یک مطالعه کیفی در مورد استفاده از خانواده درمانی برای توانمندسازی افراد مسن
Abstract
Introduction
Method
Results
Discussion
References
Abstract
Question: What is the experience of patients and families participating in a family-assisted therapy intervention to augment physiotherapy in Transition Care?
Design: Qualitative study using an interpretive description framework.
Participants: Thirteen patients and 18 family members of patients in a Transition Care Program, who had participated in a family-assisted therapy intervention. Intervention: A 4-week family-assisted therapy program to augment usual physiotherapy care. Families were trained and supported by a physiotherapist to assist with safe and simple activities tailored to the patient’s goals.
Data collection and analysis: Semi-structured interviews were audio-recorded and transcribed verbatim. Researchers independently coded transcripts line by line, and themes and subthemes were derived inductively. Qualitative results were triangulated with quantitative outcomes from a concurrent randomised controlled trial.
Results: The unifying theme was that family-assisted therapy empowered families in a healthcare setting. There were four subthemes: families made a complementary contribution to rehabilitation; familyassisted therapy brought physical and psychosocial benefits; simplicity, boundaries, training and support were important elements of the family-assisted therapy program; and implementation of family-assisted therapy requires a supportive policy and environment. Findings largely converged with quantitative outcomes from the randomised controlled trial.
Conclusion: Family-assisted therapy to augment usual physiotherapy care was a positive and empowering experience for patients and families in Transition Care. This study indicates that family-assisted therapy may increase opportunities for physical activity and, importantly, engage family in a meaningful activity that gives them a genuine role in the healthcare team.
Introduction
Transition Care was introduced in Australia in 2004 following the advent of Intermediate Care in the United Kingdom.1 Transition Care is a publicly funded program that is available for up to 12 weeks. It provides older people who have been in hospital with time, nursing or personal care and low-intensity therapy, to assist their recovery and facilitate their return to community living.1 Unlike other existing rehabilitation services that have standards available to direct care and staffing levels,2 physiotherapists working in Transition Care have little guidance about how to deliver therapy. Physiotherapy staffing levels in Transition Care are low1 but patients often have impaired mobility and are facing their last opportunity to return home instead of being admitted to permanent residential care.3 One approach to providing physiotherapy in Transition Care could be family-assisted therapy. Engaging families in physiotherapy is an emerging area of research,4 particularly as a strategy to increase therapy dose. Higher doses of therapy have been associated with better outcomes, including strength after stroke5 and balance for adults receiving rehabilitation.6 Previous family-assisted therapy research has investigated augmenting physiotherapy for people after stroke, with results suggesting that this approach is safe; however, its effectiveness is unclear.7,8 Previous qualitative research in Transition Care has explored the prospect of family-assisted therapy and suggested that training families to augment interventions provided by physiotherapists could improve patient outcomes.9 However, it is believed that this approach has not been implemented and evaluated in a Transition Care setting or in any inpatient setting with adults aged 80 years. To understand the impact of a family-assisted therapy intervention in Transition Care, a mixed methods study was completed. Given the complexity of family relationships, the authors were aware that quantitative measures may not fully capture the impact of such a program. Therefore, a qualitative research study was conducted alongside a randomised controlled trial.10 This paper reports the outcomes of the qualitative study.