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Study Design: In-depth, longitudinal grounded theory study Objectives: To investigate the management of discharging patients with stroke from physiotherapy, and to investigate the experiences of patients and physiotherapists of this process Methods: A series of interviews were conducted with 16 patients and their physiotherapists over a period of 1 year. These were supplemented by field observations of physiotherapy sessions. Patients were included if they had experienced their first incident of stroke, were aged under 80 years, and had no other major medical condition. Interviews involved discussion of the understanding and expectations of recovery, information given or received about recovery, expected duration of physiotherapy, the discharge process and its impact, and plans following discharge from physiotherapy. All interviews were taped and transcribed. Grounded theory was used to analyse the interview data. This involved line-by-line coding for issues relating to the study objectives and analysis of this coded data for emerging themes. Independent coding of initial transcripts by two researchers and open discussion amongst the research group of the emerging themes were used to establish the trustworthiness of this analysis. Results: This study found that while physiotherapists believe discharge occurs once patients have reached a 'plateau' in their physical recovery, they do not tend to use the discharge process as a forum for discussing patients' expectations of recovery nor disappointment that patients might have regarding lack of expected recovery. Instead, physiotherapists use communication techniques that encourage the maintenance of hope and the deferral of disappointment. Such techniques included discussion of 'natural recovery' that might occur following discharge and the promise of a 'review' at some time in the future (which consequentially, for the patients in this study, did not always happen). Home exercise programmes were also often prescribed on discharge without explicit discussion of whether the aim of such exercise was maintenance of current abilities or achievement of new gains - again maintaining the patients' optimism for further recovery. In contrast to the physiotherapists, patients tended to believe that they received a timelimited 'course' of physiotherapy, with discharge occurring at the end of their treatment period. They also felt discharge decisions were influenced by staffing shortages, waiting lists, and the severity of other patients' needs. Patients often felt they were discharged before they had reached their expected level of recovery, and were surprised when discharge occurred. Compared with the physiotherapists' belief that the patients' rate of recovery had reached a 'plateau', patients exited physiotherapy services with the belief that they should continue to prioritise pursuit of recovery over alternatives such as emotional adjustment to disability or physical adaptation. The negative consequences associated with this included patients pursuing expensive and possibly ineffective courses of action (such as private funded treatment), believing they had greater potential for recovery than their physiotherapists did, and delaying acceptance of strategies to address their altered abilities and identity. Conclusions: This data suggests that physiotherapists have difficulty dealing with patients' disappointment regarding the extent of their recovery, so tend to use techniques to maintain optimism and hope in favour of confronting distress and disappointment. Work needs to occur to develop ways that physiotherapists can address the possibility of patients' disappointment regarding stroke outcomes. [ABSTRACT FROM AUTHOR]

Studies the recovery of ambulation during inpatient rehabilitation. Objectives of the study; Assessment of the methods used; Evaluation of the outcome measures.