The Influence of Staff Communication Training on Cooperation and Rehabilitation Outcomes Among Patients with Dementia In an Orthopedic Ward

Background and Purpose

Older adults with dementia undergoing orthopedic rehabilitation in hospital settings often achieve low rehabilitation outcomes and demonstrate reduced cooperation during care. Given the central role of active patient participation in orthopedic rehabilitation, communication with care staff may play an important role in shaping patients’ understanding, engagement, and involvement in treatment. However, despite its potential importance, the relationship between staff communication and rehabilitation outcomes has received limited empirical attention.

The present study addresses this gap and is, to our knowledge, the first to examine the relationship between staff communication behaviors, patient cooperation, and functional rehabilitation outcomes in a geriatric orthopedic rehabilitation context at large, and among people with dementia in particular. The examined staff training intervention was initiated by the social worker of the orthopedic ward in a geriatric hospital and was grounded in core social work values of dignity, autonomy, and person-centered care. We hypothesized that following the training: (1) staff communication behaviors would improve; (2) patient cooperation would increase; (3) staff communication behaviors would predict cooperation; and (4) functional independence would improve.

Methods
A quasi-experimental design was conducted in a geriatric rehabilitation ward. Staff–patient interactions (736 incidents) involving 36 staff members were observed at three timepoints: pre-intervention post-intervention , and three months later. Five communication behaviors were observed: approaching the patients within their visual field, addressing them by name, introducing oneself and one’s role, clearly describing the upcoming activity, and using elderspeak. Patient cooperation was also documented. Rehabilitation outcomes were assessed using the Functional Independence Measure (FIM) among two independent patient groups: 49 patients discharged before the intervention and 51 patients hospitalized after it. Analyses included chi-square tests, hierarchical logistic regression, ANOVAs and ANCOVAs analyses, controlling for age and duration of hospitalization.

Results
Findings indicated significant improvements in most staff communication behaviors following the intervention. In particular, approaching patients within their visual field, addressing them by name and clearly describing activities increased, while the use of elderspeak decreased. Patient cooperation improved significantly following the intervention and was maintained over time. Regression analysis showed that the communication behaviors (approaching patients within their visual field, addressing them by name, clearly describing activities, and avoiding elderspeak) explained 30.2% of the variance in patient cooperation. Importantly, functional independence improved from admission to discharge overall, with significantly greater improvement among patients hospitalized after the intervention compared to those discharged before it.

Conclusions and Implications
The findings provide evidence that staff communication is not only a relational factor, but also impact positive substantial rehabilitation outcomes. Targeting specific, adaptive and respectful staff communication behaviors may enhance both patient cooperation and functional recovery among people with dementia. The study also highlights the value of integrating social work perspectives, particularly the emphasis on dignity, autonomy and relational care, within interdisciplinary interventions aimed at improving clinical outcomes.