Understanding Patient Engagement in Spinal Cord Injury Rehabilitation and Therapists’ Use of Communicative and Relational Strategies

PURPOSE: Patient engagement (or participation) impacts spinal cord injury (SCI) rehabilitation outcomes, and therapists’ use of communicative and relational strategies impacts patient engagement in SCI rehabilitation (Lindberg et al., 2013; Melin et al., 2018). While patients in the acute stages of SCI face barriers to engagement such as lower decision-making abilities (Scheel-Sailer et al., 2017), there has been an increasing emphasis toward collaboration between patients and therapists in the rehabilitation process (Cogan et al., 2018). Use of person-centered communicative and relational strategies may facilitate patient engagement in SCI rehabilitation (Lindberg et al., 2013; Melin et al., 2018). Further attention to therapists’ use of these strategies from the perspectives of both patients and therapists may yield insight into factors affecting rehabilitation engagement, but currently little evidence compares and contrasts the perspectives of patients and therapists in SCI rehabilitation settings. Therefore, the purpose of this study is to compare and contrast patient and therapist perspectives on communicative and relational strategies that optimize patient engagement in SCI rehabilitation.

DESIGN: Qualitative phenomenological study

METHOD: We conducted two patient focus groups and two therapist focus groups from SCI inpatient units in a rehabilitation hospital in the Midwestern United States. Each focus group consisted of five to seven participants. Patients had varying levels and completeness of injury. Therapists were occupational and physical therapists with varying levels of experience working in inpatient SCI rehabilitation. The research team utilized a focus group guide, recorded sessions, and engaged in a thematic analysis to identify factors impacting patient engagement in SCI rehabilitation.

RESULTS: Patients and therapists described six common aspects of therapists’ communicative and relational strategies impacting patient engagement in SCI rehabilitation: (1) person-centered goal-setting, (2) making therapy meaningful, (3) rapport building, (4) explaining the therapy process, (5) managing refusals to engage in therapy, and (6) managing clinical complexity. Patients identified unique factors, including the importance of therapists’ optimism and persistence, quality of the therapist and facility, the therapist’s ability to instill hope, and the therapist’s acknowledgment of the patient’s social and emotional needs. Therapists identified additional factors including the therapist’s ability to share information with other staff and effective patient education.

CONCLUSION: Both groups identified the essential role of therapists’ effective use of communicative and relational strategies to optimize patient engagement. Patients identified additional strategies and skills, such as the therapist’s ability to instill hope and acknowledgement of their emotional needs, that directly impact their engagement in therapy sessions. Therapists identified staff communication and patient education within sessions as impacting patient engagement. Future research may further investigate the development and testing of behavioral interventions that train therapists in effective strategies to promote patient-therapist interaction for successful engagement in rehabilitation.

IMPACT STATEMENT: This study identifies numerous communicative and relational strategies that optimize patient engagement in SCI rehabilitation. Therapists may reflect on their utilization of these strategies in their own practices to improve rehabilitation outcomes.

References

Cogan, A. M., & Carlson, M. (2018). Deciphering participation: An interpretive synthesis of its meaning and application in rehabilitation. Disability and Rehabilitation, 40(22), 2692–2703. https://doi.org/10.1080/09638288.2017.1342282

Lindberg, J., Kreuter, M., Taft, C., & Person, L.-O. (2013). Patient participation in care and rehabilitation from the perspective of patients with spinal cord injury. Spinal Cord, 51(11), 834–837. https://doi.org/10.1038/sc.2013.97

Melin, J., Persson, L.-O., Taft, C., & Kreuter, M. (2018). Patient participation from the perspective of staff members working in spinal cord injury rehabilitation. Spinal Cord, 56(6), 614–620. https://doi.org/10.1038/s41393-018-0061-7

Scheel-Sailer, A., Post, M. W., Michel, F., Weidmann-Hügle, T., & Baumann Hölzle, R. (2017). Patients’ views on their decision making during inpatient rehabilitation after newly acquired spinal cord injury—A qualitative interview-based study. Health Expectations, 20(5), 1133–1142. https://doi.org/10.1111/hex.12559