Place attachment in stroke rehabilitation:A transdisciplinary encounter between cultural geography, environmental psychology and rehabilitation medicine

Purpose: To increase understanding of stroke survivor's needs to successfully re-establish attachment to meaningful places at home and in the community. Methods: Qualitative research methodology including in-depth interviews with stroke survivors in the clinical, post-discharge and reintegration phases of the rehabilitation process. Results: Participants longed for recovery and domestic places in the clinical phase, for pre-stroke activities and roles in the post-discharge phase, and for recognition and a sense of belonging in the reintegration phase. The participants' selves had changed, while the spatial and social contexts of their homes had remained the same. Their spatial scope became smaller in both a social and a geographical sense. It was difficult to achieve a feeling of being at home in their bodies and own living environments again. The complexities that needed to be dealt with to engage with the outside world, turned participants unintentionally inwards. In particular, family members of participants with cognitive problems, longed for support and recognition in dealing with the changed personality of their spouses. Conclusions: Rehabilitation should put greater effort into supporting stroke survivors and their families in home-making and community reintegration processes, and help them to re-own and renegotiate their disabled bodies and changed identities in real life

The benefits of theory for clinical practice:Cognitive treatment for chronic low back pain patients as an illustrative example

Purpose. To demonstrate, with the help of an example of cognitive treatment for patients with chronic low back pain, how a systematic description of the content and theoretical underpinnings of treatment can help to improve clinical practice. Methods. A conceptual analysis, two types of theories, and a programme-theory framework were instrumental in systematically specifying the content of the treatment and the underlying assumptions. Results. A detailed description of the cognitive treatment, including: (i) The intended outcomes; (ii) the related treatment components; (iii) the therapeutic process that is expected to mediate between outcomes and components, (iv) the conditions for optimal application; and (v) the guiding principles. Conclusions. The systematic description of the treatment revealed important issues for clinical practice, such as the patient and therapist characteristics that are needed for optimal provision of cognitive treatment. The discussions on the role of theory in rehabilitation practice are taken one step further in this clinical commentary: instead of simply describing the problems, we also demonstrated a means to tackle them

Main problems experienced by children with epidermolysis bullosa:A qualitative study with semi-structured interviews

The objective of this study was to identify and specify the problems of children with epidermolysis bullosa. The questions explored were: (i) What do children with epidermolysis bullosa experience as the most difficult problems; (it) What is the impact of these problems on their daily life; and (iii) Do these experiences differ between mildly and severely affected children? Qualitative research methodology was used, comprising a series of semi-structured interviews with children with different (sub)types of epidermolysis bullosa. The interviews were analysed systematically with help of the qualitative software package Atlas-ti. Five main themes were found: (i) having an itchy skin, (ii) being in pain, (iii) having difficulties with participation, (iv) lack of understanding of others, and (v) the feeling of being different. Severely affected children suffered most from itch and treatment-related pain. Mildly affected children had more problems with activity-related pain. Mildly affected children also had more concerns about their appearance and the teasing and staring of others than did severely affected children. Both groups had difficulties with participation, the visibility of their disease and the feeling of being different

The main problems of parents of a child with epidermolysis bullosa

Epidermolysis Bullosa (EB) is a rare genetic blistering-skin disorder with varying degrees of severity, ranging from mild forms to severe forms, with chronic progression. The aim of this study was to identify and specify the problems of parents of a child with EB. Qualitative research methodology was used, comprising a series of semistructured interviews with eleven families. The key problems of parents were broken down into three themes, related to the child, the family, and the care providers. These themes comprised nine categories, including (1) the child being different, (2) the child suffering pain, (3) feelings of uncertainty, (4) restrictions on employment and leisure time, (5) difficulties in organization of care, (6) never being off-duty, (7) family problems, (8) ignorance and lack of skills of care providers, and (9) resistance to difficult care. Despite the great variance in clinical pictures of the different (sub)types of EB, the main problems parents experienced appear quite similar. However, the problems did appear to differ in extensiveness, intensity, and gravity