation manifested as responding to instructions, making plans, solving problems, expressing feelings, and evaluating personal performance and progress. The physiotherapists preferred the hands-off approach and invited the client to take an active role. However, they found it difficult to deal with the client’s expressions of fear and uncertainty. More attention should be paid to the client’s emotional expressions to enhance the client’s self-efficacy and self-management skills after stroke.

Keywords:

• Communication
• discourse analysis
• interaction
• self-efficacy
• stroke rehabilitation

Acknowledgements

The authors wish to thank the clients and the physiotherapists who participated in this study.

Disclosure statement

The authors report no conflict of interest.

Funding information

The study was funded by the Social Insurance Institution of Finland (KELA) as well as the Finnish Cultural Foundation (South Savo Regional Fund), Finnish Concordia Fund, and Mikkeli University of Applied Sciences.