Navigating uncertainty: a reflexive thematic analysis of rehabilitation staff's perception of communicative interactions in Disorders of Consciousness and Posttraumatic Amnesia

PURPOSE: This study aims to improve our understanding of how communicative interaction is perceived by experienced rehabilitation staff working with patients with Disorders of Consciousness (DoC) and Posttraumatic Amnesia (PTA).

METHOD: This qualitative study involved five workshops guided by modified Nominal Group Technique with 22 professionals from six disciplines. Reflexive thematic analysis was employed for analysis.

RESULTS: Four main themes were developed: (1) Watching carefully for any reaction, (2) The Challenge of careful interpretation, (3) Framing the interaction, and (4) Valued knowledge for involving and communicating with the patient. Rehabilitation professionals exhibited awareness of minimal communicative behaviors but reported regular focus shifts from natural interactions to testing and validating behaviors as part of their clinical reasoning. The emphasis on reliability reflected insecurity in their interpretations. Although spontaneous interactions were recognized, they were often undervalued in favor of reproducible behaviors. Participants also stressed the importance of sharing communicative strategies to ensure consistent patient care.

CONCLUSION: The findings highlight the tension between ethical awareness and clinical reasoning, with staff prioritizing reliability over spontaneous communication. Structured support, training, and interprofessional collaboration are essential to help rehabilitation professionals navigate the complexities of DoC and PTA, ensuring that communicative interactions are effectively supported throughout recovery.