72 Physiotherapy Research International

Physiother. Res. Int. 11(2) 72–83 (2006)

Published online in Wiley InterScience
(www.interscience.wiley.com) DOI: 10.1002/pri.325

Therapists’ experiences and perceptions

of teamwork in neurological
rehabilitation: reasoning behind the team
approach, structure and composition of
the team and teamworking processes
KITTY MARIA SUDDICK University of Brighton, UK
LORRAINE DE SOUZA Centre for Research in Rehabilitation, School of Health Sciences
and Social Care, Brunel University, UK

ABSTRACT  Background and Purpose.  Teamwork and the interdisciplinary team

approach have been strongly advocated for use in the provision of neurological rehabilita-
tion services. However, whether teamwork has been adopted, and in what form, has yet to
be established. The present study investigated therapists’ experiences and perceptions of
the reasoning behind the team approach in neurological rehabilitation, the structure and
composition of the team within which they worked and the teamworking process  Method.  This
article reports part of an exploratory qualitative study. Five occupational therapists and
five physiotherapists from three teams: a rehabilitation centre; a community team; and a
stroke unit based within the UK. Semi-structured interviews were undertaken with each
participant and then transcribed. Content and thematic analysis of the qualitative interview
data was carried out, with respondents validating both the transcription and analysis
stages.  Results.  Perceived composition and structure of the neurological rehabilitation
team was variable across teams and between individual team members. There was disparity
as to whether patients were included within the neurological team; the interdisciplinary
team approach had not been consistently adopted and there were sub-teams and other team
memberships in existence. Reasoning behind the team approach supported the perceived
benefits of teamwork from a number of perspectives, and the activities reported as part of
the team process were diverse.  Conclusions.  Different teams may choose to use different
strategies depending on the aims and context of the team effort. In some instances inter-
disciplinary teamwork and patient-centred approaches were not adopted consistently and
the process of teamwork itself is both complex and diverse. Copyright © 2006 John Wiley
& Sons, Ltd.

Key words:  neurological rehabilitation, team, team process, teamwork

 Physiother. Res. Int. 11: 72–83 (2006)

Copyright © 2006 John Wiley & Sons, Ltd DOI: 10.1002/pri
 Therapists’ experiences of teamwork in neurological rehabilitation 73
INTRODUCTION
Teamwork has developed within the UK as
a key component in healthcare delivery
within the National Health Service (NHS).
It has also been hailed as the cornerstone of
rehabilitation (Diller, 1990) and has been
supported by governmental directives (DoH,
2000) and professional bodies (Chartered
Society of Physiotherapy, 2002; College of
Occupational Therapists, 2000).
Within the provision of neurological
rehabilitation services, teamwork has been
reported to have a number of benefits:
• to provide comprehensive co-ordinated
care to the neurologically impaired
(LaRocca and Kalb, 1992; McGrath and
Davis, 1992)
• to promote problem solving and goal-
directed activity within the team (Feiger
and Schmitt 1979)
• to improve the outcome of the interven-
tion (Melvin, 1980)
• to promote motivation, generalization
and a patient-centred service (McGrath
and Davis, 1992).
Although these benefits have been presented
within the literature they have not been sub-
stantiated. Nor have the potential disadvan-
tages, such as the resource and cost
implications, been explored. There also
remains a lack of transparency concerning
the defining characteristics of the main team-
work models: multidisciplinary and inter­
disciplinary (Nieuwenhuis, 1993). A team
whose members utilize more traditional
methods of working in the confines of their
own professional knowledge base whilst still
co-operating is considered to be operating
under a multidisciplinary framework (Diller,
1990; Barr, 1997). Interdisciplinary team-
work requires greater collaboration and has
 Physiother. Res. Int. 11: 72–83 (2006)
Copyright © 2006 John Wiley & Sons, Ltd
been defined as a model of care delivery and
group interaction that will improve the
outcome of the intervention far and beyond
that of the summative effort of team members
working in isolation (Melvin, 1980). The
broadly defined characteristics of an interdis-
ciplinary team which have been supported
by the relevant literature include: an empha-
sis on social- or handicap-related goals (role
assumption) (McGrath and Davis, 1992);
shared responsibility for goals across profes-
sional disciplines (McGrath and Davis, 1992;
Schut and Stam, 1994); commitment to
shared working practices (collaboration)
(Barr, 1997) and joint decision-making
(Coopman, 2001); and an integrative client-
centred service (Halstead et al., 1986; Davis
et al., 1992). However, there have been no
clear guidelines or substantive research that
has clearly defined or characterized the dif-
ferences between the two.
Despite a number of individually reported
team cases from the UK (Davis et al., 1992;
McGrath et al., 1995; Stead and Leonard,
1995; Newall et al., 1997) and the USA
(Halstead et al., 1986), whether teamwork
models have been adopted as a working
framework for neurological rehabilitation
teams has not been fully established. Ques-
tions also remain about the specific compo-
sition and structure of neurological
rehabilitation teams in all varieties of setting.
Each team has individual functions, charac-
teristics and membership as well as environ-
mental influences, and they can be
geographically and organizationally diverse
(Boaden and Leaviss, 2000).
Adding to the complex nature of team-
work in neurological rehabilitation is the
teamworking process: the functions and
activities which a team carries out together,
formal and informal, structured or non-
structured, and the factors that influence
these processes. To investigate teamwork in
DOI: 10.1002/pri
74 Suddick and De Souza
practice, researchers have explored the key
activities that a team must carry out to opti-
mize its effectiveness and the characteristics
of effective or ineffective teams. The litera-
ture has covered healthcare teams across a
number of specialist areas. However, research
which has focused on the neurological reha-
bilitation teamwork process has been
minimal, and has concentrated on a particu-
lar aspect of the process, that is, communi-
cation at ward meetings, role overlap (Booth
and Hewison, 2002), the effect of using team
notes and care pathways (Gibbon et al.,
2002) or on a particular team in isolation
(Halstead et al., 1986; Davis et al., 1992;
McGrath et al., 1995; Stead and Leonard
1995; Dawson and Bartlett, 1996).
Research has not attempted to explore the
teamworking process in its entirety, although
some research on stroke units has attempted
indirectly to support the contribution of
teamwork to the stroke unit benefits reported
in the literature (functional ability, survival
and patients’ placement on discharge)
(Stroke Unit Triallists Collaboration, 1997;
Indredavik et al., 1999), it has not provided
conclusive supporting evidence, and there
has been limited discussion in the literature
on the distinction between the different but
related aspects of neurological rehabilitation
team outcomes. Effectiveness can be consid-
ered from the perspective of clients and from
management and professional perspectives
(Curry and Herbert, 1998); it may focus on
the rehabilitation outcome, or on other
factors such as the levels of satisfaction
between the members of the neurological
team and other quality of care indicators.
Evaluating team effectiveness is the subject
of another paper which is currently under
review.
The aim of the present study was to
explore the perceptions of occupational ther-
apists and physiotherapists towards the
 Physiother. Res. Int. 11: 72–83 (2006)
Copyright © 2006 John Wiley & Sons, Ltd
teams within which they worked. This explo-
ration included the structure, composition
and membership of the team, the reasoning
behind the use of the teamwork approach in
neurological rehabilitation and the types of
activities that were carried out within the
teams as part of the teamworking process.
METHOD
The physiotherapy and occupational therapy
managers of 13 neurological rehabilitation
teams were approached to ascertain whether
they wished to participate in the study. The
teams approached included stroke units,
specialist inpatient or outpatient neurologi-
cal services, specialist neurological rehabili-
tation centres and community neurological
rehabilitation teams based in the Thames
region. Four responses, from the occupa-
tional therapy and physiotherapy staff from
two stroke units, one rehabilitation centre
and one community team, were received.
The first three teams which responded were
selected to continue. Ethical approval for the
study was then obtained from the relevant
local research ethics committees.
The research procedure consisted of
nine stages (Figure 1). Using a topic guide,
semi-structured interviews were carried out
involving five occupational therapists and
five physiotherapists working within three
teams involved with the neurological reha-
bilitation of adults. The three teams were: a
team at a neurological rehabilitation centre
(Team A); a community neurorehabilitation
team (Team B); and a specialist stroke unit
team (Team C). The sample was purposive,
and occupational therapists and physiothera-
pists with less than one month’s experience
of working within the teams were excluded.
Interviewees 1–6 were occupational ther-
apists and physiotherapists from Team A;
interviewees 7 and 8 were from Team B; and
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 Therapists’ experiences of teamwork in neurological rehabilitation 75

Stage 1
Interview

Stage 2 Interview transcribed

Stage 3 Interview transcript

Stage 4 Validation of transcription (Stage 2)

Stage 5 Validated transcript

Stage 6 Content analysis and pamphlet

development

Initial pamphlet
Stage 7

Stage 8 Validation of analysis and pamphlet

development (Stage 6) by
respondent

Stage 9 Final vaildated pamphlet (indicating

respondent’s comments at validation)

FIGURE 1:  Procedure for data collection and processing.

interviewees 9 and 10 were working in Team
C. The number of years since qualification
for the study population ranged from 1.5 to
13 years (mean 5.75 years, standard devia-
tion (SD) 3.61 years) and length of time in
the current job ranged from two months to
five years (mean 1.9 years, SD 1.66 years).
Eight participants were female, the remain-
ing two were a male occupational therapist
and a male physiotherapist, both working
within Team A.
All interviews were carried out by the
researcher and a reflective account was
completed after each interview (Keats, 2000)
to minimize researcher bias (Stage 1). The
interviews were tape-recorded and tran-

 Physiother. Res. Int. 11: 72–83 (2006)

Copyright © 2006 John Wiley & Sons, Ltd DOI: 10.1002/pri
76 Suddick and De Souza
scribed verbatim (Stage 2 and Stage 3).
Respondents were then asked to validate the
transcript (Stage 4). Each validated tran-
script (Stage 5) was then organized through
content analysis (Kvale, 1996) (Stage 6) by
colour coding the information dealing with
the main themes: team composition; mem-
bership and structure; the teamwork process;
and reasoning behind teamwork in neuro-
logical rehabilitation. Each participant was
sent a pamphlet (Stage 7) that summarized
the main themes developed from the analy-
sis of their transcript and was asked to vali-
date the information presented (Stage 8).
The original pamphlet was then amended
to include the respondents comments (Stage
9).
RESULTS
Reasoning behind teamwork in
neurological rehabilitation
Figure 2 and Figure 3 summarize the themes
that were generated about why the neuro-
Patient benefits
Team is able to deal with individual holistic needs of the patient
Patient-focused or patient-centred care
Continuity between therapists
Treatment is smooth and as appropriate as possible: best treatment and
best advice
Using and combining different skills improves outcome for client
Work jointly on what the patient wants to achieve, different skills are
used and ideas are shared
Patient and relatives are involved in the goal setting process
Individual team members benefit
Sharing the load
Prevents team members being insular in their practice
Learning experience: learn about other peoples roles and increase
understanding and knowledge
Enjoyable
FIGURE 2:  Perceived reasoning behind teamwork in neurological rehabilitation: patient benefits and indi-
vidual team members’ benefits.
 Physiother. Res. Int. 11: 72–83 (2006)
Copyright © 2006 John Wiley & Sons, Ltd
logical team members felt that they worked
in a team.
There were similarities and differences
in the reported reasoning behind teamwork
in neurological rehabilitation in the three
teams studied, and between members of the
same team. Members of Team B did not
focus on efficient service provision benefits
or individual benefits, but instead reported
team benefits and patient benefits. There was
a more substantial difference between Team
C and the other two teams in the reasoning
provided, as well as between the two team
members from Team C. The occupational
therapist from the stoke unit reasoned that
teamwork improved service efficiency and
effectiveness, whilst the physiotherapist
from the same team focused on individual
team members and team benefits.
Structure and composition of the
neurological rehabilitation teams
The participants held different views and
opinions on how their teams were struc-
Service
Team
Individual team
members
Patient
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 Therapists’ experiences of teamwork in neurological rehabilitation 77

Team benefits
Allows sharing of knowledge and expertise or skills
Can manage gaps of knowledge by assisting each other
Allows integration and co-ordination of treatment across disciplines
Allows sharing of information and sharing of responsibility
Team members can take on different roles within the team Service
Everyone is working towards common goals
Nurturing and supportive role Team
Assists in the provision of 24-hour rehabilitation

Individual team
members

Service benefits
Effective rehabilitation: knowing what everyone’s working on and
where you can be most effective Patient
Effective service: achieving goals
Synergistic: more effective working together
Limits repetition and improves efficiency
Time efficient: tasks delegated to right people and well co-ordinated
Organises discharges better
Team members are not doing in appropriate jobs or tasks

FIGURE 3:  Perceived reasoning behind teamwork in neurological rehabilitation: service benefits and team
benefits.

tured, and who was included within each
team. The study population consistently
stated that the team included nurses and
therapists (occupational therapy, physiother-
apy and speech and language therapy). The
inclusion of other team members (patients,
doctors, social workers, physiotherapy assis-
tants, occupational therapy technicians) was
more variable. The occupational therapist
and the physiotherapist from the community
rehabilitation team felt that their team
extended to include administration and cler-
ical staff, and had even wider-ranging col-
laborative links with community psychiatry,
general practitioners, district nurses and
another community domiciliary team. The
occupational therapist and the physiothera-
pist from the stroke unit included doctors, a
dietician, a care manager and a specific
stroke co-ordinator within their team.
Another difference reported across the
three teams was the involvement of patients.
Two respondents felt that patients’ cognitive
ability limited how much they could be
included, others suggested that patients should
be included but were not, or that patients were
considered to be outside the team:
‘I would say with the way things are at the
moment, yes, the patient and family are quite
excluded. But it is partly because it is such an
intense rehab environment, and it is partly just
having access to the family for their involve-
ment. Also, patients not necessarily knowing
what their rehab needs are, because they
haven’t got the expertise.’ (Occupational ther-
apist, Team A)
There was a considerable consensus between
participants from Team A and Team C that
their teams were functioning as a multidis-
ciplinary team. It was not clear whether
Team B was working along a multidisci-
plinary or interdisciplinary framework,
although the occupational therapist and the
physiotherapist from Team B did report the
use of a number of interdisciplinary team-
work processes.
Despite the occupational therapists and
physiotherapists from Team A agreeing that

 Physiother. Res. Int. 11: 72–83 (2006)

Copyright © 2006 John Wiley & Sons, Ltd DOI: 10.1002/pri
78 Suddick and De Souza

their team functioned as a multidisciplinary included goal planning, meetings, joint

team, they held differing perceptions about
its specific structure: one participant intro-
duced the concept of a core treating team
and a secondary team. There was confusion
as to whether there was a specific leader in
place, and the existence of sub-teams and
other team memberships were reported by a
number of participants. Only one of the par-
ticipants made no distinction, and held the
opinion that they worked within a single
team.
The teamworking process in
neurological rehabilitation
Dimensions of the teamworking process
which were reported across the three teams
working practices and social aspects. Some
participants highlighted additional aspects:
communication, organizational, service
development and environmental factors, and
discussed how these interrelated (Figure 4).
Goal planning
The three teams used goal planning but there
were variations in how it was structured,
organized and the level of involvement of
patients and their families.
Team A participants discussed a goal-
planning process with a specific protocol
and a recognized Chair who co-ordinated
patients’ admission, goal-planning meet-
ings, liaised with patients, was responsible

FIGURE 4:  Dimensions of the teamworking process in neurological rehabilitation. No parentheses = dimen-
sion reported across all three teams; (A) = reported by Team A; (B) = reported by Team B; (C) = reported by
Team C; arrows demonstrate interdependence and overlap between dimensions.

 Physiother. Res. Int. 11: 72–83 (2006)

Copyright © 2006 John Wiley & Sons, Ltd DOI: 10.1002/pri
 Therapists’ experiences of teamwork in neurological rehabilitation 79
for co-ordinating and leading professionals
in the patient team, and could advise on the
setting of long-term goals. This process also
included a ‘plan of assessment’ meeting
which clarified areas of assessment for the
client, and which was carried out in the
second week, in addition to meetings with
patients and their families.
Team B had a separate allocated time
each week to meet for goal-setting, but
without the client.
The occupational therapist and physio-
therapist based in Team C explained that
patient goals were set and discussed within
their weekly multidisciplinary team meeting
using an multidisciplinary team goal-setting
form, again without patient or family
attendance.
Although Team A and Team B reported
more interdisciplinary teamwork practices
than Team C, team members from both Team
A and Team B reported that they did not
necessarily include patients and their fami-
lies more within the goal-setting process.
Joint working practices
All participants reported the use of joint
working practices in the teamworking
process. However, a few participants sug-
gested that these practices would not occur
across the board of the multidisciplinary
team in which they worked, with one par-
ticipant reporting that joint working worked
better with some team members than others.
Team A and Team B had weekly team train-
ing. Participants from Team C did not report
team training as part of their teamworking
process.
Communication
Three participants raised the issue of team
communication as part of the teamworking
 Physiother. Res. Int. 11: 72–83 (2006)
Copyright © 2006 John Wiley & Sons, Ltd
process. Interviewees 4, 6 and 7 reported the
use of formal and informal aspects of com-
munication, written and verbal. With regard
to the informal aspects:
‘.  .  .  and just informal liasons, you know, with
people. I mean, they seem so critical to me, to
sort of bonding, therapists to therapists and
just sharing the load.’ (Occupational therapist,
Team A)
Organizational structures,
environmental and social factors
When discussing the teamworking process,
three study participants also referred to envi-
ronmental factors. Team B shared a team
base and the physiotherapist from this team
suggested that this encouraged more infor-
mal team communication and reflection:
‘Because we sit in an open plan office, and a
lot of things get discussed outside, someone,
one of our locums earlier on this year called
them “fringe meetings”, “In the office.”,
sounds a bit like chatting, but it is quite sort
of soft, but they are the really important things
that get talked about often, I couldn’t really
put my finger on what it is, but, just as impor-
tant.’ (Physiotherapist, Team B)
Additional aspects of the teamworking
process which were reported included social
events between team members, the weekly
timetabling of activities and treatment ses-
sions for patients and the use of patient folders,
the nursing diary and named nurses.
DISCUSSION
Reasoning behind teamwork in
neurological rehabilitation
The findings suggest that teamwork is per-
ceived to have benefits from a number of
perspectives. The occupational therapists
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80 Suddick and De Souza
and physiotherapists studied reported diverse
benefits to patients, the team, individual
team members and in improving the effec-
tiveness and efficiency of the service.
This reasoning may be influenced by the
teams’ context, and, more specifically, the
aims and priorities of the team. Team
members of inpatient acute neurological
services may work to different team priori-
ties which focus on service efficiency. In
addition, members of the same team may
hold different perceptions of the possible
rewards from teamwork. Pound and Ebrahim
(1997) demonstrated that different views
were held by team members caring for
stroke patients in regard to their role, priori-
ties and successful outcome from rehabilita-
tion. These views may affect what the
members of the team wish their teamwork
to achieve. Lack of open discussion of these
issues could lead to discord and disenchant-
ment: the perceived rewards from teamwork
may not be met, or other team members may
be perceived to be working in opposition to
those aims. Other influences may be team
members’ own personal experience of team-
work, the extent of their clinical experience
and their profession.
Structure and composition of the
neurological rehabilitation team
Occupational therapists and physiotherapists
from the three teams discussed the structure
and membership of their teams. With regard
to the type of team that they worked in, 8/10
participants felt that they were working in a
multi disciplinary team, suggesting that the
use of inter disciplinary teamworking has
not been adopted consistently within neuro-
logical rehabilitation despite the literature
advocating its use (Diller, 1990; LaRocca
and Kalb, 1992; McGrath and Davis, 1992;
Strasser et al., 1994). The participants
 Physiother. Res. Int. 11: 72–83 (2006)
Copyright © 2006 John Wiley & Sons, Ltd
reported aspects of shared working prac-
tices, decision-making and collaboration
(Barr, 1997; Coopman, 2001) across the
three teams. However, the additional char­
acteristics of interdisciplinary working —
whether the team was focusing on
participation goals, sharing the responsibil-
ity of the goals equally across all members
of the team and whether it was providing a
specific client-centred service — could not
be clearly determined from the findings of
the present study.
These findings support those of Pethy-
bridge (2004), who discovered a number of
different team approaches adopted by four
different medical, stroke and discharge
teams based in an acute hospital in the UK.
The differences across the three teams in the
present study may reflect the different team
structure and composition required for the
context in which that particular team works.
A team may wish to be structured more in
accordance with the social model of disabil-
ity and functioning, and may choose to
restrict the introduction of more ‘medical’
models of working (Robinson, 1998; Moly-
neux, 2001). Variations between the reported
team membership observed between the
occupational therapists and physiotherapists
from the same team may also be attributed
to differing opinions about the composition
of a team, and/or the perceived contribution
or role of certain members of the team.
The findings from this project suggest
that in some neurological rehabilitation
teams patients and their carers are not per-
ceived to be members of the team, and are
excluded from contributing to aspects of the
team work process. This finding concurs
with the opinions of the medical and stroke
team members studied by Pethybridge
(2004). The neurological team members
investigated in the present study considered
this exclusion to be caused by the team’s
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 Therapists’ experiences of teamwork in neurological rehabilitation 81
needs, those of the client or additional factors
and variables. These findings suggest that,
in some instances, team members may be
attempting to include patients in the team-
working process more than other members
of their team. Some team members may be
aiming to work within a more patient-centred
framework, which could be a source of
discord for both patients and team relation-
ships. Conversely, there may be appropriate
decisions made about the exclusion of
patients that have not yet been clearly
addressed within the research literature.
The reasoning behind the perceived type
of teamwork model used by the teams (both
multi- and interdisciplinary) was beyond the
scope of the present study. Whether the neu-
rorehabilitation teams studied had chosen a
specific framework or model of teamwork to
meet their needs, whether they were limited
to a specific model by other factors or
whether they used a combination of
models depending on the needs of clients
(Nieuwenhuis, 1993) was unclear. The lack
of clear guidelines on interdisciplinary
working practices meant that no further
conclusions could be drawn.
Perhaps the lack of clear guidance on the
subject of teamwork in the neurological
rehabilitation literature may be attributed to
the complexity of the process. ‘Models of
teamwork’ may be an outdated ideal in the
provision of rehabilitation services which
are attempting to adapt to each individual
patient, and they may evolve alongside the
varying demands of the systems and con-
texts under which they work (Diller, 1990).
This notion was supported by written
feedback from one of the respondents at the
pamphlet validation stage:
‘I suppose it is because teamwork is such a
complex process to analyse. It is not a recipe
of ingredients like food or objects. Teamwork
 Physiother. Res. Int. 11: 72–83 (2006)
Copyright © 2006 John Wiley & Sons, Ltd
depends on a team made up of people. Person-
alities are complex and changing. I think that
a teamwork model only exists in theory. Each
team has its own model.’ (Physiotherapist,
Team C)
The continued reference to models of team-
work in the provision of neurological ser-
vices may therefore restrict the adequate
description and investigation of the collab-
orative methods by which the team approach
is delivered.
The teamwork processes in
neurological rehabilitation
These findings have provided a large amount
of information which has begun to answer
the research question about team functions
and processes that are perceived to occur
within the three teams studied. A large
number of the teamworking processes that
have been described in previous research
were reportedly in use across the three
teams. But there were also differences —
suggesting that different teams may choose
different strategies depending on the aims
and context of the team effort. Correspond-
ing with the findings of Playford et al. (2000),
all three teams used goal planning when
working in their team, but there were varia-
tions in how it was structured, organized
and in the level of patient involvement. These
goal-planning processes did not relate to
other multi- or interdisciplinary methods of
working reported by the team members, or
to the type of team (multi- or interdisciplin-
ary) that they felt they worked in.
Investment in team training (Barr, 1997)
or a lack of team training (Gibbon, 1999)
have been discussed as influencing how a
team works together, and regular staff train-
ing was perceived to be an important con-
tributor to the benefits of stroke unit care
(Stroke Unit Triallists Collaboration, 1997).
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82 Suddick and De Souza
These findings may support greater invest-
ment in the training of the neurological reha-
bilitation team, and, in particular, in stroke
unit teams. Having an opportunity to reflect
on how well a team works together, either
formally or informally, may ensure that a
team and its members have the opportunity
to evaluate their performance and learn
together (Barr, 1997). Neurological teams
that are not undertaking reflection may be
limited in the development of the team and
the service which it provides (Molyneux,
2001). The role of reflection in the develop-
ment and sustaining of optimum methods of
working within available team resources
requires further investigation. Evaluating
team effectiveness and the critical factors for
effective and ineffective teamwork is the
subject of another paper.
IMPLICATIONS
There has been no similar research under-
taken on teamwork in neurological reha-
bilitation within the UK. The present study
has therefore provided a starting point for
the development of hypotheses and future
areas of research in this field. These study
findings suggest that the occupational
therapists and physiotherapists studied
believed the rhetoric behind the benefits of
teamwork in neurological rehabilitation
(Pound and Ebrahim, 2000). Some of the
participants had worked in neurological
rehabilitation teams for a number of years
and that they were still reporting these
perceived benefits suggests that these neu-
rorehabilitation team members’ percep-
tions corresponded with the literature
supporting the wide-ranging positive
implications of teamwork. The present
study has also demonstrated that interdis-
ciplinary teamwork has not been adopted
consistently by all neurological teams, that
 Physiother. Res. Int. 11: 72–83 (2006)
Copyright © 2006 John Wiley & Sons, Ltd
there are differences in the structure and
membership of teams and that there are an
extensive and varied number of functions
and processes which occur as part of
working within different types of neuro-
logical rehabilitation teams. There needs
to be a deeper understanding of the nature
of these processes before their effective-
ness can be evaluated.
Further research must explore the issue
of patient and carer involvement within
teams, and whether the neurological reha-
bilitation service users: patients, clients and
family members, have similar or conflicting
perceptions and experiences of neurological
teamwork. The development of a more adap-
tive and realistic neurological rehabilitation
team model also needs to be evaluated and
developed through future study.
REFERENCES
Barr O. Interdisciplinary teamwork: consideration of
the challenges. British Journal of Nursing 1997;
6(17): 1005–1010.
Boaden N, Leaviss J. Putting teamwork in context.
Medical Education 2000; 34: 921–927.
Booth J, Hewison A. Role overlap between occupa-
tional therapy and physiotherapy during in-patient
stroke rehabilitation: an exploratory study. Journal
of Interprofessional Care 2002; 16: 31–40.
Chartered Society of Physiotherapy. Rules of Pro­
fessional Conduct (second edition). London: CSP,
2002.
College of Occupational Therapists. Code of Ethics
and Professional Conduct for Occupational Ther-
apists. London: COT, 2000.
Coopman SJ. Democracy, performance, and out-
comes in interdisciplinary health care teams.
Journal of Business Communication 2001; 37:
261–286.
Curry A, Herbert D. Continuous improvement in
public services — a way forward. Managing
Service Quality 1998; 8: 339–349.
Davis A, Davis S, Moss N, Marks J, McGrath J,
Hovard L et al. First steps towards an inter­
disciplinary approach to rehabilitation. Clinical
Rehabilitation 1992; 6: 237–244.
DOI: 10.1002/pri
 Therapists’ experiences of teamwork in neurological rehabilitation 83
Dawson J, Bartlett E. Change within interdisciplinary
teamwork: one unit’s experience. British Journal
of Therapy and Rehabilitation 1996; 3: 219–222.
Department of Health. The NHS Plan — A Plan for
Investment, A Plan for Reform. London: DoH,
2000.
Diller L. Congress Presidential Address: Fostering
the interdisciplinary team, fostering research in a
society in transition. Archives of Physical and
Medical Rehabilitation 1990; 71: 275–278.
Feiger SM, Schmitt MH. Collegiality in interdisci-
plinary health teams: its measurement and its
effects. Social Science and Medicine 1979; 13A:
217–229.
Gibbon B. An investigation of inter-professional col-
laboration in stroke rehabilitation team conferences.
Journal of Clinical Nursing 1999; 8: 246–252.
Gibbon B, Watkins C, Barer D, Waters K, Davies S,
Lightbody L et al. Can staff attitudes to team
working in stroke care be improved? Journal of
Advanced Nursing 2002; 40: 105–111.
Halstead LS, Rintala DH, Kanellos M, Griffin B,
Higgins L, Rheinecker S et al. The innovative
rehabilitation team: an experiment in team build-
ing. Archives of Physical and Medical Rehabilita-
tion 1986; 67: 357–361.
Indredavik B, Bakke F, Slordahl SA, Rokseth R,
H?heim LL. Treatment in a combined acute and
rehabilitation stroke unit. Which aspects are most
important? Stroke 1999; May: 917–923.
Keats DM. Interviewing. A Practical Guide for
Students and Professionals. Milton Keynes: Open
University Press, 2000.
Kvale S. Interviews. An Introduction to Qualitative
Research Interviewing. Thousand Oaks, CA:
Sage Publications, 1996.
LaRocca NG, Kalb RC. Efficacy of rehabilitation in
multiple sclerosis. Journal of Neurorehabilitation
1992; 6: 147–155.
McGrath JR, Davis AM. Rehabilitation: where are we
going and how do we get there? Clinical Rehabili-
tation 1992; 6: 225–235.
McGrath JR, Marks JA, Davis AM. Towards interdis-
ciplinary rehabilitation: further developments
at Rivermead Rehabilitation Centre. Clinical
Rehabilitation 1995; 9: 320–326.
Melvin JL. Interdisciplinary and multidisciplinary
activities and the ACRM. Archives of Physical
Medicine and Rehabilitation 1980; 61: 379–380.
Molyneux J. Interprofessional team-working: what
makes teams work well? Journal of Interprofes-
sional Care 2001; 15: 29–35.
 Physiother. Res. Int. 11: 72–83 (2006)
Copyright © 2006 John Wiley & Sons, Ltd
Newall JT, Wood VA, Langton Hewer R. Develop-
ment of a neurological rehabilitation environment:
an observational study. Clinical Rehabilitation
1997; 11: 146–155.
Nieuwenhuis R. Teamwork in Neurology (Therapy in
Practice 40) London: Chapman & Hall, 1993.
Pethybridge J. How team working influences dis-
charge planning form hospital: a study of four
multi-disciplinary teams in an acute hospital in
England. Journal of Interprofessional Care 2004;
18: 29–41.
Playford ED, Dawson L, Limbert V, Smith M, Ward
CD, Wells R. Goal setting in rehabilitation: report
of a workshop to explore professionals percep-
tions of goal setting. Clinical Rehabilitation 2000;
14: 491–496.
Pound P, Ebrahim S. Redefining doing something:
health professionals views on their role in the care
of stroke patients. Physiotherapy Research Inter-
national 1997; 2: 12–28.
Pound, P. Ebrahim, S. Rhetoric and reality in stroke
patient care. Social Science and Medicine 2000;
51: 1437–1446.
Robinson I. The rehabilitation of patients with long
term physical impairments: the social context of
professional roles. Clinical Rehabilitation 1998;
2: 339–347.
Schut HA, Stam HJ. Goals in rehabilitation team-
work. Disability and Rehabilitation 1994; 16:
223–226.
Stead A, Leonard MC. Changing to a client-focused
quality service through more effective team-
work. Health Manpower Management 1995; 21:
23–27.
Strasser DC, Falconer JA, Martino-Saltzmann D.
The rehabilitation team: staff perceptions of the
hospital environment, the interdisciplinary team
environment, and interprofessional relations.
Archives of Physical and Medical Rehabilitation
1994; 75: 177–182.
Stroke Unit Triallists Collaboration. Collaborative
systemic review of the randomised trials of organ-
ised inpatient (stroke unit) care after stroke.
British Medical Journal 1997; 314: 1151–1159.
Address correspondence to: Ms Kitty M Suddick,
Senior Lecturer in Physiotherapy, School of Health
Professions, University of Brighton, Robert Dodd
Building, 49 Darley Road, Eastbourne, East Sussex
BN20 7UR, UK (E-mail: k.m.suddick@bton.ac.uk).
(Submitted October 2005; accepted February 2006)
DOI: 10.1002/pri