Disabled People’s Experiences in Rehabilitation: A Perspective of Gender and Age

Theoretical perspective

The study is informed by critical realism (CR), a contemporary philosophical movement within sociology, pioneered by Bhaskar (2008). CR enables the examination of how mechanisms and events interact in open systems to prevent oversimplified assumptions about complex issues, such as the impact of various identities on people’s lives (Bhaskar and Danermark 2006). It allows for integrating traditional biomedical perspectives with social perspectives of disability, recognizing the complexities of people’s lives. Disability is viewed from an interactionist standpoint, emphasizing the relationship between a person’s inherent traits and the social and cultural factors they encounter. This approach strives for a balance between medical and social elements, encompassing three interconnected components. Firstly, personal factors such as age, gender, and bodily impairment. Secondly, environmental factors connected to support provided by professionals and significant others. Lastly, societal factors including social norms, access to education and work, and attitudes (Shakespeare 2013).

The critical realist (CR) perspective has been compared to a collection of family resemblances, suggesting that it is not a single framework (Archer et al. 2016). In his interactionist approach Shakespeare (2013) claims that employing various theoretical approaches–such as feminist frameworks in addition to a disability studies lens–is advantageous. Both disability studies and feminist studies focus on identity in connection to marginalization, suggesting that gender transcends biological differences (sex) and that social gender is shaped by created identities, cultural symbols, and social structures (Garland-Thomson 2017). Garland-Thomson (2005) introduced an interdisciplinary scholarly field called feminist disability studies which call for a mutually favourable integration and conversation of the two disciplines.

The interactionist lens that characterizes the CR perspective is useful for this study because it acknowledges the complex nature of each person’s circumstances. Impairments include a variety of bodily challenges such as physical differences, pain, and limited stamina. Additionally, societal expectations related to gender and other aspects of identity often significantly impact the lives of disabled people, such as their roles, responsibilities, and their opportunities for a fulfilling life.

Inspired by CR, this present study was designed to scrutinize gender differences during rehabilitation and a few years after discharge to home. The following research question was posed: How do personal, environmental, and societal factors shape the experiences of disabled individuals during rehabilitation and after discharge?

Survey data

Participants were recruited from the largest rehabilitation center in Iceland and three rehabilitation wards. Each of these institutions assigned contact persons who introduced the survey to prospective participants, distributed questionnaires, and handed back to the first author. The inclusion criteria were that people had completed their rehabilitation period and could read and write Icelandic. The recruitment process is thoroughly described in our earlier publication (Óladóttir et al. 2024).

Data collection

Data were collected with the Icelandic Client-Centred Rehabilitation Questionnaire (CCRQ-is), a self-report measure designed to evaluate a person’s experience of client-centered practice in rehabilitation. Background information about personal characteristics such as age, gender, family, living situation, and roles were also gathered. The CCRQ-is is derived from the Canadian Client-Centred Rehabilitation Questionnaire (CCRQ) (Cott et al. 2006). It is widely used and has been translated into several languages (Capdevila et al. 2023; Fisher et al. 2020; Körner et al. 2017). The Icelandic version shows good psychometric properties and contains four subscales, answered on a 5-point scale. The subscales are (1) respect and attentiveness (12 items), (2) responsiveness to needs and preferences (4 items), (3) education and enablement (4 items), and (4) interaction with significant others (4 items) (Óladóttir et al. 2024).

Participants

Altogether, 558 individuals with different types of impairments completed the questionnaire before discharge from the rehabilitation unit. The response rate was 89.7–97.7% for different institutions and 93.7% for the whole sample. Fifty-nine participants were excluded because the number of missing items exceeded our predetermined threshold of three missing items, resulting in 499 rehabilitation users in the sample, i.e., 58.9% women and 39.7% men. The average age of men was eight years higher than that of women. Length of stay at rehabilitation unit was four–eight weeks, most stayed five weeks. Characteristics of participants are presented in Table 1.

Data analysis

Responses were analyzed through descriptive and inferential statistics. Descriptive statistics for background variables of all participants included mean (M) and standard deviation (SD) for continuous variables and counts and percentiles for categorical variables. Crosstabs were used to investigate the relationship between two categorical variables. Independent t-tests were conducted to compare the means of different subscales and potentially influencing factors. A chi-squared test was used to examine whether two categorical variables independently influenced the test statistics. Effect sizes were calculated by using the Cohen’s d method. When analyzing the gender differences, we controlled for age difference. For all statistical analysis, the IBM SPSS software package, version 22, was used (IBM 2020).

Interview data

Contact persons at the rehabilitation units approached disabled people as prospective participants for the interviews. To be included, participants had to have undergone at least one in-patient period at the same unit(s) as the survey data was collected, received services from at least three different healthcare professions, and be willing and able to discuss their experiences during rehabilitation and after discharge. Efforts were made to recruit people with different impairments, ages, sexes/genders, and socio-economic backgrounds to reflect the group answering the CCRQ-is.

Participants

Altogether, 10 disabled people–five men and five women aged 35 to 64–volunteered to participate in the interviews. Participants had complex health issues and physical impairments such as muscular sclerosis, spinal cord injury, or sustained cerebral hemorrhage. Two women lived alone but other participants lived with a partner or/and a child. To ensure confidentiality, each participant was given a pseudonym, and only minimal background information is provided.

Data collection

Interviews took place after discharge in the participants’ homes. Each participant was interviewed once, and an effort was made to make the interview like a conversation, controlled equally by both parties (Brinkmann and Kvale 2015). The interview protocol was grounded in ideas and theories about rehabilitation, particularly aspects relating to client-centered practice (Bamm et al. 2015; Hammell 2015). Key issues to be discussed included, (a) the participants’ experiences, perspectives, and understanding of the services they had received and (b) their opinions on what aspects of the services had been helpful, based on their daily lives and situation after discharge. The interviews were conducted and transcribed by Palmadottir (see acknowledgment), who specializes in client-centered rehabilitation. The interviews ranged from 47 to 80 minutes.

Data analysis

The interview data were thoroughly read and then analyzed using the formal data structure analysis (FDSA) hermeneutic approach (Borell et al. 2014; Gustavsson 2000). This approach follows a multi-level interpretative inductive methodology that involves a three-step systematic way to conduct interpretations: (1) collecting information relevant to the research question, (2) formulating all reasonable interpretations, and (3) testing interpretations according to the information available and in line with explicitly formulated criteria (Borell et al. 2014; Brinkmann and Kvale 2015; Gustavsson 2000). The first author carried out the initial analysis, but co-authors continually took part in deliberations and in revising the analysis to gain new insights and re-interpretations.

Survey

Background information revealed a gender difference as half of the female participants reported obligations in caring for a home compared with only 21% of male participants (p = <0,001). This difference was found in all age groups except for the youngest. Women were also more likely to care for others, such as children or parents, than male participants (p = <0,001). Women were more likely to seek out education, or 7,8%, as opposed to 1,5% of men (p = <0,002). A significant difference in labor market participation was not observed; however, men had an 8% higher labor market participation rate than women.

CCRQ-is Results

Gender differences were found in all age groups except for the oldest one on two subscales out of four, namely “Responsiveness to needs and preferences” t(490) = 2.635, p = 0.009 and “Interaction with significant others” t(490) = 4.623, p < 0.001. Gender differences were not found on the two remaining subscales “education and enablement” and “respect and attentiveness.”

Responsiveness to needs and preferences. Gender differences were identified on responses to all questions in the youngest age group, as women under the age of 39 found the professionals to be less responsive to their needs than same-age men. In the youngest age group, gender differences were also found on specific questions. For instance, medium effect sizes were found for gender differences for consultations received from professionals while creating a personal rehabilitation program, and for professionals taking note of users’ pain descriptions. Women in the age group 40–54 scored lower than men on one question, referring to satisfaction with how professionals handled/dealt with their pain. See further in Table 2.

Interaction with significant others. Women reported lower levels of involvement of their significant others compared to men in age groups 40–54 and 55–64. Women aged 40–54 reported that their significant others received less professional support, information, and respect than men in the same age group did. Women aged 55–64 were less content with the support provided by professionals to their significant others, and a close to high effect size was found on the question about the participation of significant others in meeting users’ needs during rehabilitation; see further in Table 3.

Survey results summary

In general, women’s highest educational level was lower than men’s, but at the time of the survey, women were more likely to be in school. Also, women had more responsibilities towards home and caring for others. On the two CCRQ-is subscales, responsiveness to needs and preferences and interaction with significant others, women consistently rated the rehabilitation services as less in line with their needs than men in the same age group. In the youngest age group (<39), women reported being not heard and not consulted with. Women aged 40–64 reported a lack of family involvement during their rehabilitation.

Interviews

Our analysis consists of four themes. The first two relate to the rehabilitation program, the third relates to participants’ lives after discharge, and the last focuses on the support provided by female family members while at the rehabilitation unit and after discharge.

The relationship between the disabled person and health professionals

All participants stressed that rehabilitation professionals must be attentive to people’s needs and preferences, and the significance of being met with positive attitudes and treated with respect was highlighted. Kristinn (male, 64) was very content with his two rehabilitation periods, primarily because of the positive relations with his physiotherapist who was attentive and responded quickly to his needs and requests: “Yes, I have been quite happy […]. It is also just how she; generally, she just approaches people with so much respect.” Stefán (male, 48) also praised the professionals and claimed they respectfully met his needs: “I can tell you, these are very good people working under hard conditions.” Herbert (male, 58) emphasized how well his therapist had taken care of him and that the relaxed and informal communication with her and other professionals made him feel important: “It just meant a lot to me.” To be treated with respect signaled that participants were listened to and that professionals showed interest and reacted quickly and well to their needs and preferences.

While both men and women had experienced positive interactions, a lack of respect and collaborative decision-making was highlighted by some of the women. Halla (female, 40) claimed that her needs had been ignored during her second rehabilitation period, making her feel rejected and even worthless: “I went again this spring, and I was actually not happy with it […] I was looked at as old, really, like old furniture.” Svana (female, 51) also claimed that professionals had not elicited her opinion enough and her words: “I was sent to” and “I was put in” revealed a disregard for her needs and a lack of meaningful dialogue. And when a professional had suggested that Svana go back for further rehabilitation, she hesitated, saying: “It was quite nice […] I think I felt really well there. But still, I didn’t want to go back.” She simply did not see the value in another rehabilitation period.

Almost all participants emphasized how their families provided them with valuable support during their rehabilitation and the strength they drew from them later on. However, the extent to which family members were involved in the rehabilitation process varied greatly and planned collaboration appeared to be scarce. Unnur (female, 35) claimed that the regular meetings with her parents and the interprofessional team were disrespectful given her family’s challenging situation at the time. She described how her medical doctor painted a dark picture of her future, emphasized numerical information and statistics about her disease, and, based on that information, outlined what she should expect in the future.

“I could never take care of myself; I would never get any strength in my left hand, which I now have a little […] I would never drive a car, I would never be able to work, I would never be able to take care of myself and least of all my children […] My mother left these meetings crying more often than not. He just completely broke them down.”

Unnur said that the doctor should have provided encouragement and hope as other professionals did. At the time of the interview, Unnur was doing much better than anticipated by her doctor and ascribed much of her progress to the support of her family over the years. Herbert valued the easy access his family members had to the professionals: “And they (my sons) could come and go just as they wanted, just like that, have a say entirely with everything if they wanted to.” Like most other participants, Herbert did not recall regular meetings where they and their families jointly discussed essential aspects.

Overall, the men described more respectful interactions with professionals than the women.

Benefits of the rehabilitation program

The participants described their many benefits of the rehabilitation programme, mainly the importance of regaining physical function, such as strength, stamina, and endurance. Stefán said: “Any exercise is good. Moreover, there were many things, what can I say, occupational therapy and many things that are very good.” They also claimed to have learned important skills and received practical information and instructions. Unnur described how specific methods she learned helped her deal with daily challenges later on: “Although this was eight years ago, I still remember everything that the occupational therapist taught me and use it everyday – and many times a day.”

In contrast, Halla’s first wheelchair was ordered while she was at the center, but she never got instructions on how to operate it: “I was never trained in using the wheelchair […] no, never, I only learned it from experience.” During her second stay, she did not get enough information and training in her opinion: “Like I should know everything and know exactly how everything works. So, in my opinion, I did not get enough service.”

Benefits did not solely relate to the content of the rehabilitation program or the engagement with healthcare providers but also to interacting with other disabled people seeking rehabilitation. Hildur (female, 50) said:

“I just benefited from it, and all of us, and we were very happy together. And the people who were at the ward, these were people with lung issues, obesity, and more. I loved it. You can just imagine […] Yes, such interaction gives life meaning.”

Thus, Hildur received the most benefits through empowering, supportive connections, which underscores the significance of meaningful relationships with others. Similar experiences were described by the other women but not by the men.

Although all participants considered improved physical health and learning specific skills advantageous, some stated that they had not received sufficient guidance, information, and/or training to deal with the challenges of daily life. These concerns were more frequently expressed by women than men.

Creating a fulfilling life after discharge from rehabilitation

Despite their progress while in rehabilitation, overall, the participants felt that these gains had not translated well into their daily lives. All emphasized the importance of having meaningful roles and feeling valued, and aspects relating to employment were highlighted. In hindsight, the participants claimed these aspects had not been addressed enough in rehabilitation. None of the five women had found a life rhythm that included paid work, while two men were engaged in full-time work and one, Herbert had just retired. Kristinn, who had been living with a spinal cord injury for 35 years, worked full-time. He emphasized the importance of work and income for people’s dignity and livelihood:

“That people do not have to fall into these poverty traps, as is common, and that they have some benefits from working […]. The government must accommodate disabled people’s needs so they can have flexible working hours.”

At the time of the interview, Bárður (male, 58) had worked full-time for 30 years. He articulated that the most challenging part of receiving his MS diagnosis as a young man was the thought of being unable to provide for the family. His words: “Work is vital to us.” echoed how work was imperative to his identity. His wife managed the household at home, enabling Bárður to work full-time and attend therapy sessions four times a week. He said: “My wife spoils me a bit.” Both these men identified as active participants and described their roles and obligations with a sense of agency.

Hildur had also been living with MS for decades. Hildur had earned two master’s degrees but due to limited stamina and fatigue, she couldn’t manage a full-time job. For the past five years, Hildur had been unable to find a suitable part-time job, and her requests for support had not been met: “I asked her (a social worker) to take the first step, to make contact and she said to me: ‘You can call this and that.’ But I asked specifically for her service, and she did not provide it.” Hildur was deeply dissatisfied with her current situation:

“This is so unacceptable; I am fifty. There are 17 years until retirement; what should I do in the meantime? Watching the church over there at night? There are limited resources for people like me.”

Being unable to find work affected Hildur’s sense of purpose and agency. Halla stressed similar aspects. She had enrolled in university but struggled to attend classes due to the long distances between buildings, so she didn’t complete her degree. Halla then entered the labor market but was recently dismissed from her job. She had just started a professional education but expressed concerns about continuing her studies due to the lack of wheelchair accessibility. “I am very worried about not being able to get a practical placement due to lack of accessibility because I am in a wheelchair.”

Unnur and Svana had entered the labor market but eventually left due to inflexible work demands and working hours. Unnur explained: “I started working […]. Then I found out that my body was in no way ready for this kind of stress.” Unnur also described herself as “the foreman at home,” where she lived with her two children and three pets, handled many tasks herself, and delegated specific tasks to others. Unnur was content with the current situation, no the least because it “allowed her to be a better mom to her kids, giving them more time and patience.” After Svana’s discharge, she worked for a while at an adapted workplace but quit because she didn’t “fit in” and because she experienced “severe headaches daily” while working. Svana spoke of confidence about being in charge at home: “I take care of everything.” In contrast, the men who didn’t participate in the labor market did not identify as homemakers and some leveraged their social networks from jobs they had in the past.

Evidently, gender roles and societal norms influenced participants’ lives after discharge to home. None of the women were employed due to lack of support and opportunities. Conversely, those who had children at home expressed satisfaction with their roles as homemakers. Two of the men were employed full-time and one had just retired.

Support from female family members

Following the onset and progress of their disabilities, participants’ relatives had taken over important tasks they had previously taken care of themselves. Most received support from female family members who helped them manage their lives. These women advocated for the disabled persons’ rights and provided practical, psychological, and emotional support.

After Helga’s (female, 44) injury, her adult daughter took over various tasks at home and ensured that her mother did not harm herself. The daughter was present during the interview, and when asked how Helga managed at home, she said: “She [my mom] stopped [cooking] when I forbade her to cook because she was always burning her hand.” Herbert’s wife drove him between places and he explained: “I cannot drive. That is why she has to go with me because I cannot […] Fortunately, she only works part-time and can drive me around pretty much as I need.” Consequently, Herbert could live a more fulfilling life.

After Haraldur’s trauma (male, 57), his wife handled the relations with institutions, obtained information on his rights, and took care of applications connected to pensions and disability-related support: “My wife has taken care of this, for the most part, these relations. Several pension funds are paying me; It has been quite a package to get it all together and make it work.” In contrast, Stefan didn’t have anyone to help him navigate the welfare system and claim his rights. Although he had been diagnosed with MS for a decade and unemployed for seven years, he received no disability pension. Stefan felt powerless and his descriptions echoed a lack of voice and agency: “You absolutely have to do everything yourself […] how on earth am I going to figure this out?”

After discharge, Unnur and her two young children lived with Unnur’s parents for almost a year while waiting for an accessible apartment. Her mother provided immense support during this time and even quit her job to care for her daughter. She was also the one who at one point noticed that Unnur was almost blind and fought for the professionals to take action. “It was my mother who noticed this … and insisted I be sent to an ophthalmologist. Then, it turned out that the bottom of my eye was full of blood.”

The interviews highlighted how wives, daughters, and mothers played crucial roles in advocating for the rights of their family members and supported them in various ways. They kept track of important information and communicated with the financial support system. Some had quit their work or taken on part-time jobs to be able to provide the necessary support.

Discussion

This study explored how personal and societal factors influence people’s experiences of rehabilitation practices. We identified gender-based differences in the survey as a starting point and then supplemented with narratives from interviews. In line with our mixed methods approach, we present a combined discussion of our findings based on CR perspectives. In order to balance the interrelated elements of medical and social factors, as highlighted by Shakespeare (2013), we start discussing personal factors and support before moving to societal factors affecting participant’s experiences.

Gender and rehabilitation – personal experiences and support

Gender and age differences were identified on two out of four CCRQ-is subscales with women rating the services less in line with their needs compared to men. Younger women reported more often than young men that they felt not heard, not included in the planning of the services, and not listened to when describing their pain. The two youngest women interviewees described a lack of information and unhelpful communication with professionals who did not recognize their needs. Some of the older women interviewees had also experienced having little say during their rehabilitation period(s). Compared to men, the older women who answered the survey reported that rehabilitation professionals did not treat their pain sufficiently. These results resemble Ott et al.’s findings (2022), which identified worse rehabilitation use, adherence, and outcomes among women compared to men, and that recommendations from professionals affected women’s participation in rehabilitation more negatively. Ott’s review did not address age, and our literature search only gave information on the experiences of young women after a stroke (Leahy et al. 2016). Similar to our results, the young women in Leahy et al.’s study described not being taken seriously and receiving insufficient information from healthcare professionals. There appears to be a lack of information about the rehabilitation experiences of women, especially young women.This gap raises concerns about whether rehabilitation practices recognize and effectively meet their needs and preferences. As aforementioned, article 25 of the CRPD underscores the importance of gender-sensitive services in health-related rehabilitation. The importance of peer support was stressed by one woman interviewee. Peer support is a central tenet in article 26 of the CRPD, but as stated by Magasi and Papadimitriou (2022), more robust literature about the key considerations regarding the design and implementation of peer support within rehabilitation is needed.

The importance of family support during the rehabilitation and after discharge has long been acknowledged (Bamm et al. 2015; Bezmez et al. 2021; Gagnon et al. 2016). Both male and female interviewees expressed concerns about the lack of family involvement during their rehabilitation. Similarly, compared to other subscales the CCRQ-is subscale interaction with significant others received the lowest score by far by both genders. Middle-aged women, with more caring and household responsibilities than same-age men, expressed a lack of support and information to their families and that family members were not involved enough in their rehabilitation. In the survey, caregiving was predominantly provided by women. The interviews showed a similar pattern i.e., participants referred to how female caregivers played crucial roles in advocating for them, managed communication with the support system, and provided various forms of support during rehabilitation and after discharge. Some had even made significant work adjustments, such as quitting or switching to part-time employment to ensure that their loved ones received the necessary services and support. To our knowledge, there is limited research on the gendered aspects of caregiving within rehabilitation in general, while studies on caregiving among stroke patients support our findings (Comer et al. 2024; Greenwood and Mackenzie 2010). They suggest that female caregivers are more likely to care for their partners and experience more frequent disruptions to their daily activities and mental health. The same pattern was identified in our interviews as most of the men described better access to support through their partners. Both datasets showed fewer caregiving and home obligations for men than for women. This fact may have contributed to more possibilities for men’s employment since they often had a female partner supporting them at home.

The question remains whether men rated the survey questions–such as about the involvement of significant others–higher than women did because the foci of the services are potentially more directed at the specific needs of men. Accordingly, the survey’s gender differences may not necessarily indicate different services provided to men and women but rather reflect their somewhat different needs based on societal norms and the support available outside of the rehabilitation unit. Rehabilitation professionals must consider the circumstances and support requirements of each individual, with particular consideration for the needs and preferences of women.

The socio-cultural context

In our study, male interviewees recognized the benefits of rehabilitation in terms of improving physical health more than women. This could reflect how the emphasis on physical functioning may be experienced differently by gender. For example, Haag et al. (2016) identified the main challenges faced by women with acquired brain injury as related to physiological changes, gender roles, and altered sexual and intimate relationships. Even though our male interviewees valued gaining physical strength, most claimed they had not been adequately prepared for life outside the rehabilitation unit and expressed concerns about adjusting to a new life rhythm after discharge. For both men and women interviewed, participation in the labour market was a major concern. However, the women described greater challenges in finding a part-time job that also allowed them to manage household and childcare responsibilities than men. Our survey results did not show significant gender differences in labour participation, but men had a slightly higher employment rate compared to women. Additionally, the women surveyed were more likely to seek education. Possibly, the flexibility of working hours in school was more supportive in managing roles and obligations at home than participation in the labour market.

Women’s work has often been devalued and overlooked, including work in the domestic sphere–women’s “double day” or “second shift” (Hochschild and Machung, 1989; Stall et al. 2023). According to statistics on care in Europe, Iceland has the highest percentage of caring for others among all European countries, with middle-aged women providing most of this work (ASÍ 2021). At the same time, Iceland has received international attention for gender equality and high participation of women in the labour market (Kangas and Kvist 2018). Our findings prompt us to question whether the labour market practices, which emphasize full-time positions, have a greater impact on disabled women compared to men. Traditional gender roles place heavier responsibilities on women to manage household and caregiving duties, as seen in our survey results. Interestingly, in the interviews, some of the women described the role of being a homemaker as rewarding, while none of the men did. It can be questioned whether the different roles and norms expected of each gender may explain the differences in their perception of what is considered ordinary or “enough.” As Gibson (2016) points out, such perceptions are not formed in a vacuum but in relation to the social environment in which people are immersed. Rehabilitation should be about enhancing people’s engagement in living, considering their unique social circumstances, rather than solely on remediation, such as gaining physical strength (Hammell 2015). Abilities are of limited value if people do not have opportunities to use them in their social circumstances such as at the labour market. Rehabilitation professionals should be mindful of the disparities that often exist between women and men, particularly the challenging social situations women often face due to their numerous responsibilities and lack of control. Adequate support tailored to the life circumstances of women should be offered (UN 2006; WHO 2024).

Our study suggests that rehabilitation assumptions and practices need to be closely examined and possibly reframed. The priority should be to help individuals live well with their impairments within the social circumstances of their environment, as emphasized by Shakespeare et al. (2018) and highlighted in the CRPD (UN 2006). There is an ongoing need to integrate social science perspectives into rehabilitation (Gibson 2016; Hammell 2015) to better understand how complex sociocultural contexts intersect to shape and sustain gender inequities (Garland-Thomson 2017; Ott et al. 2022; Wiklund et al. 2016). It must be ensured that rehabilitation services are sensitive to and more adequately meet the diverse needs and identities of disabled people.

Strengths and limitations

Our mixed-methods approach provided a comprehensive understanding of the topic as it allowed for elaborating on the results of a large survey through in-depth interviews (Mertens 2007). Prior to this study a thorough validation process of the CCRQ-is was performed to ensure its appropriateness within the Icelandic context as well as for people with different types of impairments (Óladóttir et al. 2024; Óladóttir and Palmadóttir 2017; Óladóttir and Palmadóttir 2013). The interviews enabled a better understanding of some of the survey’s key findings, and the CR lens helped illuminate and reflect on how gender, societal norms, and roles affected the experiences of persons seeking rehabilitation.

Our study also has several limitations. Although we recognize that questionnaires–such as the CCRQ-is–allow for collecting large amounts of data in a structured format and thus provide important insights, they do not consider each person’s distinct viewpoint regarding the importance of the measure’s available choices regarding their life. Also, constructs like person-centered rehabilitation are not stable constants despite assumptions made in the past (Gibson 2016). Thus, the CCRQ-is may give simplified data on complex phenomena. While we recognize that gender is not restricted to binary classifications, the article discusses gender in a binary way, as the only options for identifying gender in the survey were male or female. Hence, the questionnaire needs to be adapted to include other gender identities. Only 10 people participated in the interviews and, accordingly, we make no claims of generalizing our findings.