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Research Reports |
A Wohlin Wottrich, PT, Med Lic, is University Lecturer, Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 23100, SE-141 83 Huddinge, Sweden
L von Koch, PT, PhD, is Associate Professor, Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet
K Tham, OT, PhD, is Associate Professor, Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet
Address all correspondence to Ms Wohlin Wottrich at: Annica.Wohlin.Wottrich{at}ki.se
Submitted June 3, 2006;
Accepted January 30, 2007
 | Abstract |
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Subjects: Thirteen members of a multiprofessional outreach team (physical therapists, occupational therapists, speech and language therapists, and a social worker) working at a geriatric hospital in Stockholm, Sweden, participated in the study.
Methods: A qualitative method (the Empirical Phenomenological Psychological method) was used, with data being obtained from retrospective interviews of the team members after completing home-based rehabilitation of patients after acute stroke.
Results: One main theme ("supporting continuity") and 4 subthemes ("making a journey together from hospital to home," "enabling experiences of functioning," "refraining from interventions—encouraging patient problem-solving skills," and "looking for a new phase—uncertain endings") were revealed.
Discussion and Conclusion: The findings suggest that contextual factors, both environmental and personal, were considered to be of great importance by the members of the multiprofessional team and were accounted for when they were working in the home environment in the rehabilitation of patients after stroke. Contextual factors detected in the home environment gave valuable information to the team members, who used the information in their strategies to assist the patients in finding continuity in their daily life and to link the past to the present and the "new body" to the "old body."
| Introduction |
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In recent years, it has become increasingly apparent that contextual factors contribute to the health of individuals. In 2001, the World Health Organization (WHO) launched the International Classification of Functioning, Disability and Health (ICF), which incorporates both a medical and a social perspective of health.2 The ICF model, depicted in the Figure, includes body function, body structure, activities, participation, and contextual factors. Contextual factors represent the complete background of an individual's life and living and consists of 2 components: environmental factors and personal factors. Environmental factors make up the physical, social, and attitudinal environment. These factors are external to the individual and can have a positive or negative influence on the individual's performance in society, on performance of tasks and activities, or on body function and structure.
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Stroke rehabilitation is a complex process involving teamwork by members of several professions. During the course of rehabilitation, patients spend time with their therapists, and their interaction is likely to affect the rehabilitation process. However, how their interaction influences the rehabilitation process is little understood.3–5 Furthermore, previous research indicates that contextual factors (both environmental and personal factors) are poorly accounted for in rehabilitation after stroke.4, 6
Approximately 80% of patients with stroke in Sweden are older than 65 years, and the mean age is 76 years.7 Rehabilitation for older people has acquired an increased amount of interest from both policy makers and service providers within health and social care agencies, and the growing demand for rehabilitation has generated an interest in the use of alternative care environments, such as the home. A review of studies comparing rehabilitation conducted in different environments concluded that therapy-based rehabilitation services for patients with stroke living at home improved their ability to perform personal activities of daily living and reduced the risk of deterioration of their abilities.8
Multiprofessional teams working with patients receiving home rehabilitation after stroke have been reported to work transprofessionally, and there are many similarities in the ways in which the therapists work.9 Evidence suggests that home rehabilitation is more effective when delivered by a multidisciplinary team10 and that rehabilitation in the home can offer therapists opportunities to adopt a mode of behavior that enables patients to assume responsibility for and have an influence on their rehabilitation process.10–12 It has been suggested that patients' opportunities to express their own goals are greater in their home environment.9
Home rehabilitation programs vary in terms of their organization, content, length, and the frequency of visits.9,13,14 Intervention programs for home-based rehabilitation have not yet been fully described,15 and rehabilitation team members' experiences and tacit understanding of working with patients after stroke in the home environment need to be further understood. There also is a need to understand how to support and use potentials for rehabilitation that are hidden in the patients' own environment.16 One way to study this is to examine the therapists' clinical reasoning17 as expressed in their therapeutic stories. Clinical reasoning is based on knowledge gained from tacit understanding and through experiences. It involves more than the application of theory, because complex clinical tasks, like rehabilitation after stroke in the home environment, require an approach governed by the particular patient's needs and context.18
The present study was part of a project funded by the Stockholm county council, where stroke rehabilitation in the patients' home environment has been studied from the perspective of the patients, the relatives, and the therapists. All studies in this project were conducted at a geriatric hospital to which one of the authors was associated. The aim of this study was to identify the meaning of rehabilitation in the home environment after stroke from the perspective of members of a multiprofessional team.
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Participants
Interviews were conducted with 13 team members (5 physical therapists, 5 occupational therapists, 2 speech and language therapists, and 1 social worker), all working at a geriatric hospital in Stockholm, Sweden, in outreach teams on stroke rehabilitation in the patients' home. Each team member, who worked with patients who were selected for the study, was asked to participate. The 13 team members based their interview responses on their experiences in treating 9 patients who were selected to ensure variation in age (range=63–86 years), sex (6 women, 3 men), side of lesion (6 left, 3 right), and living conditions (4 living alone, 5 living with a spouse). The patients were included in the home rehabilitation program after approximately 1 month in the hospital. The program entailed between 3 and 6 visits per week by team members according to the patients' needs. The mean duration of rehabilitation at home was 29 days (range=16–68), the mean number of home visits was 18.6 (range=4–54), and the mean time per home visit was 57 minutes.
The rehabilitation team members worked in a flexible way; that is, the professions involved could vary according to the needs of the patients. Descriptions of the team members are presented in the Table. Five of the team members were men, and 8 were women. All team members allocated to each of the 9 patients were interviewed. A separate interview was conducted with each team member for each patient; consequently, some of the team members were interviewed more than once because they collaborated with more than one of the patients.
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Data Analysis
The interviews were analyzed according to the EPP method. This method aims at describing the essence, structure, and character of a phenomenon (ie, rehabilitation in the home environment after stroke in this study) based on the participants' life-world experiences. In order to discover essential descriptions during the analysis, we disregarded, or bracketed, any theory outside phenomenology that explains or accounts for the phenomenon under study. Bracketing refers to the researchers trying to set aside, or hold in abeyance, their presuppositions and previous knowledge based on scientific ideas and theories about the phenomenon under study.20 Thus, we approached the interviews openly and unconditionally let the phenomenon present itself in the team members' described life-world experiences. We examined and analyzed each participant's concrete description (ie, the therapeutic story) of his or her experiences of rehabilitation in the patient's home for a particular patient after stroke.
The analysis was performed in 5 steps. Steps 1 through 4 were performed separately for each interview. In the first step of the analysis, we read the transcribed interview from one of the participants to obtain a general understanding of the concrete facts, events, and actual feelings pertaining to the participating team members' original experiences of conducting rehabilitation in the patients' home. Based on our understanding of the whole transcribed interview, we needed to divide the text into smaller units to analyze the meaning embedded in the text.
During the second step, the first author thus divided the participant's transcribed interview into smaller units called "meaning units." A new meaning unit was discriminated each time there was a shift in meaning in the text. The process of identifying meaning units helped the researcher to focus on the meaning structure of the phenomenon.
In the third step, we interpreted each meaning unit in light of the whole interview and the phenomenon under study. The meaning hidden in the facts was the focus of this interpretation (referred to as the "transformed meaning"). We traced out and interpreted the meaning of rehabilitation in the home environment as expressed by the participants.
The first author performed the fourth step, which entailed synthesizing the transformed meaning units into a "situated structure of meaning," which was presented in a summary of each transcribed interview. The author arranged features of the phenomenon in a phenomenologically significant way by identifying and interpreting the meaning of different aspects of rehabilitation in the home environment. In the final step, we analyzed the summaries linked to each patient to move from the "situated structure of meaning" to a "general structure of meaning" that ran across participants in order to identify the participants' shared experiences of rehabilitation after stroke in the home environment.19
Thereafter, the analysis was based on data from all team members working with a particular patient, which generated a meaning structure consisting of 1 main theme and 4 subthemes describing the meaning of stroke rehabilitation in the patient's home. The themes were general for the therapist-described experiences of the rehabilitation. Throughout the analysis, we went back to the original interview data to validate interpretations until the one that was considered to be most valid was chosen to represent what was described to be the meaning of rehabilitation in the patient's home from the perspective of the team members.19 A peer review was conducted in which the findings were read and commented on by a group of 8 experienced researchers and clinicians. The aim of the peer review was to ensure the trustworthiness of the findings (ie, that the descriptions of the themes made sense and were recognized as plausible interpretations).19 Some minor changes then were made to improve and clarify the description of the themes.
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The main theme (supporting continuity) is presented first, and then the 4 subthemes on which it was built are described separately, with concrete examples and quotations being provided to exemplify and verify the meaning structure of the studied phenomenon: rehabilitation in the patients' home environment after stroke from the team members' perspective. The themes and subthemes are presented in the order they appeared in the therapeutic stories recounted by the therapists. This order was not linear, and the themes overlapped in the rehabilitation process described.
Supporting Continuity
In the interviews, the participants described a number of different strategies as ways of assisting the patients to find continuity in their daily lives. The strategies were described as meeting the same team members in the hospital and at home, finding associations or links to former activities, assisting the patients in recognizing themselves in self-perceived former roles, and asking the patients to tell their life story.
In their therapeutic stories, the participants described how all patients wanted to return home and how they appreciated the offer of taking part in a home rehabilitation program. For one of the patients, coming home was described to be the most natural thing in her new life situation. The team members initiated collaboration with the patients while they were still in the hospital and informed them that this collaboration would continue in the patients' home. Thus, the patients met the same team members in their home as they had met in the hospital. This way of working in an outreach team was interpreted as a way to support continuity.
Working with the patients in their home environment helped the team members to see how continuity could be regained. Taking part in the patients' home life gave them unique opportunities to find associations or links to former (prestroke) activities. The team members enabled the patients to reestablish these previous activities and to find substitutions in meaningful alternatives with which they could connect. High priorities of the team members were confirming and strengthening the patients' feelings of pleasure and assisting the patients to recognize themselves in their self-perceived former social roles, whether as grandparents, housewives, or family members taking part in family life.
The team members actively sought out key activities that were unique to each patient (eg, shopping in favorite deli store) that could ripple outward to widen the spectrum of activities. The team members commented on how they were impressed by the patients' creativity and how they found the constant renewal of the patients' activities surprising, both as recounted by the patients and as observed by the team members when working in the patients' home environment. This opened up new arenas in which to work, resulted in new problems to be solved, and made the existence of new gaps between desired and attainable goals, as expressed by the individual patients, evident. The team members supported the patients' prestroke experiences by inviting the patients to try their own solutions during the home rehabilitation sessions and between these sessions. One example was when one patient with aphasia unexpectedly paid a visit to the hairdresser. The activity—to walk to the hairdresser and ask for a haircut—had not been suggested or trained by the speech and language therapist, the occupational therapist, or the physical therapist. The team members expressed that the patients' growing trust in themselves created positive expectations, gave a feeling of continuity, and made it easier to see a "possible future" for them in their familiar contexts.
A strategy used to assist the patients to recapture earlier aspects of their life that were of importance to them was to ask them to tell their life story. The life stories often opened up discussions on activities that the patient found important. They also acted as a counseling dialogue. These dialogues were often initiated by discussions of practical matters, such as whether domestic help or assisted transport services were required; however, the existence of such dialogues created an opportunity for the patient and the team member to have a heart-to-heart talk, sharing experiences and thereby contributing to the team members' understanding of how best to support continuity.
The main theme—supporting continuity—was built on 4 subthemes: (1) making a journey together from hospital to home, (2) enabling experiences of functioning, (3) refraining from intervention—encouraging patient problem-solving skills, and (4) looking for a new phase—uncertain endings.
Making a journey together from hospital to home.
At discharge, the team members described how their actions were intended to bridge the gap between the hospital and the home, which was interpreted as a way to minimize disruption to the rehabilitation process and support continuity for the patient. The process of returning home involved collaborative planning among the patients, the relatives, and the team members to ensure that the transfer was smooth. In order to be one step ahead and to avoid unforeseen events, the team members had planned this first encounter with the well-known environment beforehand and made a home visit to make sure that the patient's return would be successful. One team member commented:
At home I watched her doing things like watering the flowers and could see that she compensated well for her visual problem and had no big problems with walking around in the apartment.
To enable the patient to have an initial positive experience was described as a way for the patient to have greater confidence in his or her ability and in the home rehabilitation program. The team members also were concerned about reducing feelings of anxiety and insecurity. At the time that the patient was discharged from the hospital, one of the team members accompanied the patient home; they made the journey together. One of the team members described the experience as follows:
Team member: When she returned home I went with her.Researcher: How was it?
Team member: It was quite a short visit because she felt, "Here I am, I'm home." Her husband met her just to check that she could get inside. It felt like everything went quite well right from the beginning
Being able to make this journey together also gave the team members an opportunity to reduce their own feelings of anxiety by observing the patients performing basic activities at home. Observing the performance of the patient in his or her own environment, even if the visit was short, reassured the team member that the patient would be safe at home. Several team members emphasized that training in transferring and walking was crucial on the first visit for safety to avoid falls and to ensure that being at home started off well.
Enabling experiences of functioning.
The team members recounted how, early on in the rehabilitation, in an attempt to enable the patient to experience how his or her body functioned when performing activities, they had sought to obtain information about the patient's previous patterns of behavior in collaboration with the patient and the relatives. We interpreted this seeking as a way of mapping out the patient's individual experiences of functioning and as a way for the team members to see how the patient's "new" (poststroke) body could be linked to the "former" (prestroke) body. The team members initiated activities that enabled and promoted habitual performance, such as activities involving the use of both hands that came more naturally when using known utensils, climbing well-known stairs, and walking familiar routes. The team members stated how, during visits to the patients' home, they could see how the patients performed movements and activities spontaneously in their familiar context. With this knowledge of the individual's movement ability, activities were chosen and initiated by the team members with the specific intention of enabling the patients to have experiences with their "new" body that had previously been taken for granted. The following situation was described by one of the team members:
She cooked twice and made coffee once just to see how it went after the injury she had received. She spent some time in the kitchen confronting her body, maybe taking it easier [than she otherwise would have done] and listening more to her body.
Suggesting activities that made the patient "confront" and "listen to his or her body" was interpreted as a way for the team member to try to assist the patient in recognizing and becoming more familiar to his or her body after stroke. In training the patients to transfer themselves or to perform self-care activities, the team members described how, in some situations, being in the patient's home environment made it easier for the patient to perform the activity than it would have been in a hospital, while in other situations, it made it more difficult. One team member remarked:
We did shower training at the ward, too, so that was pretty much the same kind of training, but the transfers were different because they had a bathtub, which was quite high. It became a different experience, even if the activity of showering was the same.
When patients were not comfortable with their ability to perform an activity the activity was repeated to give varied and detailed experience of functioning. If the patient needed extensive assistance to perform an activity all the team members involved practiced that same activity with the patient. Another way to bridge a gap in the performance was through talking about the performance with the patient and to discuss tactics such as deliberately considering how to achieve the next step in the activity, thereby putting trust in one's own body. The two bridging strategies could be combined as reported by a team member in this example:
When problems occurred during an activity, the patient was encouraged to think about the problem, not just to keep repeating the task several times.
One of the team members did not express interest in building the training on the patients' previous experiences and habits because of the lack of appropriate training equipment in the home environment. All equipment had to be brought to the patients' home, and thus this team member expressed a preference for conducting the training in the hospital.
Refraining from interventions—encouraging patient problem-solving skills.
The therapeutic stories revealed that the team members allocated time and ensured that there were opportunities to allow the patients to try different solutions by themselves to identify the best way to perform an activity. This implied that, occasionally, activities that the team members had planned were not carried out, and instead they used a "wait-and-see" strategy to discover what the patients could manage to achieve on their own. Because the team members were able to observe and assess the patients in difficult but totally relevant situations, it appeared that the home environment offered many opportunities to be creative and to encourage patient problem-solving skills. It was possible for the team member to wait with interventions or to refrain from conducting a planned intervention in order to encourage the patients to find appropriate solutions on their own and to take their own actions. This was interpreted as a way in which patients can be supported in the longer term, by enabling them to find ways to continue to solve problems after being discharged from the home rehabilitation program. The team members described that by observing and working together with the patient in his or her own home, they were supplied with a large amount of detailed and specific information from each patient's context on which they could base their decisions, not only regarding what they needed to work with together, but also what could be left for the patient to solve alone.
One of our interpretations of the descriptions of how the team members were working in the home environment was that they were encouraging the patients to improve their own performance and that the team members were intervening only when assistance or advice was absolutely necessary, as revealed by the following statement of one of the team members:
There are patients who do things that almost scare you to death, but in his case, I was never really nervous that something was going to happen to him. He was a bit careless sometimes, but not without a degree of awareness. No, I was never nervous. I just think that it was great that he was in control and was a step ahead all the time. I did not try to stop him.
The team members described how they assessed what could be gained by refraining from training patients to perform a specific activity. For example, one planned activity in the kitchen was not carried out because the team member realized that the patient and her husband had already found another solution to the problem. The team member had had a different solution in mind, but refrained from intervening to strengthen the patient's trust in herself. In this way, not only was the patient's solution respected, but also her ability to make decisions was supported to make it easier for her to continue making her own decisions. One of the team members described such a situation in this way:
Yes, there was a problem of some kind, and I felt it should really have been practiced one more time, but then I was afraid she might fail to accomplish the task, so I let it be. One stops there when the patient has done something that works.
One of the other team members was not prepared to let her patient take responsibility for her own actions and advised against the patient continuing to work in the kitchen until major home adaptations had been made. However, it took too long to carry out these changes, and the patient had lost a considerable number of her former routines and great deal of confidence by waiting. In the meantime, the spouse took over the responsibility for the cooking.
Looking for a new phase—uncertain endings.
The team members expressed both negative and positive experiences of ending the home rehabilitation program. There were several reasons for the rehabilitation program to end. Either the team member or the patient might say that he or she could end the rehabilitation because he or she felt that the goals had been achieved. The most common goals achieved that led to the team member and the patient making the decision to end the rehabilitation were that the patient was able to carry out the necessary daily routines and activities for a life at home and that the patient was able to leave the home unassisted. The team members then expressed a feeling of security provided that the patients were in agreement that the goals were achieved. This positive experience was interpreted as a suitable ending to the home rehabilitation program because therapy could cease without disrupting the patient's continuity in life.
Home rehabilitation was described as being very time consuming, but all of the team members reported that it had to take time, in regard to both the length of each session and the duration of the period over which rehabilitation took place. Negative experiences, with feelings of insecurity on behalf of both the team members and the patients, were described when the rehabilitation had to end for other reasons, such as because the time allocated was running out or because a new patient was in greater need of home rehabilitation. We interpreted this described insecurity as a the team members' concern of experiencing a threat to the patients' continuity. All of the team members mentioned that they were worried over the lack of time. Here is one example:
Something always crops up. There is still only quite a short period available for rehabilitation. Maybe it takes time to land on one's feet at home, and it's possible that you miss things the team could deal with, but there are things that turn up during the course of the journey and the rehabilitation might take a little longer than anticipated.
When goals were not achieved, the team members expressed how they looked for possibilities to continue the collaboration with the patients by offering them rehabilitation as outpatients. According to one team member, becoming an outpatient at the hospital could be seen as a part of the home rehabilitation program, provided that the transport to the hospital and back home was included in the training program. At the time that the home rehabilitation program ceased, a new phase in the process occurred. This phase was accompanied by the team members' described feelings of insecurity, which they tried to find ways to overcome. One way was that the team members took the advantage of the possibility for the patient to have follow-up sessions with another team member, because the team members were working closely together. As one team member commented:
I could have assisted him more in the training, but there was not time, and he got follow-up training with the physical therapist.
This transfer of responsibility to a colleague could be viewed as a strategy for maintaining continuity parallel with the aim of enabling the patients to gradually gain more independence in their new life situation after stroke.
| Discussion |
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TopAbstractIntroductionMaterial and MethodsResultsDiscussionConclusionReferences |
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The team members in this study consciously tried to explore the patients' contextual factors, both personal and environmental, in relation to the patients' experiences of previous functioning, and this appeared to come naturally in the patients' homes. Whether consciously or unconsciously, this is in line with the components of the ICF model. The team members collected information by observing the patients and by asking the patients to tell their life story. The patients' experiences from the past, their personal goals, and their desires for the future were included in the life story. The contextual factors detected gave valuable information to the team members, who used that information in their strategies to assist the patients in finding continuity in their daily life. The findings of the present study also are in accordance with the close linkage between the home environment and elderly people described by Rubinstein21 as a body-, person-, and social-centered process.
Continuity theory, a theory about normal aging, holds that, when aging, people attempt to preserve and maintain psychological and social characteristics and circumstances. To accomplish this, people use strategies tied to their past experiences of themselves and their social world.22 According to Becker,23 the first major marker for continuity after stroke is to be able to return home. From the findings, it was obvious that the team members considered it to be an important part of their work to make the patients feel safe and secure upon their arrival home, and we interpreted this as a way to emphasize continuity. Similar findings were presented in another qualitative, patient-centered study where returning home was viewed as an important factor for recovery and rehabilitation.16 Having control over one's environment and safety have been reported to be necessities for independent living.24 However, any discharge from the hospital also can be viewed as a disruptive event. In the present study, the team members accompanied their patients from the hospital to their home to reduce the patients' anxiety about discharge from the hospital and to minimize any negative consequences attributable to this event by bridging the gap between the hospital and the home.
Ending the home rehabilitation program was, according to the team members, also a key moment for some of the patients. The team members stated that continued collaboration with these patients would be beneficial for the patients' rehabilitation process. It has previously been revealed that patients consider themselves to be ready to finish a rehabilitation program even though their team members felt that more could have been accomplished.9 Thus, it is possible that ending a home rehabilitation program might be more of a problem for the team members, because of their feelings of uncertainty, than for the patients. According to Mattingly,17 the other side of this coin is that an uncertain ending to rehabilitation also might represent a new beginning and hope for the future.
When using strategies to encourage patient problem-solving skills, the team members used a "wait-and-see" strategy, and this might include taking a risk in leaving the patients to have their own experiences. A risk can be described as a chance for the patients to continue doing things and solving problems their way.17 The need for therapists to wait so that the patients will take a more active role has been described in a phenomenological study of strategies used in self-care training.25 In a descriptive qualitative study of a poststroke home rehabilitation program,9 it was found that working in the home environment made the therapists' roles more passive, a change that the therapists initially perceived as being as though they were not doing their job properly. Thus, taking a background role was part of a learning process that the therapists needed to undergo.9
The findings revealed that working with body function (ie, performing purposeful and meaningful activities) was central to home rehabilitation after stroke. Similar findings have been reported in other studies representing both the perspectives of the patients and of the therapists,26,27 and the findings also can be seen as examples of task-specific training of motor control.28 Furthermore, it has been suggested that everyday meaningful activities can support continuity because such activities can be related to the patient's life before their stroke.23
In the present study, the team members used the home environment to explore activities and contextual factors in order to help the patient to link past experiences to present experiences, and it has previously been reported that people who have had a stroke search for ways to link their past life with their present life and their "old body" with the "new body."6,29 To understand the experiences of the poststroke body, it appears to be imperative to gain an understanding of the experiences of the prestroke body, which, according to Kvigne and Kirkevold,30 is a difficult task. According to Merleau-Ponty,31 we have access to the world through our bodies, and he makes a distinction between the "actual body" and the "habit body." The habit body has knowledge or habits gained through experiences from interaction with the world. The habits can be used without reflection and without either preparation or having to pay attention. The actual body is a body that is "here and now" and makes it possible for a person to make adjustments to the present situation. The habit body can be compared to the body before the stroke, and the actual body can be compared to the body after the stroke. Stroke rehabilitation in the home environment could be viewed as a process where the actual body links to the habit body to regain activities.
This study used a qualitative method with a phenomenological approach to gain a deeper knowledge and to reveal unknown aspects of the phenomenon under study. The findings have made explicit the team members' tacit knowledge of home rehabilitation after stroke. In qualitative studies, the findings are usually only applicable to the particular context in which the study was performed. This does not mean, however, that the findings cannot be understood, shared, and applied beyond the study setting.32
In this study, we used the EPP method because the aim was to explore general themes of rehabilitation in the home environment. The findings were arrived at after discussions of alternative interpretations of the data throughout the analysis. Furthermore, consistency was continuously ensured between the interpretations and the data in the interview transcripts and the summaries linked to each patient and across patients. To further assert the trustworthiness of the interpretations, the themes were peer reviewed and clarified. Thus, the trustworthiness of the findings was strengthened. The EPP method19 was preferred, although the focus in this approach can be considered limited because it does not identify individual characteristics such as differences between different therapists. When using the EPP method,19 however, the variations of the phenomenon may be reflected in the subthemes and specifically in quotations and examples. For other research questions, such as differences among professions in a multiprofessional team, a different approach is needed (eg, a comparative approach).
The team members were asked to tell their therapeutic stories with as many details as possible and, in particular, to recount their experiences of the concrete actions in the patients' home. The stories, however, were being described retrospectively, which might imply that the team members expressed their reflections on their previous experience, rather than recounting their lived experience without reflection, which is preferable in phenomenological studies.19 This study was conducted specifically with the intention of conveying the team members' perspective, so the experiences reported will probably reflect and to some extent be based on their theoretical knowledge.
Thus, for studies in which interviews are performed during the rehabilitation process, prospective interviews are important research projects for the future to further expand the knowledge of the meaning of rehabilitation in different environments. A deeper knowledge of the meaning of rehabilitation in the home environment also would benefit from studies addressing the patients' and the relatives' perspectives.
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| Footnotes |
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The Human Ethics Committee of Karolinska Institutet approved the study.
An abstract of this work was presented at the 4th World Congress for NeuroRehabilitation; February 12–16, 2006; Hong Kong.
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