Body
Back in the 1970s, Marcel Post needed a way to fill his time between graduating from high school and his compulsory military service in the Netherlands. He could have traveled but he was debating between a career in psychology or nursing so he did something much more practical: He took a job as an assistant in a hospital for geriatric patients with dementia.
At first the place seemed chaotic, even a bit scary, and the patients were all in their own worlds. But he soon was able to look past that. “It’s like having a class of schoolchildren. In the first five minutes they just make a lot of noise but after a while you see them as individuals,” says Post, PhD, senior researcher at the Rehabilitation Centre De Hoogstraat in the Netherlands. “Most of the people in the nursing home had a funny side even though they had dementia. You could still reach them and do simple things together.” Post also liked how the nursing team at the facility cooperated with each other and he appreciated their enthusiasm for helping patients.
Post decided to major in psychology. He initially thought he wanted to work as a clinical psychologist but he soon became interested in the social and organizational branch of the field. After receiving his master’s in 1985, Post began working as a research fellow in the Department of Health Sciences at Utrecht University. Then he successfully applied for a doctoral-student position on a study into service delivery and quality of life among people with spinal cord injury in the Netherlands. “I’m the type of person who is interested in everything. I knew that once I dove into the topic, I would become fascinated with it. It was just a coincidence it was spinal cord injury and not something like diabetes or stroke.”
Post received his PhD in 1997. As part of his PhD work, he conducted the then-largest survey of people with spinal cord injuries in Europe and was surprised by the findings. People with spinal cord injuries reported having a much higher quality of life than expected, and the association between the severity of paralysis and quality of life was much weaker. “I became hooked on the topic,” he remembers. “I was very eager to learn more about how people adapt to their spinal cord injury and also to tackle the confusion about the concept of quality of life and how to measure it.”
It turned out that Post was onto something. His research showed that there was a substantial impact on a person’s quality of life from secondary health problems such as bladder and bowel problems and pain. He went on to develop several life-satisfaction measures for people with SCI. “I’m also happy to see that our work has contributed to a greater focus on issues of return to work, mental health and social participation for people living with SCI,” Post says.
That paradigm shift has led to an increase of psychologists in rehabilitation departments, which is a good thing, according to Post. But he says there is still work to do with respect to getting people with SCI ready to return to work. Physicians and physical therapists are more focused on medical issues and helping patients regain function, not how they might return to a job months later. It’s not exactly a top priority for people with SCI either during their inpatient rehabilitation. “They want to get home and return to their families first,” Post says. “Only later they start worrying about return to work, thereby missing a window of opportunity early after injury.”
After a spinal cord injury, the length of a patient’s first stay in a rehabilitation facility has been sharply reduced in the Netherlands as it has in the U.S. and other countries. “At the time of my PhD study, the goal was to train people with a recent spinal cord injury to reach their highest possible level of functioning, and it was not uncommon that patients were admitted for more than a year,” Post says. Nowadays, partly driven by financial constraints, the focus is more on quick discharge, leaving many rehabilitation professionals feeling that their patients do not get enough rehabilitation time.
Even so, the average length of stay in the Netherlands is still two to three times longer than in the U.S. “We’re very worried that our lengths of stay will further shrink, as some policy makers use this difference with the U.S. to suggest that further reduction is possible,” Post says. That’s why he readily agreed to be part of an international study being run by the Center for Rehabilitation Outcomes Research (CROR) at the Shirley Ryan AbilityLab. “Marcel’s international preeminence and the Dutch approach to funding and delivering rehabilitation services made him a high-priority collaborator for our international SCI project,” says CROR Director Allen Heinemann, PhD.
Post is now 67, the retirement age in the Netherlands, so he is officially retired but still working on the CROR project. “I kept a small appointment just for this project,” he says. “I really want to finish it.”