Rollen im Kontext: Interaktion während Physiotherapie in der Schlaganfallrehabilitation

Zusammenfassung

Hintergrund: Die Schlaganfallrehabilitation ist ein komplexer Vorgang. Bei der Physiotherapie wurden die Perspektiven der beteiligten Parteien bisher wenig beachtet.

Ziel: Das Ziel der Studie bestand darin, qualitative Studien zu Physiotherapie bei Schlaganfallrehabilitation mit besonderer Berücksichtigung der Interaktion zu untersuchen.

Methode: Anhand einer Schlüsselwörtersuche in 8 Datenbanken wurden 4 Studien gefunden. Weitere 14 Studien ergaben sich mittels Handsuche.

Ergebnisse:Übliche Themen der qualitativen Forschung zu Physiotherapie in der Schlaganfallrehabilitation waren: Rollen einschließlich Verhalten und Einstellungen, Kontext, Kommunikation einschließlich Interaktion, Informationsaustausch und Anweisungen sowie Zielsetzung. Wenn Patienten und Physiotherapeuten die Rehabilitation beschreiben, ist vordergründig Übereinstimmung zu erkennen. Geht es jedoch um Aspekte der Gewährleistung der Behandlungsqualität, besteht wenig Einheitlichkeit. Interaktionsmuster waren hauptsächlich durch hierarchische Strukturen gekennzeichnet. Es zeigte sich aber, dass sich diese Interaktionsmuster durch Kontextfaktoren, Einstellungen und Handlungen ändern ließen. Des Weiteren wurde eine Diskrepanz zwischen den Einstellungen von Physiotherapeuten und ihrer klinischen Praxis festgestellt. Die Auswirkungen auf die Arbeit der Physiotherapeuten werden aufgezeigt.

Schlussfolgerungen:Angesichts eines derart komplexen Phänomens wie Schlaganfall muss der gegenwärtige Ablauf von Physiotherapie zur Schlaganfallrehabilitation überdacht und weiter erforscht werden. Themen wie Rollen, Kontext, Kommunikation und Zielsetzung in der Physiotherapie sollten Gegenstand von Ausbildung und beruflicher Weiterbildung werden, um die Behandlungsqualität für Patienten mit Schlaganfall zu verbessern.

Abstract

Background: Stroke rehabilitation is a complex process and with regard to physiotherapy, little attention has been paid to the perspectives of the parties involved.

Objective: The aim of the study was to review qualitative studies of physiotherapy in stroke rehabilitation with special regard to interaction.

Method: 4 studies were identified by means of a search in 8 databases using key words. 14 additional 14 studies were identified by hand search.

Results: Topics common in qualitative research on physiotherapy in stroke rehabilitation were roles including behaviour and attitudes, context, communication including interaction, information exchange and instructions as well as goal setting. When patients and physiotherapists describe rehabilitation, there is superficial agreement but little consistency in aspects assuring treatment quality. Patterns of interaction were mainly characterized by hierarchy. However, the patterns of interaction were shown to be alterable by means of context factors, attitudes and actions. Another finding was a discrepancy between the physiotherapists’ attitudes and their clinical practice. The implications for the physiotherapists’ work are outlined.

Conclusion: In the light of a complex phenomenon such as stroke, the current process of physiotherapy in stroke rehabilitation requires reconsideration and future research. Education and professional development need to attend to issues like roles, context, communication and goal setting in physiotherapy in order to improve treatment quality for stroke patients.

Schlüsselwörter

Schlaganfallrehabilitation - qualitative Forschung - Physiotherapie - Interaktion - Kontext

Key words

stroke rehablitation - qualitative research - physiotherapy - interaction - context

Literatur

• 1 Barth C, Pott C. Untersuchung der Bewegungsentwicklung und Bewegungskontrolle: von der Hypothese zur Zielformulierung. Hüter-Becker A Das Neue Denkmodell in der Physiotherapie. Bd.2: Bewegungsentwicklung und Bewegungskontrolle Stuttgart; Thieme 2005
• 2 Bendz M. Rules of relevance after stroke.  Social Science & Medicine. 2000;  51 713-723
• 3 Bendz M. The first year of rehabilitation after a stroke - from two perspectives.  Scandinavian Journal of Caring Sciences. 2003;  17 215-222
• 4 Carpenter C, Hammell K. Evaluating qualitative research. Hammell KW, Carpenter C, Dyck I Using qualitative research - a practical introduction for occupational and physical therapists Edinburgh; Churchill Livingstone 2000
• 5 Carr J, Shepherd R. Stroke rehabilitation. Guidelines for exercise and training to optimize motor skill. Oxford; Butterworth-Heinemann 2003
• 6 Dowswell G, Lawler J, Dowswell T. et al . Investigating recovery from stroke: a qualitative study.  Journal of Clinical Nursing. 2000;  9 507-515
• 7 Dowswell G, Dowswell T, Lawler J. et al . Patients’ and caregivers’ expectations and experiences of a physiotherapy intervention 1 year following stroke: A qualitative study.  Journal of Evaluation in Clinical Practice. 2002;  8 361-365
• 8 Fasoli S E, Trombly C A, Tickle-Degnen L. et al . Effect of instructions on functional reach in persons with and without cerebrovascular accident.  The American Journal of Occupational Therapy. 2002;  56 380-390
• 9 Freeman J A. Assessment, outcome measurement and goal setting in physiotherapy practice. Edwards S Neurological physiotherapy Edinburgh; Churchill Livingstone 2002 2nd ed
• 10 Von Koch L, Wottrich A W, Holmqvist L W. Rehabilitation in the home versus the hospital: the importance of context.  Disability and Rehabilitation. 1998;  20 367-372
• 11 Von Koch L, Widén Holmquist L, Wohlin Wottrich A. et al . Rehabilitation at home after stroke: a descriptive study of an individualised intervention.  Clinical Rehabilitation. 2000;  14 574-583
• 12 Lewinter M, Mikkelsen S. Patients’ experience of rehabilitation after stroke.  Disability and Rehabilitation. 1995;  17 3-9
• 13 Lewinter M, Mikkelsen S. Therapists and the rehabilitation process after stroke.  Disability and Rehabilitation. 1995;  17 211-216
• 14 Parry M H. Communication during goal-setting in physiotherapy treatment sessions.  Clinical Rehabilitation. 2004;  18 668-682
• 15 Pound P, Bury M, Gompertz P. et al . Views of survivors of stroke on benefits of physiotherapy.  Quality in Health Care. 1994;  3 69-74
• 16 Pound P, Gompertz P, Ebrahim S. Social and practical strategies described by people living at home with stroke.  Health & Social Care in the Community. 1999;  7 120-128
• 17 Proot I M, Crebolder H F, Abu-Saad H H. et al . Stroke patients’ needs and experiences regarding autonomy at discharge from nursing home.  Patient Education and Counselling. 2000;  41 275-283
• 18 Röding J, Lindström B, Malm J. et al . Frustrated and invisible - younger stroke patients’ experiences of the rehabilitation process.  Disability and Rehabilitation. 2003;  25 867-874
• 19 Sabari J S, Meisler J, Silver E. Reflections upon rehabilitation by members of a community based stroke club.  Disability and Rehabilitation. 2000;  22 330-336
• 20 Schiepek G. Die Gestaltung der Therapeut-Klient-Beziehung. Schiepek G Die Grundlagen der Systemischen Therapie. Theorie, Praxis, Forschung Göttingen; Vanden Hoeck & Ruprecht 1999
• 21 Stokes M. Physical Management in Neurological Rehabilitation. London; Mosby 2004 2nd ed
• 22 Talvitie U, Reunanen M. Interaction between physiotherapists and patients in stroke treatment.  Physiotherapy. 2002;  88 77-88
• 23 Van Veenendaal H, Grinspun D R, Adriaanse H P. Educational needs of stroke survivors and their family members, as perceived by themselves and by health professionals.  Patient Education and Counselling. 1996;  28 265-276
• 24 Wiles R, Ashburn A, Payne S. et al . Discharge from physiotherapy following stroke: The management of disappointment.  Social Science & Medicine. 2004;  59 1263-1273
• 25 Wiles R, Ashburn A, Payne S. et al . Patients’ expectations of recovery following stroke: a qualitative study.  Disability and Rehabilitation. 2002;  24 841-850
• 26 Wohlin Wottrich A, Stenstrom C, Engardt M. et al . Characteristics of physiotherapy sessions from the patient’s and therapist’s perspective.  Disability and Rehabilitation. 2004;  26 1198-1205
• 27 World Health Organisation (WHO) .Disability and Rehabilitation: Future Trends and Challenges in Rehabilitation. 2003. 10.5.2005 www.who.int/ncd/disability/trends.htm
• 28 World Health Organisation (WHO) .International Classification of Functioning, Disability and Health (ICF). 2001. 10.5.2005 www3.who.int/icf/icftemplate.cfm
• 29 World Health Organisation (WHO) .International Classification of Impairments, Disabilities and Handicaps (ICIDH). Manual of classification relating to the consequences of disease. Geneva; WHO 1980
• 30 Wressle E, Oberg B, Henriksson C. The rehabilitation process for the geriatric stroke patient - An exploratory study of goal setting and interventions.  Disability and Rehabilitation. 1999;  21 80-87
• 31 Wulf G, Weigelt C. Instructions about physical principles in learning a complex motor skill: to tell or not to tell.  Research Quarterly for Exercise and Sport. 1997;  68 362-367
• 32 Wulf G, Höß M, Prinz W. Instructions for motor learning: Differential effects of internal versus external focus of attention.  Journal of Motor Behaviour. 1998;  30 169-179
• 33 Wulf G, Prinz W. Directing attention to movement effects enhances learning: a review.  Psychonomic Bulletin & Review. 2001;  8 648-660
• 34 Wulf D. Physiotherapeutische Untersuchung, Behandlungsprinzipien und Planung. Hüter-Becker A, Dölken M Physiotherapie in der Neurologie Stuttgart; Thieme 2000