How do Patients, Relatives and Healthcare Professionals View Person-centered Rehabilitation.

Development of the PEC-REHAB Instrument: Enhancing and Measuring Person-Centeredness in Rehabilitation Services, a Qualitative Study

This research project aims to integrate insights from marketing and rehabilitation sciences to investigate Person Centered in rehabilitation.

The research objectives are

1. to better understand what Person Centered Rehabilitation means in rehabilitation,
2. to understand how Person Centered Rehabilitation can be enhanced
3. to develop an instrument that can be used as a quality indicator to evaluate and monitor Person Centered Rehabilitation in rehabilitation
4. to understand the impact of Person Centered Rehabilitation on key outcomes in rehabilitation.

To recruit respondents, we will work together with different rehabilitation centers and hospitals with a rehabilitation department.

The interviews will be based on the Trajectory Touchpoint Technique. The interviews will be transcribed and uploaded in NVivo 14. To code the data, we will use the Gioia method which offers a systematic approach to bring qualitative rigor in qualitative research and contains of four steps.

1. We will code the data based on first-order terms.
2. we will systematically examine these first-order terms to organize them into second-order theory-centric themes.
3. we will investigate whether it is possible to categorize the second-order themes into aggregate dimensions which serve to summarize the key components of the emerging theory
4. when we have the full set of first-order terms, second-order themes and aggregate dimensions, we will have all ingredients for building a data structure. The data structure provides a graphical presentation of how we progressed from raw data to themes and dimensions.

Person-centeredness (PEC) has emerged as a key concept in modern healthcare, marking a shift away from disease-centered models toward approaches that acknowledge and respond to the unique needs, wishes, and contexts of each individual. Within rehabilitation services, this holistic orientation is especially pertinent, given the complex interplay between physical, emotional, psychological, and social factors influencing recovery and reintegration into daily life.

Despite growing recognition of its importance, PEC remains under-defined and insufficiently operationalized in rehabilitation settings. Current efforts to assess PEC tend to focus on outcomes such as patient satisfaction or functional status, rather than directly measuring the degree to which care is aligned with individual needs and preferences. A valid and reliable measurement instrument to evaluate PEC from the patient's perspective is currently lacking.

This study addresses that gap by developing the PEC-REHAB instrument. It aims to conceptualize PEC in rehabilitation, identify its key dimensions, explore ways to enhance PEC, and ultimately validate a tool to serve as a quality indicator. This protocol describes the second step of the qualitative phase of the study, which consists of in-depth interviews with patients and their informal caregivers.

The qualitative research follows a two-step structure:

1. Interviews and focus groups with rehabilitation care professionals.
2. In-depth interviews with patients and their relatives.

Data collection in this second step uses the Trajectory Touchpoint Technique (TTT)-a person-centered qualitative methodology that helps respondents articulate their lived experiences through visual prompts representing key stages of the rehabilitation journey. These stages include:

• First symptoms
• Pre-arrival planning
• Admission
• Stay in the rehabilitation center or department
• Discharge and aftercare

Each stage is represented by a laminated picture card showing various potential touchpoints. Respondents are encouraged to use these cards flexibly to narrate their experiences, ensuring a comprehensive yet personalized account of their rehabilitation journey. The TTT approach fosters inclusivity, reduces interviewer bias, and enhances respondent engagement.

The interviews also include semi-structured questions focused on:

• Respondents' understanding and experience of person-centeredness
• Perceived gaps and areas for improvement in PEC delivery
• The perceived importance and impact of PEC on well-being

All interviews will be audio-recorded with consent and transcribed verbatim. Data analysis will follow the Gioia methodology, a rigorous approach to qualitative coding that progresses through:

1. First-order coding based on respondents' own words
2. Development of second-order theory-based themes
3. Aggregation into overarching dimensions
4. Creation of a structured data model to inform theory development

Insights derived from this qualitative phase will directly inform the design and content of the PEC-REHAB instrument. The tool will be validated in a subsequent quantitative phase and used to assess whether rehabilitation services align with person-centered care principles from the patient's perspective.

Ultimately, this research aims to support the implementation of PEC in rehabilitation, provide actionable quality indicators, and contribute to improved outcomes by ensuring that rehabilitation services respond to the individuality of each patient.

Patients and relatives

Inclusion Criteria:

• (1) are or were admitted to a rehabilitation centre or is related/ acquainted with someone admitted to a rehabilitation centre
• (2) are older than 18 years
• (3) speak the Dutch language
• (4) suffer from a non-congenital brain injury, neurological or locomotor condition can participate in this study.

Exclusion Criteria:

(1) did not sign informed consent

Healthcare professionals and board members, staff members and representatives

Inclusion Criteria:

1. are employed at a rehabilitation centre
2. are older than 18 years
3. speak the Dutch language

Exclusion Criteria:

(1) did not sign informed consent

Healthcare students

Inclusion Criteria:

1. did internships in a rehabilitation centre
2. are older than 18 years
3. speak the Dutch language

Exclusion Criteria:

(1) did not sign informed consent