Hannold EM (Rehabilitation Outcomes Research Center of Excellence)
Young ME (University of Florida)
Rittman MR (Rehabilitation Outcomes Research Center of Excellence)
Behrman AL (University of Florida, Brain Rehabilitation and Research Center of Excellence)
The aims of this study were to define and describe patient-therapist interactions during locomotor training (LT) and to explore the impact of these interactions from patients’ perspectives. LT is an emerging treatment used to promote neural recovery and enhance walking in persons with chronic central nervous system (CNS) damage.
Qualitative methods were used to collect and analyze data from eight patients, currently or formerly enrolled, in an ongoing LT study. The sample included seven males and one female. Four patients were veterans. Patients had chronic, incomplete spinal cord injuries (I-SCI) and were three months to three years post-injury at time of treatment. All patients completed 45 sessions of LT. Data were obtained from 60+ observations of patient-therapist interactions during LT sessions and 14 patient interviews.
Empowerment was a predominant theme to emerge from the data. Therapists fostered empowerment by engaging patients as active members of the treatment team; encouraging them to make decisions regarding treatment goals and activities, and to provide feedback to therapists. Therapists' also enhanced empowerment through behaviors representative of the roles of coach, teacher, and therapist. Patients identified increased confidence, self-esteem, knowledge and a sense of altruism as benefits of the treatment approach. These attributes are consistent with empowerment, or a sense of personal power.
A patient-centered approach to SCI care, in which therapists fully engaged LT patients in the therapeutic process, empowered patients by enhancing their sense of personal power or competence. Patients described several benefits of this approach, including improved functional and psychosocial outcomes. Patient-centered strategies that promote empowerment may enhance patient-provider interactions and improve patient outcomes.
Findings from this preliminary study reveal the value of a patient-centered, empowerment-driven approach to SCI care. Although this study examined patient-therapist interactions within the context of an experimental study of LT, findings hold implications for enhancing patient-provider interactions throughout health care delivery systems. Specifically, findings have implications for educating health care providers about specific strategies they may use to empower patients and the personal value such strategies hold for patients.