Physiotherapy practice in reablement services. A qualitative study with observations and interviews

Abstract

Reablement is a community-based health care service aiming to enable people with (or those at risk of) functional decline to stay independent in their own homes. The service entails short-term, goal-oriented interventions provided by an interprofessional team. Support personnel, referred to as home trainers (HTs), mainly conduct the treatment initiatives under supervision of professionals including physiotherapists (PTs), occupational therapists, and nurses. There is a lack of knowledge about the roles of PTs and practices in reablement teams. The PTs’ supervision practices and the contents of services have been sparsely investigated. This dissertation explores how the new organization of reablement may challenge traditional physiotherapy professionalism. We produced qualitative data based on fieldwork in seven Norwegian reablement teams involving workplace observations, video recordings of user visits, and interviews with PTs and HTs. The data were thematically analyzed in a systematic manner, and theory within a constructionist perspective guided the interpretation. The study revealed large variation in the practices of Norwegian reablement teams. Through our analysis, we created two typologies of reablement teams. Teams with a fixed division of labor provided limited assessments and supervision and used nonspecific approaches. Teams with a flexible division of labor provided thorough assessments, regular supervision and user-tailored interventions. Physiotherapy practices with fixed structured teams were characterized by mechanical labor, limiting individualization and contextual adaptations. In flexibly structured teams, PTs utilized their traditional professional competence and extended their practices towards a broader and more holistic perspective due to interprofessional collaboration.