Hope Jervis Rademeyer1,2, Cindy Gauthier1,3, José Zariffa1,4, Kristen Walden5, Tara Jeji6, Shane McCullum7, Kristin E Musselman1,2,3. 1. KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada. 2. Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 3. Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 4. Institute of Biomedical Engineering, Faculty of Applied Science & Engineering, University of Toronto, Toronto, ON, Canada. 5. Praxis Spinal Cord Institute, Vancouver, BC, Canada. 6. Ontario Neurotrauma Foundation, Toronto, ON, Canada. 7. Stan Cassidy Centre for Rehabilitation, Fredericton, NB, Canada.
Abstract
OBJECTIVE: To understand if and how physical therapists (PTs) and occupational therapists (OTs) use activity-based therapy (ABT) and its associated technologies for the rehabilitation of individuals living with spinal cord injury or disease (SCI/D) in Canadian rehabilitation hospital settings. DESIGN: Qualitative study. SETTING: Through rehabilitation hospitals participating in the Rick Hansen Spinal Cord Injury Registry, we recruited licensed OTs and PTs to participate in focus groups. PARTICIPANTS: Twelve PTs and ten OTs from nine sites across eight provinces participated. OUTCOME MEASURES: To inform the development of a semi-structured interview guide, we used the Theoretical Domains Framework. To analyze the data, we used interpretive description. RESULTS: We identified three themes that influenced therapists' use of ABT and associated technologies for SCI/D rehabilitation. (1) Therapists' decision-making approach to ABT and technology. Therapist roles, site-specific dynamics and goal setting influenced decision-making. Assuming roles such as mentor, liaison and advocate led to more ABT use. Site-specific dynamics concerned levels of ABT knowledge, teamwork, and staffing. In hospital rehabilitation, there was competition between discharge and neurorecovery goals. (2) Therapist perceived individual factors. Patient factors either increased (i.e. patients' motivation, self-advocacy) or prevented (i.e. mourning period, tolerance) the likelihood that ABT was introduced by therapists. (3) ABT and equipment access. Technology was used for ABT in a variety of ways. Access was affected by visible (e.g. equipment cost) and invisible barriers (e.g. departmental relations). CONCLUSIONS: The use of ABT and its associated technologies in Canadian rehabilitation hospitals is variable. Ongoing education could be offered, and site-specific implementation strategies could be developed, to promote ABT use.
OBJECTIVE: To understand if and how physical therapists (PTs) and occupational therapists (OTs) use activity-based therapy (ABT) and its associated technologies for the rehabilitation of individuals living with spinal cord injury or disease (SCI/D) in Canadian rehabilitation hospital settings. DESIGN: Qualitative study. SETTING: Through rehabilitation hospitals participating in the Rick Hansen Spinal Cord Injury Registry, we recruited licensed OTs and PTs to participate in focus groups. PARTICIPANTS: Twelve PTs and ten OTs from nine sites across eight provinces participated. OUTCOME MEASURES: To inform the development of a semi-structured interview guide, we used the Theoretical Domains Framework. To analyze the data, we used interpretive description. RESULTS: We identified three themes that influenced therapists' use of ABT and associated technologies for SCI/D rehabilitation. (1) Therapists' decision-making approach to ABT and technology. Therapist roles, site-specific dynamics and goal setting influenced decision-making. Assuming roles such as mentor, liaison and advocate led to more ABT use. Site-specific dynamics concerned levels of ABT knowledge, teamwork, and staffing. In hospital rehabilitation, there was competition between discharge and neurorecovery goals. (2) Therapist perceived individual factors. Patient factors either increased (i.e. patients' motivation, self-advocacy) or prevented (i.e. mourning period, tolerance) the likelihood that ABT was introduced by therapists. (3) ABT and equipment access. Technology was used for ABT in a variety of ways. Access was affected by visible (e.g. equipment cost) and invisible barriers (e.g. departmental relations). CONCLUSIONS: The use of ABT and its associated technologies in Canadian rehabilitation hospitals is variable. Ongoing education could be offered, and site-specific implementation strategies could be developed, to promote ABT use.