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Professional approaches to stroke treatment in Japan: a relationship-centred model.

RATIONALE
To examine how stroke professionals in Japan approach rehabilitation therapy.


METHODS
This qualitative study was based on Grounded Theory. Data collection included (1) non-participatory observation, (2) non-structured interviews, and (3) semi-structured interviews. A national hospital located in an urban area of the prefecture of Kanagawa in Japan specializing in the treatment of stroke and other neurological disorders. Stroke professionals (doctors, nurses, clinical psychologists, physiotherapists, occupational therapists and speech therapists), patients and patients' families.


RESULTS
(1) Professionals recognized patient motivation as a factor related to rehabilitation outcome, but believed it to be a direct product of fostered fiduciary relationships and effective patient interaction. (2) Professionals regarded fiduciary relationships as the most important determinant of rehabilitation outcome. (3) Professionals adapted their behaviour and communication style in aims of fostering fiduciary relationships. These findings informed a three-component model of care: the Relationship-centred Model.


CONCLUSIONS
The Relationship-centred Model describes how stroke professionals in Japan approach rehabilitative therapy. This model of care may be preferred by patients in other countries who also favour a family-centred approach to decision making.