Client-centred ADL intervention after stroke: Occupational therapists’ experiences

Abstract

Background This study was conducted in the context of a randomized controlled trial evaluating the effect of a client-centred activities in daily living intervention (CADL). The aim of the CADL was to enable agency in daily activities and participation in everyday life among persons with stroke. Objective This qualitative, longitudinal study aimed to describe how occupational therapists (OTs) applied the CADL in their clinical practice by studying their experiences and reflections concerning their interaction with the clients with stroke. Methods Six OTs who conducted the CADL were followed through interviews and observations on four separate occasions over one year. Data were analysed using a grounded theory approach. Results Sharing was the core category showing how the OTs helped their clients to achieve agency in daily activities. Through sharing the situation the OTs strove to obtain an empathetic understanding of the clients’ lived experience throughout the whole intervention process in order to enable the clients’ ownership of their daily activities. Conclusion The continuity of sharing seems to be the key for a gradual increase in agency. The approach of sharing should preferably be applied by all members of the interprofessional team, including the client and significant others.

KEYWORDS:

• Clinical reasoning
• goal-setting
• person-centred care
• qualitative method
• shared decisions
• stroke rehabilitation
• therapeutic strategies

Acknowledgements

The authors thank the six participating OTs who generously shared their experiences and reflections. Financial support was provided by the Doctoral School in Health Care Sciences at Karolinska Institutet, the Swedish Research Council (VR), and grants were provided by the Stockholm County Council (ALF project), Strategic Research Area in Health Care Science, and the Swedish Stroke Association.

Disclosure statement

The authors alone are responsible for the content and writing of the paper.