The involvement of older people in their rehabilitation: Generating a substantive grounded theory

Aims: To identify the process of involvement in rehabilitation and produce a substantive theory of involvement based on data from a grounded theory study. Methods: Qualitative data were collected longitudinally from 4 older people and 15 health care staff during the older people's stay in a rehabilitation unit in the UK and after discharge. Data were collected as recorded interviews with the older person in rehabilitation, interviews with their practitioners and routine conversations between the participants and staff. Results: This study describes the components of involvement and how they interact within therapeutic relationships. The results suggest that involvement in rehabilitation operates through a set of involvement attributes, which are either psychologically based or action-based. The involvement attributes are: vision and incentive with goal planning, setting and achievement; a disposition towards rehabilitation; personal learning; and risk taking, all of which operate within therapeutic relationships. To be maximally involved, the involvement attributes have to be strong and balanced, with alignment between the psychologically based and action-based attributes. Conclusions: The findings of this research and substantive grounded theory suggest that the process of involvement is managed through a set of involvement attributes within therapeutic relationships. This substantive theory of involvement is associated with earlier research and provides a fuller understanding of the process of involvement of older people in rehabilitation. Further research is now needed to demonstrate the transferability of this substantive theory in other settings and with other client groups.