Aile Temelli Rehabilitasyon: Kronik Hastaliklarda Ailenin Terapötik Rolü: Bir Derleme

Year 2025, Volume: 1 Issue: 2, 56 - 65, 30.09.2025

Safa Heybet

Abstract

Amaç: Bu derlemenin amacı, kronik hastalıklarda aile temelli rehabilitasyonun terapötik süreçlere katkılarını incelemek ve hasta–aile–terapist etkileşimi temelinde geliştirilen uygulamaların klinik sonuçlara etkisini ortaya koymaktır.
Gereç ve Yöntem: Bu çalışma, 2000–2024 yılları arasında aile temelli rehabilitasyon, evde bakım ve kronik hastalıklar konularında yayımlanmış güncel literatürün tarandığı niteliksel bir derlemedir. Elektronik veri tabanları kullanılarak seçilen çalışmalarda; aile eğitimi, bakım süreci, klinik sonuçlar ve dijital destek uygulamaları gibi temalar üzerinden içerik analizi yapılmıştır.
Bulgular: Aile temelli rehabilitasyonun, nörolojik (inme, MS, Parkinson) ve pediatrik (serebral palsi, gelişimsel bozukluklar) hasta gruplarında terapötik sonuçları anlamlı düzeyde iyileştirdiği görülmüştür. Literatür, aile katılımının özellikle tedaviye uyum, motivasyonun korunması, duygusal destek, egzersiz sıklığı ve fonksiyonel bağımsızlık kazanımı gibi alanlarda etkili olduğunu ortaya koymaktadır. Ev ortamında sürdürülen egzersiz programlarının başarısı, büyük ölçüde aile bireylerinin aktif katılımına ve düzenli geribildirim sağlamasına bağlıdır. Aile desteği, hastaların sosyal izolasyonunu azaltmakta; depresyon, kaygı ve tedaviye karşı direnç gibi psikososyal zorlukların üstesinden gelinmesine yardımcı olmaktadır. Yapılandırılmış aile eğitimlerinin; bilgi düzeyini artırdığı, doğru bakım uygulamalarını desteklediği ve terapötik süreçle ilgili özyeterlik algısını güçlendirdiği belirlenmiştir. Ayrıca dijital sağlık teknolojilerinin kullanımı (mobil uygulamalar, uzaktan danışmanlık) ailelerin profesyonel desteğe erişimini kolaylaştırmakta ve bakım kalitesini artırmaktadır. Aile bireylerinin sürece entegrasyonu, yalnızca klinik çıktılarda değil, hastane yatış süresinin kısalması, komplikasyon riskinin azalması ve sağlık sistemine maliyetin düşürülmesi gibi parametrelerde de olumlu yansımalar doğurmaktadır.
Tartışma: Elde edilen bulgular, aile bireylerinin sadece destekleyici değil, aynı zamanda tedavi sürecinin aktif paydaşları olarak değerlendirilmesi gerektiğini göstermektedir. Dijital sağlık uygulamaları, ailelerin bilgiye erişimini kolaylaştırarak bakım kalitesini artırma potansiyeline sahiptir.
Sonuç: Kronik hastalık yönetiminde aile temelli rehabilitasyon yaklaşımlarının yaygınlaştırılması, hem hasta sonuçlarını iyileştirmek hem de sağlık sisteminde sürdürülebilirliği desteklemek açısından kritik önemdedir.

Keywords

Aile , rehabilitasyon , evde bakım , motor iyileşme , kronik hastalık

Family-Centered Rehabilitation: The Therapeutic Role of the Family In Chronic Diseases: A Review

Abstract

Aim: The aim of this review is to examine the therapeutic contributions of family-centered rehabilitation in chronic diseases and to evaluate the clinical outcomes of interventions developed based on the interaction between patient, family, and therapist.
Materials and Methods: This study is a qualitative review that includes current literature published between 2000 and 2024 on topics such as family-centered rehabilitation, therapeutic alliance, home-based care, and chronic diseases. Studies selected through electronic databases were analyzed using content analysis based on themes such as family education, caregiving processes, clinical outcomes, and digital support interventions. Results: Family-centered rehabilitation has been shown to significantly improve therapeutic outcomes in neurological (stroke, MS, Parkinson’s), orthopedic (hip fracture, knee replacement), and pediatric (cerebral palsy, developmental disorders) patient groups. The literature highlights that family involvement plays a critical role in areas such as treatment adherence, maintaining motivation, emotional support, exercise frequency, and gaining functional independence. The success of home-based exercise programs largely depends on active family participation and consistent feedback. Family support reduces social isolation and helps overcome psychosocial challenges such as depression, anxiety, and resistance to treatment. Structured family education programs have been found to enhance knowledge levels, reinforce proper caregiving practices, and strengthen self-efficacy in therapeutic processes. Additionally, the use of digital health technologies (e.g., mobile applications, remote consultations) facilitates access to professional support and improves the quality of
care. Family integration into the rehabilitation process has also been associated with reduced hospital stays, lower complication risks, and decreased healthcare costs.
Discussion: The findings suggest that family members should be regarded not only as supporters but also as active stakeholders in the rehabilitation process. Digital health technologies offer significant potential to enhance care quality by improving access to information.
Conclusion: Expanding family-centered rehabilitation approaches in chronic disease management is critically important both for improving patient outcomes and supporting the sustainability of healthcare systems.

Keywords

Family , rehabilitation , home-based care , motor recovery , chronic disease

References

• Acoba E. F. (2024). Social support and mental health: the mediating role of perceived stress. Frontiers in psychology, 15, 1330720. https://doi.org/10.3389/fpsyg.2024.1330720
• Akmeşe PP., Mutlu A., Günel MK., (2007). Serebral paralizili çocukların annelerinin kaygıdüzeyinin araştırılması. Çocuk Sağlığı ve Hastalıkları Dergisi. 50: 236-240
• Almarwani, M., & Alosaimi, B. (2023). Exercise Self-Efficacy and Fatigue as Predictors of Adherence to Home-Based Exercise Among Patients with Multiple Sclerosis. Patient preference and adherence, 17, 1441–1449. https://doi.org/10.2147/PPA.S414884
• Argent, R., Daly, A., & Caulfield, B. (2018). Patient Involvement With Home-Based Exercise Programs: Can Connected Health Interventions Influence Adherence?. JMIR mHealth and uHealth, 6(3), e47. https://doi.org/10.2196/mhealth.8518
• Augustine, M. R., Intrator, O., Li, J., Lubetsky, S., Ornstein, K. A., DeCherrie, L. V., Leff, B., & Siu, A. L. (2023). Effects of a Rehabilitation-at-Home Program Compared to Post-acute Skilled Nursing Facility Care on Safety, Readmission, and Community Dwelling Status: A Matched Cohort Analysis. Medical care, 61(11), 805–812. https://doi.org/10.1097/MLR.0000000000001925
• Bogner, J., Hade, E. M., Peng, J., Beaulieu, C. L., Horn, S. D., Corrigan, J. D., Hammond, F. M., Dijkers, M. P., Montgomery, E., Gilchrist, K., Giuffrida, C., Lash, A., & Timpson, M. (2019). Family Involvement in Traumatic Brain Injury Inpatient Rehabilitation: A Propensity Score Analysis of Effects on Outcomes During the First Year After Discharge. Archives of physical medicine and rehabilitation, 100(10), 1801–1809. https://doi.org/10.1016/j.apmr.2019.04.008
• Cabilan, C. J., Hines, S., & Munday, J. (2015). The effectiveness of prehabilitation or preoperative exercise for surgical patients: a systematic review. JBI database of systematic reviews and implementation reports, 13(1), 146–187. https://doi.org/10.11124/jbisrir-2015-1885
• Camden, C., Swaine, B., Tétreault, S., & Brodeur, M. M. (2012). Reaching families to promote participation in pediatric rehabilitation services: A scoping review. Child: Care, Health and Development, 38(6), 811–821. https://doi.org/10.1111/j.1365-2214.2011.01336.x
• Babatunde, F., MacDermid, J., & MacIntyre, N. (2017). Characteristics of therapeutic alliance in musculoskeletal physiotherapy and occupational therapy practice: a scoping review of the literature. BMC health services research, 17(1), 375. https://doi.org/10.1186/s12913-017-2311-3
• Gibson, B. E., Teachman, G., Wright, V., Fehlings, D., Young, N. L., & McKeever, P. (2012). Children's and parents' beliefs regarding the value of walking: rehabilitation implications for children with cerebral palsy. Child: care, health and development, 38(1), 61–69. https://doi.org/10.1111/j.1365-2214.2011.01271.x
• Gilliss, C. L., Pan, W., & Davis, L. L. (2019). Family Involvement in Adult Chronic Disease Care: Reviewing the Systematic Reviews. Journal of family nursing, 25(1), 3–27. https://doi.org/10.1177/1074840718822365
• Hekmatpou, D., Mohammad Baghban, E., & Mardanian Dehkordi, L. (2019). The effect of patient care education on burden of care and the quality of life of caregivers of stroke patients. Journal of multidisciplinary healthcare, 12, 211–217. https://doi.org/10.2147/JMDH.S196903
• Heredia-Callejón, A., García-Pérez, P., Armenta-Peinado, J. A., Infantes-Rosales, M. Á., & Rodríguez-Martínez, M. C. (2023). Influence of the Therapeutic Alliance on the Rehabilitation of Stroke: A Systematic Review of Qualitative Studies. Journal of Clinical Medicine, 12(13), Article 4266. https://doi.org/10.3390/jcm12134266
• Hulshoff, M., Sun, C., Book, E., Tanner, C., Dahodwala, N., Reynolds, B., Boon, H., & Marras, C. (2025). Care partner needs in Parkinson's disease: A systematic review of qualitative and quantitative data. Journal of Parkinson's disease, 15(6), 1043–1061. https://doi.org/10.1177/1877718X251344066
• Jee, S., Jeong, M., Paik, N. J., Kim, W. S., Shin, Y. I., Ko, S. H., Kwon, I. S., Choi, B. M., Jung, Y., Chang, W., & Sohn, M. K. (2022). Early Supported Discharge and Transitional Care Management After Stroke: A Systematic Review and Meta-Analysis. Frontiers in neurology, 13, 755316. https://doi.org/10.3389/fneur.2022.755316
• Kalra, L., Evans, A., Perez, I., Knapp, M., Donaldson, N., & Swift, C. G. (2004). Training carers of stroke patients: Randomised controlled trial. BMJ, 328(7448), 1099. https://doi.org/10.1136/bmj.328.7448.1099
• Khetani, M. A., Graham, J. E., Davies, P. L., Law, M. C., & Simeonsson, R. J. (2015). Psychometric properties of the Young Children's Participation and Environment Measure. Archives of physical medicine and rehabilitation, 96(2), 307–316. https://doi.org/10.1016/j.apmr.2014.09.031
• Kruijsen-Terpstra, A. J., Ketelaar, M., Boeije, H., Jongmans, M. J., Gorter, J. W., Verheijden, J., Lindeman, E., & Verschuren, O. (2014). Parents' experiences with physical and occupational therapy for their young child with cerebral palsy: a mixed studies review. Child: care, health and development, 40(6), 787–796. https://doi.org/10.1111/cch.12097
• Langhorne, P., Bernhardt, J., & Kwakkel, G. (2011). Stroke rehabilitation. The Lancet, 377(9778), 1693–1702. https://doi.org/10.1016/S0140-6736(11)60325-5
• Lin, C., Zhu, X., Wang, X., Wang, L., Wu, Y., Hu, X., Wen, J., & Cong, L. (2025). The impact of perceived social support on chronic disease self-management among older inpatients in China: The chain-mediating roles of psychological resilience and health empowerment. BMC geriatrics, 25(1), 284. https://doi.org/10.1186/s12877-025-05902-z
• Lippi, L., de Sire, A., Folli, A., Turco, A., Moalli, S., Ammendolia, A., Maconi, A., & Invernizzi, M. (2022). Environmental Factors in the Rehabilitation Framework: Role of the One Health Approach to Improve the Complex Management of Disability. International journal of environmental research and public health, 19(22), 15186. https://doi.org/10.3390/ijerph192215186
• Luo, F., Lu, Y., Qiu, R., Wang, J., & Yu, X. (2025). Positive collaboration in rehabilitation nursing significantly improves neurological function, emotional well-being, fall efficacy, and quality of life in elderly. International Journal of Nursing Studies. Advance online publication. https://doi.org/10.1016/j.ijnurstu.2025.104810
• Nematifard, T., Arsalani, N., Nourozi Tabrizi, K., Fallahi-Khoshknab, M., & Borimnejad, L. (2024). Improvement of family-centered care in the pediatric rehabilitation ward: a participatory action research. Frontiers in pediatrics, 12, 1325235. https://doi.org/10.3389/fped.2024.1325235
• Rosenbaum, P., King, S., Law, M., King, G., & Evans, J. (2009). Family-centred service: A conceptual framework and research review. Physical & Occupational Therapy in Pediatrics, 18(1), 1–20. https://doi.org/10.1080/J006v18n01_01
• Rosland, A. M., & Piette, J. D. (2010). Emerging models for mobilizing family support for chronic disease management: a structured review. Chronic illness, 6(1), 7–21. https://doi.org/10.1177/1742395309352254
• Szeto, S. G., Wan, H., Alavinia, M., Dukelow, S., & MacNeill, H. (2023). Effect of mobile application types on stroke rehabilitation: a systematic review. Journal of neuroengineering and rehabilitation, 20(1), 12. https://doi.org/10.1186/s12984-023-01124-9
• Turkish Statistical Institute. (2023). Statistics on Ageing. https://data.tuik.gov.tr
• Turnbull, A. P., Turnbull, H. R., Erwin, E. J., Soodak, L. C., & Shogren, K. A. (2007). Families, professionals, and exceptionality: Positive outcomes through partnerships and trust (5th ed.). Pearson. Welmers-van de Poll, M. J., Roest, J. J., van der Stouwe, T., van den Akker, A. L., Stams, G. J. J. M., Escudero, V., Overbeek, G. J., & de Swart, J. J. W. (2018). Alliance and Treatment Outcome in Family-Involved Treatment for Youth Problems: A Three-Level Meta-analysis. Clinical child and family psychology review, 21(2), 146–170. https://doi.org/10.1007/s10567-017-0249-y
• World Health Organization. (2021). Rehabilitation 2030: A call for action. https://www.who.int/rehabilitation
• Zhang, Y., Qiu, X., Jin, Q., Ji, C., Yuan, P., Cui, M., Zhang, J., & Chen, L. (2023). Influencing factors of home exercise adherence in elderly patients with stroke: A multiperspective qualitative study. Frontiers in psychiatry, 14, 1157106. https://doi.org/10.3389/fpsyt.2023.1157106