Listening to the client voice - A constructivist grounded theory study of the experiences of client-centred practice after stroke.

INTRODUCTION: Collaboration, choice and power-sharing are cornerstones of practice as occupational therapists support individuals to re-establish an occupational identity and reintegrate into the community following stroke. Yet evidence of unmet client needs suggests client-centred care is not optimal, and little is known of client perspectives of client-centred practice. A deeper understanding of the client experience of therapeutic relationships during adjustment following stroke, will help facilitate client-centred practice. This paper reports on a study exploring the research question: how do stroke survivors perceive their relationship with their health care team as they adjust to life following stroke?
METHODS: In this constructivist grounded theory study, in-depth interviews were conducted with six adult stroke survivors from South-East Queensland, Australia. Transcribed interviews were analysed using a constant comparative approach, identifying emerging concepts and patterns, to construct a theoretical understanding of the experience and meaning of adjustment and reintegration back into the community, with a specific focus on perceptions of therapeutic relationships and client-centred practice.
RESULTS: Participant perspectives of client-centred care during their rehabilitation following stroke were revealed and implications of this for their recovery identified. Themes of being understood; out of the driver's seat; knowing what's going on; and what I need when I need it emerged. Participants described not being: involved in decision making, provided with information, or receiving services aligned to their needs. Periods of frustration, loss of hope and fluctuating motivation were also common.
CONCLUSION: Findings shed further light on previously reported health service and discharge experiences. The insight gained into individual experiences of client-centred care following stroke suggest ways therapists can understand and address each client's adjustment experience and the impact this has on their needs, goal-setting, motivation, and confidence. Client-centred care must be grounded in client reality.