Barriers and Facilitators to Rehabilitation Care of Individuals with Spatial Neglect: A Qualitative Study of Professional Views

Abstract Objective To identify barriers and facilitators to achieving optimal inpatient rehabilitation outcome among individuals with spatial neglect (SN). Design Cross-sectional, semi-structured focus group discussions Setting Rehabilitation hospitals Participants 15 occupational therapists and 14 physical therapists treating patients with SN on three campuses of a rehabilitation hospital system. Six focus group sessions were conducted and audio-recorded for transcription. Interventions Not applicable. Main Outcome Measures Not applicable. Results Participants identified several patient-related characteristics that posed barriers to treatment, including the symptoms of SN itself, cognitive issues, physical weakness, co-morbidities, and reduced therapy engagement. Supportive family members were considered a key facilitator, while lack of preparedness to assume caregiving roles, poor understanding of SN and rehabilitation goals, and inadequate levels of involvement were family-related barriers to successful treatment. Participants expressed that having resources and technologies available at one's center to support SN treatment facilitated positive outcomes and perceived limited staff knowledge and skills and poor inter-clinician communication as barriers to treatment. At the healthcare system level, barriers included a lack of responsive measures of SN progress and insurer-related issues. Strong continuity of care between transitions was considered an important factor for enabling effective treatment. Conclusions Barriers and facilitators to the current practice of SN care were identified from occupational and physical therapists’ point of view. Opportunities exist to promote identified facilitators, and minimize barriers, to improve SN rehabilitation. The present study makes a unique contribution in identifying specific needs for innovative interventions that involve family support and training, promotion of inter-disciplinary collaboration, development of interprofessional vocabulary, and continuous treatment and follow-up assessment for SN through care transitions.