Study Background and Aims: Specialist physiotherapy service processes for treating people with acquired brain injury (ABI) are poorly described and evaluated in the literature. The most important factor which limits the understanding of the physiotherapy service is the lack of a system to define, describe and record the interventions made by physiotherapists. The aim of this study was to develop and evaluate a physiotherapy documentation tool for use in inpatient ABI rehabilitation settings. To achieve this aim, it was imperative that the researcher consider all the different factors and identify all the key attributes of the documentation process followed in inpatient settings. It was therefore necessary to map the process of the physiotherapy rehabilitation service provided to patients with ABI. Mapping the process of the service helped the researcher to understand all aspects which make a large contribution to and have a great effect on the rehabilitation process so as to achieve the main aim of this study. It also helped to establish a theoretical basis for the documentation process and to develop a clear understanding of the specific attributes of rehabilitation services. Research Method: The researcher used a wide range of data collection methods, including interviews, questionnaires and observational processes. Interviews were conducted with the heads of rehabilitation teams working in inpatient rehabilitation services in the UK. Thereafter, a national questionnaire was sent to physiotherapists with experience of treating patients with ABI in the UK so as to capture the breadth and scope of current physiotherapy practice. It was also designed to identify the physiotherapy treatment activities provided to people with ABI in an inpatient rehabilitation setting. The validity, reliability and acceptability of the questionnaire were tested before the questionnaire was sent out to physiotherapists. Information gathered during the early phases was then used to design a physiotherapy treatment recording tool for use with people with ABI in an inpatient rehabilitation setting. The process of developing a new treatment recording tool went through many different stages, including considering all the reported advantages and disadvantages of the documentation methods currently used, as well as the policy, ethical and legal issues involved in physiotherapy documentation. Once the final draft of the treatment recording tool was developed, the reliability, validity and acceptability of the tool were evaluated. Six experienced physiotherapists working in one of the two rehabilitation centres treating ABI in Wales, UK were invited to take part in this stage of the study. Eighteen treatment sessions were observed and video recorded to evaluate the treatment recording tool. The piloting process included testing the treatment recording tool's comprehensiveness and its ability to describe physiotherapy treatment sessions. Results: The information gathered in this research and the descriptions provided by the ICF framework were used in this study to guide the process of describing the pathway that patients follow if they have an ABI. Four themes, namely pre-rehabilitation, rehabilitation and post-rehabilitation stages and the documentation process, were identified. Each theme had different sub-themes. The feedback from the heads of the rehabilitation teams and physiotherapists helped the researcher to gather in-depth details of these themes and sub-themes. A valid, reliable and acceptable treatment recording tool for use by physiotherapists with people with ABI in an inpatient rehabilitation setting was developed using the information gathered during the previous phases, including a literature review. The results show that the newly developed documentation tool has the ability to record comprehensive details of treatment sessions using a very simple coding process in a very quick way. The treatment recording tool offers a sufficiently structured method to collect information about treatment sessions, including treatment tasks, treatment positions, interventions provided, adjuncts used and the treatment duration of each treatment task. Treatment packages (combinations of physiotherapy interventions) were also investigated using a geometric coding process. The results showed that the treatment recording tool records more comprehensive and organised details about physiotherapy treatment sessions compared to SOAP notes completed by the same physiotherapists. Conclusion: The main outcome of this current study was the development of a new, valid, acceptable and reliable treatment recording tool. This tool brought an order and rigour to the description of physiotherapy treatment activities provided for people with ABI in an inpatient setting. It helped to characterise the many treatments, procedures and interventions used in physiotherapy, taking into account their multidimensionality with respect to content, purpose, intensity, duration, sequence, frequency and other characteristics of care provided. The new treatment recording tool has been designed to improve patient care by facilitating accurate and appropriate communication between physiotherapists, and between physiotherapists and other specialists. Developing the documentation method in inpatient settings will help other professionals to better understand physiotherapy practice and the role that physiotherapists play in the multidisciplinary rehabilitation service.
|Electronic Thesis or Dissertation
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