The rehabilitation process for the geriatric stroke patient - an exploratory study of goal setting and interventions

Purpose: The aim was to describe and analyse the rehabilitation process of the geriatric stroke patient from two perspectives; the treatment goals exp ressed by the staff and the patient and the treatment interventions chosen by the physiotherapist and occupational therapist. A secondary aim was to t est whether the process, treatment goals and interventions could be classif ied according to the international Classification of Impairments, Disabilit ies and Handicaps (ICIDH). Method: Qualitative interviews were performed with patients and personnel; diaries were used to register treatment interventions. The 30 interviews we re categorized according to the goals expressed by physiotherapists, occupa tional therapists, physicians and patients. The diaries (n = 22) were analy sed to describe how treatment interventions were connected in time, at what levels (impairment, disability and handicap) the interventions were direct ed, and finally, whether certain decisions were made in order to change the rehabilitation process. Results: The patients talked more about attaining their prestroke status th an about their goals. The therapists set goals according to functional leve l, whereas the doctors expressed themselves in general terms. Three pattern s of rehabilitation processes were found: one with clearly identified decis ion points, one with a set programme which was not changed through the proc ess, and one where the goal was changed according to changes in medical sta tus. Conclusions: The patient does not participate in the goal-setting process, and the vaguely expressed goals are not measurable. The rehabilitation proc ess and reason for discharge demonstrate different patterns. Treatment inte rventions, if related to the ICIDH, give a clear picture of the process, th ough certain interventions do not fit in the classification.