Discharge criteria for patients with neck problems in physiotherapy out-patient department

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Discharge criteria for patients with neck problems in physiotherapy out-patient department


Author: Lam, Sai-lok Rosana
Title: Discharge criteria for patients with neck problems in physiotherapy out-patient department
Degree: M.Sc.
Year: 1998
Subject: Hospitals -- Admission and discharge
Neck -- Diseases -- Patients -- China -- Hong Kong
Physical therapy services -- Evaluation
Hong Kong Polytechnic University -- Dissertations
Department: Multi-disciplinary Studies
Dept. of Rehabilitation Sciences
Pages: xiv, 198 leaves : ill. ; 30 cm
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b1441864
URI: http://theses.lib.polyu.edu.hk/handle/200/1416
Abstract: Patients with neck problems are one of the major groups of patients treated by physiotherapists in Physiotherapy Out-patient Department of Yung Fung Shee Memorial Centre. The issue of when these patients should be discharged from physiotherapy is a question encountered by therapists treating this type of patients. The purpose of this study is to set up discharge criteria for physiotherapists to follow in discharging patients by integrating the criteria from the perspectives of both the physiotherapists and the patients. The study is exploratory in nature, adopting a qualitative approach by conducting semi-structured face to face in-depth interviews with both the physiotherapist and the patient subjects. The whole population of physiotherapists working in the physiotherapy department of Yung Fung Shee Memorial Centre (n1=8) were recruited, and 13 patients with neck problems (n2=13) attending the physiotherapy department for treatment were sampled by convenience. Their preferred discharge criteria, the relative importance, and the reasons for adopting those criteria were explored. The interviews were tape-recorded, and the recordings were transcribed in verbatim into transcripts which were then analysed by content analysis. To ensure validity and reliability of the study, two independent judges were involved to assess the accuracy of the translation and transcription, as well as to give comments on the coding framework. The patients' preferred discharge criteria had three main categories, namely "the subjective complaints", "counselling, education and self-care program" and "overall recovery or improvement". The health and well-being aspects of the subjective complaints relating to the quality of life were expressed in details showing the patients' particular concern. The patients' reasons for adopting of those criteria were "meeting the basic human and social needs of daily life", "improving the well-being and health", "satisfying their expectation" and "adapting to the service availability". Physiotherapists need to understand these four aspects and strike a balance in providing a holistic approach in patient care. In formulating the discharge criteria for patients with neck problems, physiotherapists are recommended to pay attention to the "Convergent Compass-point Phenomenon" with reference to patient care management. Most of the discharge criteria identified by the patients were also identified by the physiotherapists except that less emphasis was put on "quality of life". In addition, the physiotherapists also considered "the achievement of physiotherapists' pre-set treatment goal" and "expertise consultation and referral". In making a discharge decision, the physiotherapists face a "Wobble Board Dilemma": they seem to be standing on a wobble board; the rim of which consists of a number of pairs of contrasting considerations. In the interplay between the traditional professionalism and the new concept and challenge of health care, the physiotherapists need to strike a balance among all the contrasting considerations. They also need to open their positional sensory system to diagnose and adjust their discharge criteria to be in line with the specific needs of individual patients, as well as with the evolving environment and culture related to the current expectation on health care. It is recommended to use the discharge criteria of the physiotherapists as the blue-print with more emphasis being put on the quality of life of patients so as to formulate a checklist of integrated discharge criteria. It is also recommended that discharge decision should be enhanced by using comprehensive measure for health-related quality of life disturbance, appropriate interviewing skills in subjective assessment and involving the patients in the setting of treatment goals.

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