“What standard should we set?”: A qualitative study of rehabilitation professionals’ perspectives on rehabilitation needs after traumatic injuries
DOI:
https://doi.org/10.2340/jrm.v57.44087Keywords:
Physical trauma, focus groups, rehabilitation, health care professionalsAbstract
Objective: To assess rehabilitation professionals’ perspectives on unmet rehabilitation needs in patients with traumatic injuries and how to bridge the gap between met and unmet needs.
Design: Semi-structured focus-group interviews analysed using a reflexive thematic approach.
Methods: Eighteen strategically sampled health professionals (67% female, aged 27–56 years) from specialist and community-based rehabilitation services in Northern and South-Eastern Norway were interviewed regarding their perspectives on alignment of current rehabilitation services with patient needs, reasons for misalignment, and potential service improvements.
Results: Care continuity and multidisciplinary collaboration was identified as essential for high-quality rehabilitation services. Unmet needs were noted in community-based services for cognitive and mental health support, as well as financial assistance for patients. Health professionals faced challenges prioritizing patient needs and expressed frustration with not being able to provide legally mandated services. Contributing factors included insufficient resources, lack of competency standards, and weak organizational structure. Suggested improvements were early rehabilitation assessments and stronger collaboration between specialist and community services.
Conclusions: Strengthening community-based rehabilitation for traumatic injuries requires establishing professional competency standards, stronger coordination across care levels, and greater integration of psychosocial support. Advancing these dimensions calls for critical reflection on clinical practice, service organization, and health policy.
Downloads
References
World Health Organization. Injuries and violence: the facts 2014. Geneva: World Health Organization; 2014.
Andelic N, Ye J, Tornas S, Roe C, Lu J, Bautz-Holter E, et al. Cost-effectiveness analysis of an early-initiated, continuous chain of rehabilitation after severe traumatic brain injury. J Neurotrauma 2014; 31: 1313–1320.
https://doi.org/10.1089/neu.2013.3292 DOI: https://doi.org/10.1089/neu.2013.3292
Corcoran JR, Herbsman JM, Bushnik T, Van Lew S, Stolfi A, Parkin K, et al. Early rehabilitation in the medical and surgical intensive care units for patients with and without mechanical ventilation: an interprofessional performance improvement project. PM R 2017; 9: 113–119.
https://doi.org/10.1016/j.pmrj.2016.06.015 DOI: https://doi.org/10.1016/j.pmrj.2016.06.015
Steiner E, Murg-Argeny M, Steltzer H. The severe traumatic brain injury in Austria: early rehabilitative treatment and outcome. J Trauma Manag Outcomes 2016; 10: 5.
https://doi.org/10.1186/s13032-016-0035-8 DOI: https://doi.org/10.1186/s13032-016-0035-8
Moksnes HO, Andelic N, Schafer C, Anke A, Soberg HL, Roe C, et al. Unmet rehabilitation needs in the first 6 months post-injury in a trauma centre population with moderate-to-severe traumatic injuries. J Rehabil Med 2024; 56: jrm40078.
https://doi.org/10.2340/jrm.v56.40078 DOI: https://doi.org/10.2340/jrm.v56.40078
Andelic N, Roe C, Tenovuo O, Azouvi P, Dawes H, Majdan M, et al. Unmet rehabilitation needs after traumatic brain injury across Europe: results from the CENTER-TBI study. J Clin Med 2021; 10: 1035.
https://doi.org/10.3390/jcm10051035 DOI: https://doi.org/10.3390/jcm10051035
Borg SJ, Borg DN, Arora M, Middleton JW, Marshall R, Nunn A, et al. Unmet healthcare needs, access to services and experiences with health providers among persons with spinal cord injury in Australia. Spinal Cord 2024; 62: 396–405.
https://doi.org/10.1038/s41393-024-00997-4 DOI: https://doi.org/10.1038/s41393-024-00997-4
Kamenov K, Mills JA, Chatterji S, Cieza A. Needs and unmet needs for rehabilitation services: a scoping review. Disabil Rehabil 2019; 41: 1227–1237.
https://doi.org/10.1080/09638288.2017.1422036 DOI: https://doi.org/10.1080/09638288.2017.1422036
Jones SM, West C, Rappoport J, Akhtar K. Rehabilitation outcomes based on service provision and geographical location for patients with multiple trauma: a mixed-method systematic review. Injury 2023; 54: 887–895.
https://doi.org/10.1016/j.injury.2023.01.034 DOI: https://doi.org/10.1016/j.injury.2023.01.034
Andelic N, Moksnes H, Rasmussen MS, Schafer C, Hellstrom T, Howe EI, et al. Needs for community-based rehabilitation services and support 12 months after moderate and severe physical traumatic injuries: a brief report. Am J Phys Med Rehabil 2024; 103: 740–744.
https://doi.org/10.1097/PHM.0000000000002492 DOI: https://doi.org/10.1097/PHM.0000000000002492
Mahoney EJ, Silva MA, Reljic T, Dams-O’Connor K, Hammond FM, Monden KR, et al. Rehabilitation needs at 5 years post-traumatic brain injury: a VA TBI model systems study. J Head Trauma Rehabil 2021; 36: 175–185.
https://doi.org/10.1097/HTR.0000000000000629 DOI: https://doi.org/10.1097/HTR.0000000000000629
Christie N, Beckett K, Earthy S, Kellezi B, Sleney J, Barnes J, et al. Seeking support after hospitalisation for injury: a nested qualitative study of the role of primary care. Br J Gen Pract 2016; 66: e24–31.
https://doi.org/10.3399/bjgp15X688141 DOI: https://doi.org/10.3399/bjgp15X688141
Copley A, McAllister L, Wilson L. We finally learnt to demand: consumers’ access to rehabilitation following traumatic brain injury. Brain Impairment 2013; 14: 436–449.
https://doi.org/10.1017/BrImp.2013.32 DOI: https://doi.org/10.1017/BrImp.2013.32
Goodridge D, Rogers M, Klassen L, Jeffery B, Knox K, Rohatinsky N, et al. Access to health and support services: perspectives of people living with a long-term traumatic spinal cord injury in rural and urban areas. Disabil Rehabil 2015; 37: 1401–1410.
https://doi.org/10.3109/09638288.2014.972593 DOI: https://doi.org/10.3109/09638288.2014.972593
Odumuyiwa T, Kennedy M, Norman A, Holloway M, Suffield F, Forrest H, et al. Improving access to social care services following acquired brain injury: a needs analysis. J Long Term Care 2019; 10.31389/jltc.6.
https://doi.org/10.31389/jltc.6 DOI: https://doi.org/10.31389/jltc.6
Schulz-Heik RJ, Poole JH, Dahdah MN, Sullivan C, Adamson MM, Date ES, et al. Service needs and barriers to care five or more years after moderate to severe TBI among Veterans. Brain Inj 2017; 31: 1287–1293.
https://doi.org/10.1080/02699052.2017.1307449 DOI: https://doi.org/10.1080/02699052.2017.1307449
World Health Organization. WHO rehabilitation competency framework. 2020 [cited 2025 5 October]. Available from: https://www.who.int/teams/noncommunicable-diseases/sensory-functions-disability-and-rehabilitation/rehabilitation-competency-framework
National Institute for Care Excellence (NICE). Rehabilitation after traumatic injury. London: NICE; 2022.
Bradshaw J. Taxonomy of social need. In: McLachlan G, editor. Problems and progress in medical care: essays on current research. London: Oxford University Press; 1972: p. 71–82.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3: 77–101.
https://doi.org/10.1191/1478088706qp063oa DOI: https://doi.org/10.1191/1478088706qp063oa
Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport, Exerc Health 2019; 11: 589–597.
https://doi.org/10.1080/2159676X.2019.1628806 DOI: https://doi.org/10.1080/2159676X.2019.1628806
Ndoro S. Effective multidisciplinary working: the key to high-quality care. Br J Nurs 2014; 23: 724–727.
https://doi.org/10.12968/bjon.2014.23.13.724 DOI: https://doi.org/10.12968/bjon.2014.23.13.724
Ljungholm L, Edin-Liljegren A, Ekstedt M, Klinga C. What is needed for continuity of care and how can we achieve it? Perceptions among multiprofessionals on the chronic care trajectory. BMC Health Serv Res 2022; 22: 686.
https://doi.org/10.1186/s12913-022-08023-0 DOI: https://doi.org/10.1186/s12913-022-08023-0
Kellezi B, Earthy S, Sleney J, Beckett K, Barnes J, Christie N, et al. What can trauma patients’ experiences and perspectives tell us about the perceived quality of trauma care? A qualitative study set within the UK National Health Service. Injury 2020; 51: 1231–1237. https://doi.org/https://doi.org/10.1016/j.injury.2020.02.063 DOI: https://doi.org/10.1016/j.injury.2020.02.063
McKinley S, Nagy S, Stein-Parbury J, Bramwell M, Hudson J. Vulnerability and security in seriously ill patients in intensive care. Intensive Crit Care Nurs 2002; 18: 27–36.
https://doi.org/10.1054/iccn.2002.1611 DOI: https://doi.org/10.1054/iccn.2002.1611
Menachemi N, Rahurkar S, Harle CA, Vest JR. The benefits of health information exchange: an updated systematic review. J Am Med Inform Assoc 2018; 25: 1259–1265.
https://doi.org/10.1093/jamia/ocy035 DOI: https://doi.org/10.1093/jamia/ocy035
Riksrevisjonen. Riksrevisjonens undersøkelse av rehabilitering i helse- og omsorgstjenestene. Oslo; 2024. Report No. 3:12.
Foster M, Allen S, Fleming J. Unmet health and rehabilitation needs of people with long-term neurological conditions in Queensland, Australia. Health Soc Care Community 2015; 23: 292–303.
https://doi.org/10.1111/hsc.12146 DOI: https://doi.org/10.1111/hsc.12146
Graham SK, Cameron ID. A survey of rehabilitation services in Australia. Aust Health Rev 2008; 32: 392–399.
https://doi.org/10.1071/ah080392 DOI: https://doi.org/10.1071/AH080392
Gorgoraptis N, Zaw-Linn J, Feeney C, Tenorio-Jimenez C, Niemi M, Malik A, et al. Cognitive impairment and health-related quality of life following traumatic brain injury. NeuroRehabilitation 2019; 44: 321–331.
https://doi.org/10.3233/NRE-182618 DOI: https://doi.org/10.3233/NRE-182618
Shepherd-Banigan ME, Shapiro A, McDuffie JR, Brancu M, Sperber NR, Van Houtven CH, et al. Interventions that support or involve caregivers or families of patients with traumatic injury: a systematic review. J Gen Intern Med 2018; 33: 1177–1186.
https://doi.org/10.1007/s11606-018-4417-7 DOI: https://doi.org/10.1007/s11606-018-4417-7
Torisson G, Minthon L, Stavenow L, Londos E. Cognitive impairment is undetected in medical inpatients: a study of mortality and recognition amongst healthcare professionals. BMC Geriatrics 2012; 12: 47.
https://doi.org/10.1186/1471-2318-12-47 DOI: https://doi.org/10.1186/1471-2318-12-47
Turner A, Eccles FJ, Elvish R, Simpson J, Keady J. The experience of caring for patients with dementia within a general hospital setting: a meta-synthesis of the qualitative literature. Aging Ment Health 2017; 21: 66–76.
https://doi.org/10.1080/13607863.2015.1109057 DOI: https://doi.org/10.1080/13607863.2015.1109057
Dekker J, de Groot V, Ter Steeg AM, Vloothuis J, Holla J, Collette E, et al. Setting meaningful goals in rehabilitation: rationale and practical tool. Clin Rehabil 2020; 34: 3–12.
https://doi.org/10.1177/0269215519876299 DOI: https://doi.org/10.1177/0269215519876299
Roodbeen RTJ, Lugtenberg M, Pöstges H, Lansink KWW, Theeuwes HP, de Jongh MAC, et al. Experiences of recovery and posthospital care needs of working-age adults after physical trauma: a qualitative focus group study. BMJ Open 2022; 12: e053330.
https://doi.org/10.1136/bmjopen-2021-053330 DOI: https://doi.org/10.1136/bmjopen-2021-053330
World Health Organization, International Labour Office, Unesco. CBR: a strategy for rehabilitation, equalization of opportunities, poverty reduction and social inclusion of people with disabilities: joint position paper/International Labour Organization, United Nations Educational, Scientific and Cultural Organization and the World Health Organization. 2005. Geneva: World Health Organization; 2005.
Ekenes M, Oldeide O, Wehling E. Allocating municipal services to individuals with complex rehabilitation needs: a discourse analysis of individual administrative decision letters. BMC Health Serv Res 2024; 24: 460.
https://doi.org/10.1186/s12913-024-10972-7 DOI: https://doi.org/10.1186/s12913-024-10972-7
Jansen-van Vuuren JM, Aldersey HM. Training needs of community-based rehabilitation workers for the effective implementation of CBR programmes. Disability, CBR & Inclusive Development 2019; 29: 5–31.
https://doi.org/10.5463/dcid.v29i3.742 DOI: https://doi.org/10.5463/dcid.v29i3.742
Kraft M, Blomberg K, Hedman AM. The health care professionals’ perspectives of collaboration in rehabilitation: an interview study. Int J Older People Nurs 2014; 9: 209–216.
https://doi.org/10.1111/opn.12020 DOI: https://doi.org/10.1111/opn.12020
Skumsnes R, Thygesen H, Groven KS. Facilitators and barriers to communication in rehabilitation services across healthcare levels: a qualitative case study in a Norwegian context. BMC Health Serv Res 2023; 23: 1353.
https://doi.org/10.1186/s12913-023-10222-2 DOI: https://doi.org/10.1186/s12913-023-10222-2
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2025 Emilie Isager Howe, Helene L. Søberg, Cecilie Røe, Marianne Løvstad, Nada Andelic
This work is licensed under a Creative Commons Attribution 4.0 International License.
All digitalized JRM contents is available freely online. The Foundation for Rehabilitation Medicine owns the copyright for all material published until volume 40 (2008), as from volume 41 (2009) authors retain copyright to their work and as from volume 49 (2017) the journal has been published Open Access, under CC-BY-NC licences (unless otherwise specified). The CC-BY-NC licenses allow third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
From 2024, articles are published under the CC-BY licence. This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.
