The Importance of Support Groups in Rehabilitation

When you imagine the work of healthcare practitioners, you probably think of identifying symptoms, making diagnoses and building treatment plans.

Indeed, that’s what the large majority of our training focuses on.

But for many practitioners – especially someone like myself who uses biomechanics (the application of physics to the human body) as part of the assessment and treatment plan – it’s easy to think entirely in terms of the hard science of orthotics, and disregard the emotional aspect of the condition.  We are taught that ‘gravity does not discriminate’ and that biomechanics can be applied to anyone regardless of the emotional and mental health.  But while this may be true, the rehabilitation of a patient – even with a purely musculoskeletal condition that does not affect the brain – is not all about physics and biomechanics.

Over my 9 years of training and practice, I have observed (anecdotally) a correlation between positive rehabilitation results and involvement in social support groups. I looked into the research literature. As it turns out my initial observation is well-supported, and there are several other fascinating and clinically useful conclusions.

Reviewing the literature

One systematic review performed in 2013 looked at studies that examined stroke survivors and the health related quality of life (HRQoL)¹.   This review concluded that there was an association between perceived social support and the HRQoL.  The authors said that the patient’s satisfaction with social support at two weeks and three months post stroke were both associated with better HRQoL.  This suggests an importance on getting a patient affiliated with a support group quickly after the event.  This review also found a significant association between more social companionship as well as a larger network size (sum of friends, family, support group members) and the HRQoL.  These results all point towards participation in a support group having a beneficial result.

Why might this be the case?  Well, my specialty of orthotics is all about the application of physics to the human body – which is about as far from psychology as you can get. But here are my thoughts. When going through an adverse health event as significant as a stroke or a cardiac issue, the emotional response will be complex and multi-faceted.  This response can have a significant effect on a patient’s mental and emotional wellbeing.  A study looking at the support groups and their effect on anxiety and depression highlighted a positive relationship between those who went to support groups and their anxiety levels.  Specifically, it found patients’ anxiety levels decreased after participating in support group sessions².

Interestingly, this study also found that this effect was decreased or nullified if their support partner also took part in the same support group².  The authors postulated that the presence of the support partners in the support groups created a response of overprotectiveness on behalf of the support partners and this in turn limited the autonomy of the patients resulting in higher anxiety². The results of this study suggest that support groups can be beneficial on the anxiety level of the patients but that it may warrant separate support groups for the patient and the support partner.

The impact of support groups specifically for the support partners was also examined in another review looking at stroke patient and their support partners³.  So we know that the participation of the patient in a support group can have a positive effect on the health of the patient (as pointed out in this study as well as the previously mentioned studies).  But this review also came to the conclusion that the participation of the support partner, in a support group specifically for support partners, can have a beneficial effect on the health of the patient³.  This I find amazing!

If you are the support partner you can help improve the health of your loved one by attending support groups designed specifically for support partners.

In these particular support groups, participants focused on problem solving strategies as well as stress coping strategies for the support partners. This goes along with the notion that you have to take care of yourself before you can take care of others.

Another result that I found interesting came up in a couple of different studies.  It was reported that those who participated in support groups often contacted and met up with members of the support groups outside of the designated times^4,5.  I think that this result is very interesting, and makes a strong – perhaps definitive – case for the importance and efficacy of support groups.

In the final study I’d like to highlight in this article, the authors conducted lengthy interviews with patients to achieve a greater sense of clarity on the motives and thought processes guiding support group participants. The authors suggested the relationships built with group members helped provide a sense of belonging within the group, and encouraged participants to feel comfortable asserting their right to belong in their broader communities⁴.

Conclusion

The key takeaway from this post is that if you have recently gone through a major health event, please don’t discount the potential value of participation in a support group. I’ve personally watched many of my patients thrive as a result of their participation in support groups, and the scientific literature bears out my anecdotal impression.

And if you are a clinician –orthotic or otherwise – I hope you give some thought to the promotion of support groups as an evidence-based practice with a very strong potential to improve your patient outcomes.

In conclusion, I hope this post has emphasized the importance of support groups on the rehabilitation of an individual to you as much as it has for myself while researching it.  I hope to start a list of different support groups in the area as part of this website to help connect individuals faced with various challenges in their lives with others in similar circumstances.

Please feel free to comment if you have any questions about support group promotion as a clinical best practice, and please share what support groups have done for you or your loved one. Thanks for reading!

– James Christensen

 References

1. Kruitholf W., van Mierlo, M., Visser-Meily, J., van Heugten, C., and Post, M.    Associations between social support and stroke survivors’ health related quality of life – A systematic review.  Patient Education and Counseling.  93, 169-176.
2. Lopez de Roda, A., Moreno, E., Montero, I. and Churnin, S. Support groups and cardiac rehabilitation:  Effects of partner participation on anxiety and depression.  Spanish Journal of Psychology.  17, e10, 1-8.
3. Yu Cheng, H., Ying Chair, S. and Pak Chun Chau, J.   The effectiveness of psychosocial interventions for stroke family caregivers and stroke survivors:  A systematic review and meta-analysis.  Patient Education and Counseling.  95, 30-44.
4. Melissa Muller, Susan Toth-Cohen & MJ Mulcahey (2014) Development and Evaluation of a Hospital-Based Peer Support Group for Younger Individuals with Stroke. Occupational Therapy In Health Care, 28:3, 277-295.
5. Mejias, N., and Gill, C.   Influence of a support group for young women with disabilities on sense of belonging.  American Psychological Association.  61:2, 208-220.