Client’s role and participation in stroke physiotherapy encounters: an observational study
Sammanfattning
Client participation is a basic principle in rehabilitation encounters. Coping at home after stroke requires
self-confidence and autonomy, which can be enhanced by active collaboration and knowledge sharing.
Earlier studies show, however, that clients are not always offered the role of an active participant in
physiotherapy practice. A contradiction remains between official rhetoric and clinical practice. The purpose
of this study was to investigate the interaction between the client and the physiotherapist in
stroke rehabilitation sessions. Eight video-recorded treatment sessions were observed after an educational
intervention that focused on client participation. Discourse analysis was used to examine the client’s
involvement in the sessions. Four discourses were identified: taking on expert talk, inviting the
client to participate in self-guided planning, neglecting emotional talk and supporting reflection. The client’s
active participation manifested as responding to instructions, making plans, solving problems,
expressing feelings, and evaluating personal performance and progress. The physiotherapists preferred
the hands-off approach and invited the client to take an active role. However, they found it difficult to
deal with the client’s expressions of fear and uncertainty. More attention should be paid to the client’s
emotional expressions to enhance the client’s self-efficacy and self-management skills after stroke.