Canvassing patient perspectives

Dr. Cheryl Cott knows the rehabilitation system inside out. An eminent researcher, she has also practiced as a physical therapist and advocated for family members who have physical disabilities.

Her experiences in these roles have attuned her to the crucial importance of "client-centred" rehabilitation. Simply put, this means actively involving patients so that their care reflects their individual needs.

"We're talking about clients and health professionals in partnership. Each brings strengths to the table," explains Dr. Cott, a Senior Scientist at Toronto Rehab.

Dr. Cott has gone straight to the people who know best-the patients-to find out what they want. "People want their rehabilitation program to be individualized. They don't want their limitations identified without consideration given to their own strengths," she says. "They want to be treated with respect and dignity and to have the emotional challenges they are facing acknowledged by staff."

Identifying what "client-centred" rehabilitation looks like is one thing. Measuring it is another. So Dr. Cott set out in 2002 to design a tool to do just that. The result was the Client-Centred Rehabilitation Questionnaire (CCRQ), which she developed in partnership with Toronto Rehab and St. John's Rehabilitation Hospital.

Today, the questionnaire is sent to all patients discharged from designated rehabilitation beds in Ontario. Hospitals can see how they are doing by checking results on an interactive website, maintained and regularly updated by NRC+Picker, the research firm that manages the data collection.

Dr. Cheryl Cott (right)

Quick Biography

Dr. Cott is a Senior Scientist at Toronto Rehab, where she heads the Participation Team. She is also an Associate Professor in the Department of Physical Therapy and Graduate Department of Rehabilitation Science at the University of Toronto, with a cross appointment to the Department of Public Health Sciences. A physical therapist and social gerontologist, she is Deputy Director of the Arthritis Community Research and Evaluation Unit at the University Health Network, a member of the Hospital Report Research Collaborative and Co-principal Investigator of Hospital Report: Rehabilitation. Dr. Cott has published and presented widely in her area of research, which focuses on understanding the aspects of rehabilitation service delivery that are important for quality care for older adults with chronic illness and disability. She holds a PhD from the University of Toronto.

The questionnaire provides a wealth of information for hospitals. Patients are asked to agree or disagree with 30 statements, such as: "The program staff treated me as a person instead of just another case"; "I was encouraged to participate in setting my goals"; and "I felt comfortable expressing my feelings to program staff."

Says Dr. Cott: "The interactive web site is an exceptional tool that can be used for quality improvement by administrators."

The questionnaire results are also used in Hospital Report: Rehabilitation, a joint initiative of the Ontario Hospital Association and Ontario government that reports on the performance of provincial hospitals with designated rehabilitation beds. Dr. Cott is Co-principal Investigator of the Report. She is responsible for two "quadrants" - client perspectives, and system integration and change.

Hospital Report 2003: Rehabilitation was the first to incorporate results from Dr. Cott's CCRQ questionnaire.

"The findings emphasized that hospitals need do a better job of including patients and families in the whole rehabilitation process," she says. "They also need to pay more attention to the transition from rehabilitation back to the community."

That transition is a prime interest of Dr. Cott's-and a cause for concern on her part. In focus groups, she has heard patients say that, once back in the community, they feel "isolated" and "disconnected." Dr. Cott plans to study in greater depth the transition from rehabilitation facilities back to the community.

"Rehabilitation patients have conditions they will have to live with for the rest of their lives. So they need ongoing access to rehabilitation as they age, as their abilities change and as technologies develop that might help them," says Dr. Cott. "How do we keep them able to function at their highest level?"

With funding from the Canadian Institutes of Health Research, Dr. Cott will use the CCRQ questionnaire to study specific patient-care units at several rehabilitation hospitals. Her goal: to see what is working best from a client-centred perspective.

"If you are more client-centred, then hopefully the client is better prepared for life in the real world when they get out there. So we'll also follow up with people six months after they've been discharged to see how they are doing."

As someone whose father, sister and nephew have all had to deal with the challenges of physical disabilities, Dr. Cott knows that rehabilitation is a long-term thing. And she's determined to make sure it is "client-centred" at every step along the way. Says Dr. Cott: "It's something I feel very passionate about."

Curriculum Vitae