Discourses in rehabilitation as they present themselves in current physiotherapy and occupational therapy

Background: Throughout recent decades, rehabilitation has been a concept gaining increasing political attention in Western countries. With regard to stroke rehabilitation in Denmark, a fundamental context for professional... [ view full abstract ]

Background: Throughout recent decades, rehabilitation has been a concept gaining increasing political attention in Western countries. With regard to stroke rehabilitation in Denmark, a fundamental context for professional practice has been provided by the publishing of extensive political guidelines, textbook and research on how professionals working within stroke rehabilitation can provide consistent and coherent client-centred rehabilitation of high quality. This study aims to explore discourses expressed in central government publications and in written notes concerning rehabilitation practice, in order to discuss current perceptions of rehabilitation.
Method:The frame of reference is Fairclough’s critical discourse analysis.The analysis comprised seven official documents relevant to stroke rehabilitation provided in Danish health services, along with notes written by occupational therapists and physiotherapists in medical records of 10 patients with a stroke diagnosis admitted to hospital in 2012.The documents included were read thoroughly. The texts were analysed deductively, focusing on discursive practice in relation to articulated understandings of rehabilitation, health practice approaches and social practice.
Results: The dominating discourses seem to be Western neoliberalism organisatorial, medical and ethical discourses. The macro level of discourses was constituted of political documents addressing rehabilitation at a national level. The meso level mainly concerned medical discourses within stroke rehabilitation whereas the micro level represented local medical and ethical discourses.
Conclusion: The neoliberal discourse underpins the medical discourse with strong emphasis on evidence-based interventions. In contrast to ethical discourses documentation of rehabilitation practice indicated more attention to facilitating the patient’s independence than to enabling the patient regains meaningful activities and participation.