Client participation in the rehabilitation process

This thesis evaluates the rehabilitation process with respect to client participation. The Swedish version of a client-centred structure, the Canadian Occupational Performance Measure (COPM), is evaluated from the perspectives of the clients, the occupational therapists and the members of a rehabilitation team. Data have been collected through diaries, the COPM, assessments of ability to perform activities of daily living, mobility, selfassessments of pain and health, interviews with clients, interviews with staff, and focus groups interviews. The results show that a structured method is needed in order to improve clients’ active participation in goal formulation. The Swedish version of the COPM has high responsiveness to change over time. The use of the COPM improved client participation in the goal-formulation process, according to the results from a study with experiment and control groups. The clients perceived that treatment goals were identified, they were able to recall the goals and felt that they were active participants. They also perceived they had a higher ability to manage after the rehabilitation period was completed compared to clients in the control group. The clinical utility of the Swedish version of the COPM was confirmed in focus-group interviews with occupational therapists. The occupational therapists perceived the COPM as helpful in the goal-setting process and planning of treatment interventions. Even though problems are identified, they are directly related to, and formulated as, goals. Clients receive feedback on improvement over time. The COPM ensures a client-centred approach, facilitates communication within the rehabilitation team, and encourages therapists in their professional role. Therapists need knowledge about the theoretical foundation of the instrument and have to develop a personal interview technique. When the COPM is used in a team setting, it provides the team with broader information on what is purposeful occupation to the client. The focus is on occupational performance rather than function. According to team members the use of the COPM as a team tool increased client participation, was a good outcome measure, resulted in distinct goals, and focused on goals that were meaningful to the client. Implementation of a client-centred approach is facilitated when a structured method is used, but this is not enough. Involvement and motivation from all team members are required, as well as support during the introduction and implementation period. Support from management, knowledge about the underlying theory, time for discussions and reflections as well as opportunities to develop a personal interview technique are pointed out as important factors for a successful implementation.