http://www.tandfonline.com/doi/abs/10.3109/09638288.2015.1123304
- DOI:
- 10.3109/09638288.2015.1123304
- Received: 14 May 2015
- Accepted: 18 Nov 2015
- Published online: 05 Jan 2016
Abstract
Purpose
Following stroke, re-engagement in personally valued activities
requires some experience of risk. Risk, therefore, must be seen as
having positive as well as negative aspects in rehabilitation. Our aim
was to identify the dominant understanding of risk in stroke
rehabilitation and the assumptions underpinning these understandings,
determine how these understandings affect research and practise, and if
necessary, propose alternate ways to conceptualise risk in research and
practise. Method Alvesson and Sandberg’s method of
problematisation was used. We began with a historical overview of stroke
rehabilitation, and proceeded through five steps undertaken in an
iterative fashion: literature search and selection; data extraction;
syntheses across texts; identification of assumptions informing the
literature and; generation of alternatives. Results Discussion of
risk in stroke rehabilitation is largely implicit. However, two
prominent conceptualisations of risk underpin both knowledge development
and clinical practise: the risk to the individual stroke survivor of
remaining dependent in activities of daily living and the risk that the
health care system will be overwhelmed by the costs of providing stroke
rehabilitation. Conclusions Conceptualisation of risk in stroke
rehabilitation, while implicit, drives both research and practise in
ways that reinforce a focus on impairment and a generic,
decontextualised approach to rehabilitation.
Implications for rehabilitation
- Much of stroke rehabilitation practise and research seems to centre implicitly on two risks: risk to the patient of remaining dependent in ADL and risk to the health care system of bankruptcy due to the provision of stroke rehabilitation.
- The implicit focus on ADL dependence limits the ability of clinicians and researchers to address other goals supportive of a good life following stroke.
- The implicit focus on financial risk to the health care system may limit access to rehabilitation for people who have experienced either milder or more severe stroke.
- Viewing individuals affected by stroke as possessing a range of independence and diverse personally valued activities that exist within a network of relations offers wider possibilities for action in rehabilitation.
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