Client-Centred Rehabilitation - Arthritis Community Research ...

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Chapter 4: Components of
Client-centred Rehabilitation
The objective of this work was to develop
the definition of client-centred care as it
applies to rehabilitation, identify clientcentred
parameters for rehabilitation
programs and identify criteria for evaluating
the extent to which various rehabilitation
programs are client-centred. Our findings
indicate that client-centred rehabilitation
encompasses much more than goal setting
and decision-making between individual
clients and health care professionals. It
refers to a philosophy or approach to the
delivery of rehabilitation services that
reflects the needs of individuals and groups
of clients.
At the level of the individual client, clientcentred
rehabilitation refers to clients being
actively involved in managing their health
care and their rehabilitation process in
partnership with service providers. At the
service level client-centred rehabilitation
refers to an approach to care that strives to
incorporate the clients’ perspectives into the
provision of services. Attention must be paid
to both levels in order to ensure a clientcentred
approach.
From the literature review and focus group
data, we identified the following
components that should be considered at
each stage of the rehabilitation process:
4.1 Individual Client Level
Client participation in decision-making and
goal setting: The rehabilitation program
should be individualized to meet each
client’s individual needs and condition. The
client defines the need, defines important
goals and outcomes, and sets the priorities in
collaboration with health professionals.
Client-centred education: Education and
information are crucial to informed client
participation in decision-making and goal
setting. Information should be appropriate,
timely and according to the client’s wishes
(Allshouse, 1993; Ellers, 1993). The client
is at the center of the educational process
and defines educational needs. Clientcentred
education encourages: autonomy;
client participation; planning with client;
empowerment; and, independence (Skelton,
1997). Education needs to include the skills
needed for effective community living.
Evaluation of outcomes from the client’s
perspective: Evaluation of outcomes
incorporates expectations of the client and
considers the importance of performance
areas to the client. Interventions need to be
evaluated using outcomes that tap multiple
dimensions (e.g. ICIDH-2). e.g. move
beyond traditional measures of impairment
and disability to include participation in
mobility, personal maintenance, social
relationships, home life, education, work,
economic life. Further, the clients should
evaluate their own progress towards the
achievement of these goals.
Effective communication: Effective
communication includes the transmission of
information, thoughts, and feelings, so that
they are satisfactorily received and
understood (Daley, 1993). Client-centred
communication allows clients to give their
accounts in their own language and
chronology, elicits clients’ thoughts,
perspectives, expectations, values, and
goals, in the context of their lives, expresses
concern for the client’s well-being, provides
clients with information for self-care and
participation in health care decisions, and