Disability meanings according to patients and clinicians: imagined recovery choice pathways

Abstract

Objective: The purpose of this study was to explore how the meaning of disability varies between patients with acute-onset activity limitations and clinicians, and between males and females.

Methods: Seventy-nine patients undergoing inpatient rehabilitation and 93 practicing rehabilitation clinicians in the USA developed personal recovery choice pathways through recovery preference exploration (RPE). Imagining complete dependence in 18 activities as diverse as eating and expression, each individual determined an optimal sequence of recovery. This sequence was used to determine the relative value of each activity compared with the other 17. Three comparisons were made by calculating the mean absolute difference (MAD) in median utilities, including patients versus clinicians, male versus female patients, and male versus female clinicians. The MAD shows the relative magnitude of disparity between each pair.

Results: The MAD value between patients and clinicians was 3.4 times larger and 4.8 times larger than the MAD values between male and female patients and male and female clinicians, respectively.

Conclusions: The much larger difference in recovery preferences between patients and clinicians compared with differences between genders suggests that life contexts of being a patient with disabilities versus a clinician are more potent determinants of activity limitation perspectives than being a man or woman.

Fig. 1

Example game board showing how one individual imagined recovery. The numbers included in each box represent the order of moves made by the individual from which utilities were calculated. The pattern illustrates a primarily physical pattern in which the person chose to recover the physical activities before the cognitive activities (i.e., the physical activities had lower move numbers). Reprinted from Archives of Physical Medicine and Rehabilitation, 89, Rist, P. M., Freas, D. W., Maislin, G., & Stineman, M. G., Recovery from disablement: What functional abilities do rehabilitation professionals value the most?, 1600–1606, (2008), with permission from Elsevier

Fig. 2

Comparison of patient and clinician median utility profiles. Activities falling above the line equidistant from the x- and y-axes are relatively more valued by patients than clinicians whereas activities falling below the line are relatively more valued by clinicians than patients. Key to letters used in Figs 2–4: Ea, Eating; G, Grooming; Ba, Bathing; Du, Dressing upper body; Dl, Dressing lower body; To, Toileting; Bl, Bladder management; Bo, Bowel management; Be, Bed chair wheelchair transfer; Tt, Toilet transfer; Ts, Tub/Shower transfer; W, Walk/Wheelchair; S, Stairs; C, Comprehension; Ex, Expression; Si, Social interaction; P, Problem solving; M, Memory

Fig. 3

Comparison of female and male clinician median utility profiles. Activities falling above the line equidistant from the x- and y-axes are relatively more valued by female than male clinicians whereas activities falling below the line are relatively more valued by male than female clinicians

Fig. 4

Comparison of female and male patient median utility profiles. Activities falling above the line equidistant from the x- and y-axes are relatively more valued by female than male patients whereas activities falling below the line are relatively more valued by male than female patients