When worlds collide: Managing resource and client-centred practice when prescribing equipment after stroke

Background: Adaptive equipment is commonly prescribed during rehabilitation after stroke, to support people to take part in valued occupations, however the reasoning used by health professionals issuing equipment is not well... [ view full abstract ]

Background:
Adaptive equipment is commonly prescribed during rehabilitation after stroke, to support people to take part in valued occupations, however the reasoning used by health professionals issuing equipment is not well understood.

Method:
Six focus groups with 30 health professionals (n=13 occupational therapists and n=17 physiotherapists) were conducted, audio-taped and transcribed verbatim and analysed using grounded theory.

Results:
Client engagement, including willingness and capacity to engage, was the primary consideration of health professionals. This engagement was influenced by clients' physical and cultural environment, other people such as family members and caregivers and the relative risk versus benefit of equipment. Equipment provision was affected by tensions within the healthcare system when there were competing resource management issues. The way the healthcare system prioritised allocation of equipment funding could either align with, or oppose, an allied health professional’s own professional philosophy.

Conclusion:
An allied health professional is expected to take on multiple roles simultaneously including as an assessor, a gatekeeper of resource, a consultant or an advocate. While equipment provision is an inherent part of many health professionals’ practice, there is concern that their responsibilities to the health service create moral distress when in conflict with their professional philosophy.

Application to Practice:
Recommendations made when providing equipment are based on non-clinical factors and client-related factors. An increasing expectation that health professionals are fiscally responsible needs to be balanced with a critical awareness of the political factors which shape our practice and an awareness of the roles we adopt during equipment provision.