Client-Centred Rehabilitation - Arthritis Community Research ...

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Executive Summary
Objectives
♦ To further develop the concept of
client-centred care in the Draft
Policy Framework and Service
Delivery Model as it applies to
rehabilitation.
♦ To identify client-centred parameters
for rehabilitation programs.
♦ To identify criteria for evaluating the
extent to which various rehabilitation
programs are client-centred.
Methodology
♦ Review of the literature
♦ Focus groups with adult clients with
chronic disabling conditions
Results
We did not find a universal definition for
client-centred care, rather, a variety of terms
such as client-centred practice, patient
focused care and patient centred care is
used. Two main categories of literature were
identified: individual client /practitioner
level literature and system level literature.
At the individual client/practioner level the
majority of the work was profession specific
such as occupational therapy, medicine and
nursing. Occupational therapy literature on
client-centred practice was the most
extensive and relevant to client-centred
rehabilitation. However, it tended not to
include broader system level issues. Other
than the occupational therapy literature that
focuses on individual therapist and client,
little work has been done specifically in
rehabilitation. As well, the professionspecific
literatures define client-centred care
from the professional’s perspective, not the
client’s.
At the system level, much of the work to
date is acute care, hospital focused that
emphasizes patient focused care that refers
to the redesign of patient care so that
personnel and resources are organized
around the patient instead of departments.
The notable exception is the work of the
Picker Institute that has identified
components of patient centred care at both
the individual and system levels from the
client’s perspective. However, their work
tends to be acute care focused.
In order to address the limitations in the
literature with respect to identifying
components of client-centred rehabilitation
from the client’s perspective we conducted
focus groups with adults with chronic
disabling conditions such as arthritis, total
joint replacement, acquired brain injury,
respiratory conditions, spinal cord injury,
and multiple sclerosis. These client groups
were chosen based on the target groups from
the Rehabilitation Reform Pilot Projects.
The main themes that emerged from the
focus groups were: individualization;
participation in goal setting and decisionmaking,
lack of preparation for life in the
real world, the need for emotional support,
and systems issues. The major theme
underlying both the individual and system
level issues was the issue of transition from
rehabilitation programs to the community.
Participants felt ill-prepared for community
living and, once discharged, felt isolated and
had difficulty finding out about and
accessing community services.
Furthermore, all participants talked about
the need for ongoing access to rehabilitation
and services once they have returned to the