Perceptions of self-efficacy and rehabilitation among neurologically disabled adults

Objective: To explore constructs relevant to self-efficacy in neurological rehabilitation. Design: Qualitative methods using semi-structured interviews. Setting: Specialist neurological rehabilitation unit, Liverpool, UK. Subjects: Twenty-four patients (12 male) with experience of inpatient rehabilitation, aged 17-59 (mean 38.1) years at onset, with diagnoses of stroke (n = 8), traumatic brain injury (n = 6) or other monophasic neurological impairment (n = 10). Results: Eleven themes emerged from the data that reflect self-efficacy beliefs: self-reliance and independence were deemed important and many patients recognized the importance of determination, making time to take an active role and working in partnership with the multidisciplinary team. Patients had complex information needs but were able to use goal setting and the vicarious experiences of other inpatients to map out the stages of their own recovery. It was important for patients to be able to recognize for themselves that they were making progress and they valued external reassurance on this from other patients, staff and visitors. A number of difficulties were identified that interfered with their developing self-efficacy in rehabilitation, such as structuring their time. Two different models for rehabilitation emerged from the data, 'recovery' and 'adaptation'. Conclusions: Patients consistently identified 11 factors falling in the supraordinate themes of self, others and process, and these influenced their self-efficacy to participate in neurological rehabilitation. Patients consider rehabilitation in terms of either an 'adaptation' or 'recovery' model.