title: Problematising risk in stroke rehabilitation.
abstract: Following stroke, re-engagement in personally valued activities requires some experience of risk. Risk, therefore, must be seen as having positive as well as negative aspects in rehabilitation. Our aim was to identify the dominant understanding of risk in stroke rehabilitation and the assumptions underpinning these understandings, determine how these understandings affect research and practise, and if necessary, propose alternate ways to conceptualise risk in research and practise.
  
  
  
  Alvesson and Sandberg's method of problematisation was used. We began with a historical overview of stroke rehabilitation, and proceeded through five steps undertaken in an iterative fashion: literature search and selection; data extraction; syntheses across texts; identification of assumptions informing the literature and; generation of alternatives.
  
  
  
  Discussion of risk in stroke rehabilitation is largely implicit. However, two prominent conceptualisations of risk underpin both knowledge development and clinical practise: the risk to the individual stroke survivor of remaining dependent in activities of daily living and the risk that the health care system will be overwhelmed by the costs of providing stroke rehabilitation.
  
  
  
  Conceptualisation of risk in stroke rehabilitation, while implicit, drives both research and practise in ways that reinforce a focus on impairment and a generic, decontextualised approach to rehabilitation. Implications for rehabilitation Much of stroke rehabilitation practise and research seems to centre implicitly on two risks: risk to the patient of remaining dependent in ADL and risk to the health care system of bankruptcy due to the provision of stroke rehabilitation. The implicit focus on ADL dependence limits the ability of clinicians and researchers to address other goals supportive of a good life following stroke. The implicit focus on financial risk to the health care system may limit access to rehabilitation for people who have experienced either milder or more severe stroke. Viewing individuals affected by stroke as possessing a range of independence and diverse personally valued activities that exist within a network of relations offers wider possibilities for action in rehabilitation.
authors.affiliation: a School of Rehabilitation Sciences, University of Ottawa , Ottawa , Canada ;
authors.forename: Mary Y
authors.initials: MY
authors.lastname: Egan
authors.affiliation: b Primary and Community Care, Bruyere Research Institute , Ottawa , Canada ;
authors.forename: Dorothy
authors.initials: D
authors.lastname: Kessler
authors.affiliation: c Faculty of Nursing, University of Alberta , Edmonton , Canada ;
authors.forename: Christine
authors.initials: C
authors.lastname: Ceci
authors.affiliation: d School of Occupational Therapy, Western University , London , Canada ;
authors.forename: Debbie
authors.initials: D
authors.lastname: Laliberté-Rudman
authors.affiliation: d School of Occupational Therapy, Western University , London , Canada ;
authors.forename: Colleen
authors.initials: C
authors.lastname: McGrath
authors.affiliation: e Library, University of Ottawa , Ottawa , Canada ;
authors.forename: Lindsey
authors.initials: L
authors.lastname: Sikora
authors.affiliation: f Department of Health Sciences , Brock University , St Catherines , Canada.
authors.forename: Paula
authors.initials: P
authors.lastname: Gardner
mesh_terms: D000203:Activities of Daily Living; D003863:Depression / Q000209:etiology; D006233:Persons with Disabilities / Q000534:rehabilitation; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000628:therapy*; D000071939:Stroke Rehabilitation
keywords: Activities of daily living; problematisation; resource allocation; risk; stroke