Perspective matters. Differences in viewpoint on the role of cognition and its impact on prosthetic rehabilitation.
Erinn Dawes1, Vida Bliokas1,3, Lyndel Hewitt2,3, Val Wilson1,21NSW Health, Illawarra Shoalhaven, NSW, Australia2University of Wollongong, Wollongong, NSW, Australia3Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
Abstract
Background: The Agency for Clinical Innovation recommend that all patients undergoing amputation receive comprehensive care, incorporating cognitive assessment. In one regional local health district, only 21.9% of patients receive this assessment. This research set out to understand what factors clinicians (occupational therapists, physiotherapists, vascular surgeons, and rehabilitation specialists) consider when prescribing prosthetic rehabilitation and to establish their understanding on the role of cognition in prosthetic rehabilitation.
Method: An exploratory sequential mixed methods data collection was undertaken over a 10-month period using focus groups, interviews and survey methods. Braun and Clarkes thematic analysis approach was used to generate themes from the focus groups and interviews.
Results: A total of 56 allied health (physiotherapy and occupational therapy) and six medical staff participated. All clinicians agreed that cognition was an important consideration to enable the provision of holistic care and rehabilitation, with themes such as patients’ memory and learning emerging. It became evident that there were differences in perspectives regarding ongoing care of the patients with medical staff viewing the patient as palliative and allied health staff looking at rehabilitation as the goal of care.
Discussion: Given all clinicians agree that understanding the cognitive profile of patients is important for holistic care and rehabilitation future research could focus on establishing a pathway for routine cognitive screening for patients. The perspective expressed by medical staff that they view patients undergoing amputation for vascular reasons as palliative patients is a new finding not discussed in the literature. This requires further exploration if allied health and medical staff are to work towards a common goal for patients post amputation.
Biography
I completed my Master of Physiotherapy in 2012 and have spent the subsequent 10 years working in Aged Care, being familiar with both ward and community-based work. Community based work has provided a unique insight into the challenges patients discharged from hospital face at home and integrating into the community. My area of interest is amputees, and this has led me back into the world of academia, commencing a Philosophical Doctorate in 2019.