Comparing the experience of outpatient therapy in home and day hospital settings after traumatic brain injury: patient, significant other and therapist perspectives.
OBJECTIVE
To explore how therapy in a home and day hospital setting impacts on rehabilitation processes and outcomes from the perspective of the patients, their significant others and their treating occupational therapists.


METHODS
Fourteen participants with severe traumatic brain injury received a one-to-one, goal-directed, client-centred outpatient occupational therapy programme (a) in their home for 6 weeks and (b) in a day hospital clinic for 6 weeks. The experience of rehabilitation in both settings was explored using semi-structured interviews with the participants, their significant others and their treating occupational therapists.


RESULTS
Participants and their significant others described the two environments as disparate with home-based therapy perceived as more relaxing, normal, satisfying and effective. The approach to therapy at home was commonly described as 'real-life' whereas the therapy approach in day hospital was characterised as 'simulation of real life tasks' and 'remedial exercises'. Participants' experience of therapy relationships at home was characterised as 'friendship', in which the therapist was a 'visitor', whereas in the hospital, participants were characterised as 'patients' and therapists as 'bosses' and 'teachers'.


CONCLUSIONS
The experience of home-based therapy was perceived as more convenient, positive and preferred by patients and their family members. Therapists described more therapeutic benefits and the ability to work more effectively on activity and participation level goals in the client's real-life environment.
Doig
Emmah
E
Department of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4072, Australia. emmah.doig@optusnet.com.au
Fleming
Jennifer
J
Cornwell
Petrea
P
Kuipers
Pim
P
D000328:Adult; D001930:Brain Injuries / Q000534:rehabilitation*; D005260:Female; D006272:Health Facility Environment; D006297:Health Services Accessibility; D006699:Home Care Services; D006801:Humans; D008297:Male; D009788:Occupational Therapy; D010044:Outpatient Clinics, Hospital; D057240:Patient Preference; D011793:Queensland