Implementation of Patient Engagement in Spinal Cord Injury Rehabilitation: A Qualitative Investigation Open Access

PURPOSE: The aim of this study was to identify barriers to patient engagement implementation in inpatient spinal cord injury (SCI) rehabilitation.

BACKGROUND: Engaging patients is widely recognized as a key factor in improving health service delivery and quality. Although studies indicated that patients who are actively engaged in their own care achieve better health outcomes and have lower health costs in primary care settings, there is limited evidence to support whether patient engagement can be equally applicable to inpatient rehabilitation. Furthermore, no research exists to provide guidance on how to identify key factors and develop patient engagement implementation strategies into inpatient rehabilitation.

DESIGN: Qualitative exploratory study

PARTICIPANTS: We conducted two patient and two clinician focus groups. Each focus group consisted of 5–7 participants. Participants in the patient groups were persons with varying completeness and severity of injury, and those in the clinician groups were occupational and physical therapists who were working in the SCI rehabilitation to foster the interdisciplinary discussion.

METHOD: During focus groups, the research staff used a standard script to identify perceived barriers to and facilitators of patient engagement implementation in inpatient rehabilitation. All sessions with the participants were audio recorded.

ANALYSIS: Qualitative analysis of the data was conducted using standardized procedures: (1) review and transcript of the audiotapes; (2) review of the tape transcriptions; (3) discussions among the research team members about key elements of participants’ statements; (4) determination of conceptual themes; and (5) assignment of relevant responses to appropriate themes. All research team members had experiences with SCI rehabilitation through clinical or research efforts.

RESULTS: Thematic analysis identified several barriers to engagement: (1) lack of confidence and knowledge of therapeutic engagement; (2) mood disturbance influencing active engagement to rehabilitation therapies; (3) limited resources and financial constraints affecting rehabilitation engagement and service quality; and (4) inadequate communication and support across various rehabilitation stakeholders and care settings.

DISCUSSION: We proposed an exploratory model that delineates factors influencing patient engagement and recommends strategies for fostering therapeutic engagement. This model can form the basis for future research that yields data for understanding and intervening in engagement in care for neurological conditions.

IMPACT STATEMENT: Occupational therapists have recognized the importance of patient-centered care, in which the increased sense of empowerment is central to the practice. Findings in this study provide the blueprint for enabling active engagement of patients receiving neurological rehabilitation in care.