PHYS THER
Vol. 87, No. 6, June 2007, pp. 791-792
DOI: 10.2522/ptj.20060152.ar
Author Response
Annica Wohlin Wottrich,
Lena von Koch and
Kerstin Tham
We are most grateful to Dr Jensen for providing this very informative commentary on our article, in which important additional ways of interpreting and understanding our findings were outlined. We have not much to add in this regard, but that it is our opinion that Dr Jensen's knowledgeable and comprehensive comments will inspire and create an interest among physical therapists to conduct qualitative studies with the aim "to shine the light" on the many unexplored areas in physical therapy.
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The Swedish Health Care Context
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Regarding the context of the Swedish health care delivery system, we are happy to have the opportunity to provide some additional information. In Sweden, health care services are provided by the county councils and the local authorities, and the central government establishes policies, sets up guidelines, and makes recommendations through the National Board of Health and Welfare. The cost of health care is met, to a large extent, by tax revenues and, to a lesser extent, by patient fees.
In 2005, the National Board of Health and Welfare presented the National Guidelines for Stroke Care,1 in which it was stated that patients with acute stroke are to be treated in stroke units. In 2003, approximately 75% of patients with acute stroke in Sweden received such care. With regard to rehabilitation after stroke, the same guidelines recommend a home rehabilitation program supplied by a multiprofessional team for some patients with stroke.
In the last decade, there has been a reduction in the length of hospital stay after stroke and in the number of beds for inpatient hospital-based rehabilitation. Instead, rehabilitation in the primary health care sector has increased. Consequently, there are basically 2 modes of organizing home rehabilitation: (1) an outreach team from the hospital delivers the home rehabilitation service, or (2) an in-reach team, based in a primary health care center, will supply the service and will contact the patient before hospital discharge. No statistics are available with regard to the number of teams supplying home rehabilitation after stroke in Sweden.
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The Multiprofessional Team
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The functioning of teams, whether collaborating interprofessionally or working in parallel as separate professions, is indeed an important contextual aspect, and the multiprofessional team in this study was not analyzed and described regarding their functioning as a team. However, in a previous study of a similar team,2 we found that the members were working not only collaboratively and interprofessionally but also transprofessionally,3 meaning that they incorporated a wider domain of activities than usual and to some extent performed activities on behalf of other team members (ie, other professions). Because the functioning of the team was not specifically monitored in this study, we cannot present in detail in what way the team members collaborated except that, as suggested by Dr Jensen, the data indicate that they were indeed collaborating and not working in parallel.
The emerging body of qualitative research makes the case for metasyntheses that will further shine the light on, increase our understanding of, and contribute to a deeper knowledge of areas that have not been investigated previously.
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References
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- National Board of Health and Welfare Web site. Available at: www.Socialstyrelsen.se.
- von Koch L, Widén Holmqvist L, Wohlin Wottrich A, et al. Rehabilitation at home after stroke: a descriptive study of an individualized intervention. Clin Rehabil. 2000;14:574–583.[Abstract/Free Full Text]
- Thylefors I, Persson O, Hellström D. Team types, perceived efficiency and team climate in Swedish cross-sectional teamwork. J Interprof Care. 2005;19:102–114.[CrossRef][Medline]
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Copyright © 2007 by the American Physical Therapy Association.
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The Multiprofessional Team
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