“It Was Definitely an Eye-Opener to Me”—People with Disabilities’ and Health Professionals’ Perceptions on Combining Traditional Indoor Rehabilitation Practice with an Urban Green Rehabilitation Context
Abstract
:1. Background
2. Materials and Methods
2.1. Methodology and Theoretical Frame
2.2. Setting
2.3. Sampling
2.4. Data Source
2.5. Data Generation
2.6. Analysis
- Initial impression and coding in NVivo; organisation and comparison of data. The research team read through all transcripts, followed by a joint discussion of the initial impression of the data. The first author re-read and coded all data material using NVivo. Codes were developed based on the empirical data and the research aim, and interpretations were informed and guided by Schein’s culture framework [37].
- Fractured coded data were subsumed using descriptive labels. The first author mapped data by hand to enhance mobility and expand on the associations in the data, followed by a joint discussion with the research team.
- Themes and patterns were identified and tested through interpretive processes. The first author condensed and drafted memos on each theme with illustrative quotes, which were tested and challenged by the research team through written and verbal input. All quotes were translated from original language to English with the assistance of a professional translator.
- Interpretations and relationships of the thematic findings; extraction of main messages arising from key insights in the data. The first author condensed and drafted the thematic findings, which were qualified and co-authored by the research team through joint critical discussions and are illustrated by a figure in the results section.
2.7. Ethical Considerations
3. Results
3.1. Ambivalence Due to Contextual Change
“When you think about the health professional dilemmas, they are certainly there. When you on the one hand can find the meaningfulness and the motivation for the persons in rehabilitation out in the real world, right. And on the other hand, as a health professional can have doubts if it complies with the high-quality standards for a rehabilitation process, you know.”Occupational therapist, >50 years
“In the beginning, I had serious doubts if this was actually useful. Is it not just a sloppy job? We just walk around, right? This was of course because I didn’t know anything about it and was really insecure. Along the process, I realised that maybe we were not completely precise with the physical rehabilitation part, but it [the physical part] played a secondary role. There was a bunch of other benefits … And seeing how people improved…it made me change my attitude, you see.”Physiotherapist, 40–50 years
“I hadn’t thought about going outside would be considered exercise. I thought it was a bit special in the beginning. But I could see that after the first five minutes you feel ready because there’s a good atmosphere and it’s another way of exercising. It was definitely an eye-opener to me.”Participant recovering from a back injury, <40 years
3.2. Negotiating Rehabilitation Assumptions
“We are in a health professional world where measuring things is a top priority…our municipality is very much in favour of data-documented work. Well, it is not a lot of what we do outside that can be measured just like that. We are really stuck in this way of thinking!”Occupational therapist, 40–50 years
“You have a lot of methods and so on in your work. But right outside the door, there will be a park where you can re-think your way of managing your practice. It’s a new opportunity of making the person in rehabilitation re-start, you know, after being ill … You have to go in front as professionals. It really means a lot that you take the first step. And that you dare to! To cross the barrier, I can hear you have. You all have a kind of barrier—is this beneficial or what? Will we be a little ridiculed for this? NO you won’t [be ridiculed]!”Participant recovering from stroke, >50 years
“There are many things I was not aware of…especially the part about challenging the established testing approach—that we have to document a result of the rehabilitation period they [the people in rehabilitation] have been through. Usually we make a 6-min walk test or a mini balance evaluation system test, and then think…we can’t really do that outside, yet.”Physiotherapist, 40–50 years
3.3. Expanding the Frame of Rehabilitation
“Well, it shouldn’t be either or; it should be a combination of the two. Because we get something positive from both worlds … Sometimes we as physiotherapists want to focus and only think about the bodily functions and the physical part. But it is also about daring to come out and bring the whole person [attending rehabilitation] into play, you know. It may not just be about the body, but you get a lot of other things. And I believe, that is also what rehabilitation is about.”Physiotherapist, 40–50 years
“The outdoor environment is everybody’s space. We work with the whole person and not just the body … And it may seem that we just play outside in the green area, but it all has a deeper meaning, and it also takes a lot to both be able to see—what is actually needed—and to take a step back and know when to assist and when you have to step back and allow the persons [in rehabilitation] to do it their own way; or to allow the participants to interact.”Physiotherapist, >50 years
“The transformation from rehabilitation or training to your everyday life has been really easy…in this way it has meant that we [he and his family] use the green areas in our neighbourhood more than ever before (laughing) … If you had only trained in a fitness centre or a gym, then you would probably have thought about the fitness centre when transferring it to your everyday life. And this can be difficult if you live far away [from a fitness centre or gym] or you, as it has been mentioned, don’t want to be part of a formal sports community or fitness centre.”Participant recovering from a back injury, <40 years
4. Discussion
5. Methodological Considerations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Centre | Conventional Indoor Rehabilitation Services | Rehabilitation in Outdoor Contexts | Types of Disabilities Handled |
---|---|---|---|
Orthopaedic Rehabilitation Centre: A multidisciplinary service for people with musculoskeletal injuries |
| Nature training programmes in teams delivered outside during all seasons of the year. Additionally, some individual consultations and team programmes were performed outside during the summer season. |
|
Neurological Rehabilitation Centre: A multidisciplinary service for people with acquired brain injury or related neurological injuries |
| Balance training in teams was often performed outside during the summer season. Additionally, some individual consultations and home visits were performed outside, in the garden or in the local community. |
|
Dementia Activity and Rehabilitation Centre: A day and activity service for community-dwelling elderly with dementia or related issues |
| Strolls in the park in suitable weather conditions. Weekly excursions to nearby communities and nature parks. |
|
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Madsen, L.S.; Poulsen, D.V.; Nielsen, C.V.; Handberg, C. “It Was Definitely an Eye-Opener to Me”—People with Disabilities’ and Health Professionals’ Perceptions on Combining Traditional Indoor Rehabilitation Practice with an Urban Green Rehabilitation Context. Int. J. Environ. Res. Public Health 2021, 18, 5994. https://doi.org/10.3390/ijerph18115994
Madsen LS, Poulsen DV, Nielsen CV, Handberg C. “It Was Definitely an Eye-Opener to Me”—People with Disabilities’ and Health Professionals’ Perceptions on Combining Traditional Indoor Rehabilitation Practice with an Urban Green Rehabilitation Context. International Journal of Environmental Research and Public Health. 2021; 18(11):5994. https://doi.org/10.3390/ijerph18115994
Chicago/Turabian StyleMadsen, Louise Sofia, Dorthe Varning Poulsen, Claus Vinther Nielsen, and Charlotte Handberg. 2021. "“It Was Definitely an Eye-Opener to Me”—People with Disabilities’ and Health Professionals’ Perceptions on Combining Traditional Indoor Rehabilitation Practice with an Urban Green Rehabilitation Context" International Journal of Environmental Research and Public Health 18, no. 11: 5994. https://doi.org/10.3390/ijerph18115994
APA StyleMadsen, L. S., Poulsen, D. V., Nielsen, C. V., & Handberg, C. (2021). “It Was Definitely an Eye-Opener to Me”—People with Disabilities’ and Health Professionals’ Perceptions on Combining Traditional Indoor Rehabilitation Practice with an Urban Green Rehabilitation Context. International Journal of Environmental Research and Public Health, 18(11), 5994. https://doi.org/10.3390/ijerph18115994