title: Discourses in stroke rehabilitation as they present themselves in current physiotherapy and occupational therapy.
abstract: Aim This study aims to discuss current perceptions of rehabilitation and how present rehabilitation practice is affected by dominating discourses in Danish society by exploring discourses expressed in official publications and the constructed journal notes of occupational and physiotherapists' practice of stroke rehabilitation. Method The frame of reference is Fairclough's critical discourse analysis. The analysis comprises seven official documents relevant to stroke rehabilitation provided in Danish health services in 2012-2013. Also, notes written by occupational therapists and physiotherapists in medical records of 10 patients with a stroke diagnosis admitted to hospital in 2012. The documents included were read thoroughly. The texts were analyzed deductively, focusing on discursive practice on articulated understandings of rehabilitation, health practice approaches, and social practice. Results The dominating discourses seem to be Western neoliberalism organizational, medical and ethical discourses. The macro level of discourses consisted of political documents addressing rehabilitation nationally. The meso level mainly concerned medical discourses within stroke rehabilitation whereas the micro level represented local medical and ethical discourses. Conclusion The neoliberal discourse supports the medical discourse with strong emphasis on evidence-based interventions. In contrast to ethical discourses, documentation of rehabilitation practice marked more attention being paid to facilitating the patient's independence than to enabling the regaining of meaningful activities and participation. Implications for Rehabilitation Individualized rehabilitation must be organized with flexibility as it is a complex process Critical reflectiveness among health professionals is needed to provide individualized rehabilitation of high quality A broader range of stake holders, including patient organizations, are in demand within health policy making The discourses that construct rehabilitation policy and practices are sometimes in conflict, which may impact on, and impede, the rehabilitation for the individual patient.
authors.affiliation: a Health Sciences Research Center, University College Lillebaelt , Odense , Denmark.|b Institute of Clinical Research, University of Southern Denmark , Odense , Denmark.
authors.forename: Hanne Kaae
authors.initials: HK
authors.lastname: Kristensen
authors.affiliation: c Department of Physiotherapy , University College Capital , Hillerod , Denmark.
authors.forename: Jeanette
authors.initials: J
authors.lastname: Præstegaard
authors.affiliation: b Institute of Clinical Research, University of Southern Denmark , Odense , Denmark.|d Department of Neurobiology, Care Sciences and Society , Karolinska Institutet , Stockholm , Sweden.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Ytterberg
mesh_terms: D000328:Adult; D000368:Aged; D003718:Denmark; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy; D026741:Physical Therapy Modalities; D000071939:Stroke Rehabilitation / Q000941:ethics / Q000379:methods*
keywords: Denmark; discourse; health practice approaches; occupational therapy; physiotherapy; stroke rehabilitation