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Person-Centred Rehabilitation: Development and testing of a theory of person-centredness for rehabilitation practice in stroke or other complex health conditions


School of Health Sciences

About the Project

For stroke survivors, and survivors of other conditions leading to the onset of complex disability, recovery entails both physical recovery and adaptation to living with the condition (1). Although rehabilitation is critical in this process, survivors’ experiences show rehabilitation is often driven by practitioner-led decision-making based on evidence-based biomedical perspectives, not always focused on what survivors see as relevant (2-4). Enabling survivors to regain autonomy in social, relational, psychological, cultural and spiritual dimensions of their lives is often not considered (4-6). Consequently, after rehabilitation survivors struggle to adjust and to find ways to engage in meaningful activities (3).

These limitations have led to a shift from practitioner led decision-making, to espoused use of person-centred approaches in rehabilitation (7). Person-centeredness is a philosophical approach underpinned by individuals’ rights to self-determination, mutual respect and understanding (8). Person-centeredness in rehabilitation is typically limited to negotiated goal-setting relating to survivors’ needs, values and expectations, which has shown some benefits for quality of life and wellbeing (7,9). However, rehabilitation professionals, trained in biomedical discourse and evidence-based practice, are often uncomfortable with collaborative roles that empower patients in decision making. Thus, truly person-centred rehabilitation is rarely implemented (10), and beyond that, person-centeredness across all aspects of rehabilitation is even more rare (2).

This is partly because person-centeredness in rehabilitation has not been fully defined (11) and few theoretical frameworks of person-centred stroke rehabilitation exist to underpin and guide rehabilitation practice. A theoretical framework of person-centred rehabilitation is now required. This must account for relationships between survivors and practitioners, making expectations, behaviours, and ‘ways of being’ necessary for person-centred rehabilitation explicit. It will guide rehabilitation practice to better enable survivors to adapt to life with their condition, in ways that matter to them.

AIMS AND EXPECTED OUTCOMES
To develop a theoretical framework that articulates critical elements and processes of person-centred rehabilitation for complex and disabling conditions. We will do this by addressing the following research questions:
1. What are the core elements of person-centred rehabilitation?
2. What processes are essential for person-centred rehabilitation and how do these interact?
3. How is person-centred rehabilitation enacted and experienced by survivors and their families?
4. How do rehabilitation professionals conceptualise and enact person-centred rehabilitation?
5. How do person-centred philosophies and approaches (such as shared goal setting) influence how rehabilitation professionals enact and think about person-centred rehabilitation

Methods
The project will involve literature review and is likely to involve ethnographic/observational studies of rehabilitation practice in different contexts to explore if and how person-centredness is enacted in practice, and associated participant interviews to explore emerging issues. Analysis will inform development of a theoretical framework that will be refined through final consultation with stakeholders to explore if the theory captures their experiences, is relevant, explains person-centeredness with practical value, and whether it is modifiable and relevant in a range of in-patient and community rehabilitation contexts. The work will provide a platform for development and testing of person-centred approaches in rehabilitation settings.

For informal enquiries about the project, contact Dr Jacqui Morris ()
For general enquiries about the University of Dundee, contact


QUALIFICATIONS
Applicants must have obtained, or expect to obtain, a first or 2.1 UK honours degree, or equivalent for degrees obtained outside the UK in a relevant discipline.

English language requirement: IELTS (Academic) score must be at least 6.5 (with not less than 5.5 in each of the four components). Other, equivalent qualifications will be accepted. Full details of the University’s English language requirements are available online: http://www.dundee.ac.uk/guides/english-language-requirements.


APPLICATION PROCESS

Step 1: Email Dr Jacqui Morris () to (1) send a copy of your CV and (2) discuss your potential application and any practicalities (e.g. suitable start date).

Step 2: After discussion with Dr Morris, formal applications can be made via UCAS Postgraduate. When applying, please follow the instructions below:

Apply for the Doctor of Philosophy (PhD) degree in Nursing and Health Sciences: https://digital.ucas.com/coursedisplay/courses/bb40be12-d003-4ca1-8834-ec9dccff7103. Select the start date and study mode (full-time/part-time) agreed with the lead supervisor.

In the ‘provider questions’ section of the application form:
- Write the project title and ‘FindAPhD.com’ in the ‘if your application is in response to an advertisement’ box;
- Write the lead supervisor’s name and give brief details of your previous contact with them in the ‘previous contact with the University of Dundee’ box.

In the ‘personal statement’ section of the application form, outline your suitability for the project selected.

Funding Notes

There is no funding attached to this project. The successful applicant will be expected to provide the funding for tuition fees and living expenses, via external sponsorship or self-funding.

References

1. Levack et al. Disability and Rehabilitation. 2010;32(12):986-99.

2. Mudge S et al. Disability and Rehabilitation. 2014;36(6):457-63.

3. Sarre S et al. Disability and Rehabilitation. 2014;36(9):716-26.

4. Luker J et al. Archives of Physical Medicine and Rehabilitation. 2015;96(9):1698-708.e10.

5. Rosewilliam S. et al. Clinical Rehabilitation. 2011 2018/10/04;25(6):501-14.

6. McCormack B, editor. Person-centered Healthcare Research. Chichister: Wiley Blackwell; 2017. p. 1-17.

7. Cott C. Disability and Rehabilitation. 2004;26(24):1411-22.

8. Levack WMM et al. Cochrane Database of Systematic Reviews DOI: 10.1002/14651858.CD009727.pub2. 2015(7).

9. Van de Velde D,et al. Disability and Rehabilitation. 2016;38(16):1567-77.

10. Jesus TS et al. BMJ Open. 2016;6(7).

11. Glaser BG, & Strauss, A. L. The discovery of grounded theory: Strategies for qualitative research. Chicago: Aldine Publishing Company; 1967.

12. Guest G et al. Field Methods. 2006 2018/10/07;18(1):59-82.

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