QUALITY OF EXPERIENCE DURING HOSPITAL REHABILITATION: THE ROLE OF AUTONOMY AND PERCEIVED CHALLENGES
Creators: name: SARTORI, RAFFAELA DARIA GIOVANNA
Publisher: name: Universit� degli Studi di Milano
Year: 2012

description: In most studies on rehabilitation, well-being is synonymous with high levels of physical autonomy. However, little attention is paid to the psychological dimensions of rehabilitation and the role of subjective experience in promoting the patient?s recovery and functioning. Several studies have highlighted that one of the core dimensions of well-being is the perception of high challenges in daily activities, matched with the individual skills and abilities. In order to design patient-centered programs this aspect should be evaluated jointly with physical autonomy. 
Moving from these premises, the study was aimed at investigating the quality of experience reported by hospitalized patients engaged in a rehabilitation training. Specific attention was paid to the impact of daily activities and participants? level of autonomy on the promotion of well-being and resource mobilization. 
Participants were 50 patients (30 women and 20 men aged 25-87) admitted to a Rehabilitation Unit for orthopaedic pathologies (80%), neurological disorders (18%) and respiratory syndromes (2%). Sample features were consistent with the hospital yearly pathology and gender distribution. 
Data were collected through Experience Sampling Method (ESM), providing on-line information on the experience fluctuation during daily life. For one week participants carried an electronic device sending acoustic randomized signals 6-8 times a day. At signal receipt, they provided self-reports about ongoing activities and the associated experience. Likert-type scales measured cognitive, emotional and motivational psychological dimensions, including challenges perceived in the activity and related personal skills. Patients? autonomy was assessed through Barthel index (BI). Before data analysis participants were divided into three groups, characterized by low (LBI), moderate (MBI) and high (HBI) levels of autonomy respectively. 
Answers to open-ended questions were coded and grouped into categories. The values of scaled variables were standardized before analysis. Analysis of variance was used to compare the quality of experience across groups. The experience fluctuation pattern related to the level of perceived challenges and skills was analyzed across activities. To examine the role of autonomy level and typology of activities in influencing participants? quality of experience, a series of regression analyses were run adopting a multilevel (ML) approach.
Findings showed that participants reported motor rehabilitation activities in one tenth of their self-reports, mostly associating them with the perception of high challenges, and in particular with optimal experience, characterized by concentration, engagement, high challenges balanced with adequate personal skills. Anxiety, characterized by high challenges and low skills, high engagement, but also control of the situation, was more frequently reported by LBI participants. During the most frequent daily activities ? personal care and leisure ? participants reported instead low challenging experiences of apathy and boredom. Interactions were mainly associated with the perception of high challenges, and in particular with optimal experience.
ML showed that the type of activity represented a significant predictor of the quality of experience, while the level of autonomy had a modest impact on it. Cognitive dimensions of the experience, and perceived challenges and skills significantly increased during rehabilitation tasks, in particular for HBI patients. On the other hand, similar experiential patterns were identified in all groups in the other major daily activities, regardless of participants? level of autonomy.
Results suggest that the added value of physiotherapy as an opportunity for promoting psychological well-being should be more carefully taken into account in rehabilitation programs. On the opposite, the prominently negative experiences associated with the other daily activities point to the need for organizational changes supporting patients? autonomy and active resources mobilization.