Acquired brain injury rehabilitation: dilemmas in neurological physiotherapy across healthcare settings

People with acquired brain injury (PwABI) are usually hospitalized for emergency care and often require both specialist and primary healthcare long-term follow-up. Higher intensity rehabilitation featuring early intervention is recommended. This study investigated how implementation of redistributed responsibilities in Norway affects neurological physiotherapy practice within and across healthcare levels and how physiotherapists experience and address these changes. We performed qualitative research interviews with physiotherapists, complemented by non-participatory field observations of physiotherapist treatments, during the rehabilitation of 10 PwABI from specialist to primary healthcare. We performed a content analysis of the interviews connected to perspectives on professionalism. Physiotherapy services for PwABI seem to be constrained, as reforms shift responsibilities for rehabilitative work between healthcare levels. Earlier hospital transfer, structural limitations and resource insufficiencies challenge the ability to provide good-quality and intensive physiotherapy services for PwABI, especially in primary care. Furthermore, the traditional division of responsibilities and organizational boundaries appears to limit expectations of future treatment and to influence the delivery of recommendations across healthcare levels. This study draws attention to the possible unintended consequences of reform initiatives, which should be considered during further development and efficiency improvements in rehabilitative work across healthcare levels