Patient Perspectives on Physical Therapy Outcome Measures and Engagement after Stroke

  • Author / Creator
    Kwok, Alyson
  • Introduction
    Outcome measures are highly recommended in stroke physical therapy, however, most of the existing research has been performed from the provider perspective. Patient engagement encourages active participation in the therapy process and requires partnership between patient and therapist. Relational autonomy recognizes that patients may not be able to be fully autonomous at all points of their recovery journey. In relational autonomy, therapists aim to facilitate the level of autonomy that the patient is able and willing to attain. Understanding the patient perspective of outcome measures may help therapists to better support patient engagement and autonomy, particularly during this time of significant change as Alberta Health Services moves to a provincial electronic health record.
    This qualitative case study is based on patient-oriented research principles, with three patient partners embedded in the research team. The case is a stroke physical therapy program in a major rehabilitation hospital in Canada, involving both inpatients and outpatients. Data collection included chart reviews, observations, patient interviews, and therapist interviews. Patient partners participated in all aspects of research, including thematic analysis of the data set.
    Ten patients and seven therapists participated in this case study. Patients of both genders, as well as a variety of ages, ethnicities, and ability levels, were recruited. Therapist experience ranged from 3.5 months to 31 years. Analysis of the data revealed the following two themes: 1) tracking progress, and 2) partnership. Tracking progress included the expectations patients had for improvement, the importance of objectively measuring change and the functional improvement observed day by day. Partnership described the relationship between therapist and patient including communication, encouragement and affirmation, the therapist as expert and the gradual shift in autonomy from therapist to patient.
    Patients valued the objective results of outcome measures. They had high expectations for treatment and were interested in testing that could show that they were making progress towards their goals. Patients were encouraged by observable changes in their ability to perform everyday activities. Patients and therapists found that simple measures that showed progress in these day-by-day activities were most meaningful.
    The partnership between patient and therapist seemed to provide a foundation for effective therapy. Patients placed a high degree of trust in their therapists and looked to them for expertise and encouragement. Effective communication helped patients to better understand the results of the outcome measures and facilitated patient decision making, particularly as therapy came to an end. Patients expressed that they are interested in accessing results of physical therapy outcome measures through an electronic patient portal. Maximizing the use of physical therapy outcome measures may improve patient engagement and support relational autonomy.

  • Subjects / Keywords
  • Graduation date
    Fall 2021
  • Type of Item
  • Degree
    Master of Science
  • DOI
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.