Resuming previously valued activities post-stroke: who or what helps?

Purpose. In this article, we aim to develop the understanding of what helps or hinders resumption of valued activities up to 12-months post-stroke. Method. As part of a longitudinal study, semi-structured interviews were conducted with 19 people with stroke and eight informal carers 12-months post-stroke. Interviews covered ongoing effects of stroke, experience of trying to resume activities highlighted as important pre-stroke and factors that influenced progress. Interviews were transcribed, coded and analysed in depth to explore this aspect of the experience of living with stroke. Results. Valued activities discussed related to employment; domestic and social roles including driving; hobbies, sports and socialising. Outcomes for individuals were influenced by: aspects of physical or cognitive disability; environmental factors; the adaptability of the individual; support from others and professional help. Inability to resume activities impacted on people's sense of self and quality of life, but some tolerated change and presented themselves as adaptable. Conclusions. This study indicates a long-term role for rehabilitation services such as: identifying the significance of different types of activities; providing access to support and treatment for debilitating symptoms such as fatigue and dizziness; addressing patients' emotional and behavioural responses to their condition; working with patients' wider social networks and where appropriate, supporting adaptation to a changed way of life.

[1]  Manifestations of mental slowness in the daily life of patients with stroke: a qualitative study , 2006, Clinical rehabilitation.

[2]  T. Hafsteinsdóttir,et al.  Being a stroke patient: a review of the literature. , 1997, Journal of advanced nursing.

[3]  A. Ashburn,et al.  Going home to get on with life: Patients and carers experiences of being discharged from hospital following a stroke , 2009, Disability and rehabilitation.

[4]  J. Secrest,et al.  Continuity and discontinuity: the quality of life following stroke. , 1999, Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses.

[5]  Lynn Rochester,et al.  How feasible is the attainment of community ambulation after stroke? A pilot randomized controlled trial to evaluate community-based physiotherapy in subacute stroke , 2008, Clinical rehabilitation.

[6]  K. McPherson,et al.  Occupational therapy after stroke , 2007, BMJ : British Medical Journal.

[7]  D. Ezzy,et al.  Illness narratives: time, hope and HIV. , 2000, Social science & medicine.

[8]  F. Mold,et al.  A review and commentary of the social factors which influence stroke care: issues of inequality in qualitative literature. , 2003, Health & social care in the community.

[9]  C. Murphy,et al.  Discharge from physiotherapy following stroke: the management of disappointment. , 2004, Social science & medicine.

[10]  Rose Wiles,et al.  Continuity, transition and participation: Preparing clients for life in the community post-stroke , 2007, Disability and rehabilitation.

[11]  M. Bury Chronic illness as biographical disruption. , 1982, Sociology of health & illness.

[12]  E. Guba,et al.  Naturalistic inquiry: Beverly Hills, CA: Sage Publications, 1985, 416 pp., $25.00 (Cloth) , 1985 .

[13]  L. Spencer,et al.  Qualitative data analysis for applied policy research , 2002 .

[14]  E. Hart Evaluating a pilot community stroke service using insights from medical anthropology. , 1998, Journal of advanced nursing.

[15]  S. Payne,et al.  Self-body split: issues of identity in physical recovery following a stroke , 2000, Disability and rehabilitation.

[16]  Brett Smith,et al.  Men, sport, spinal cord injury, and narratives of hope. , 2005, Social science & medicine.

[17]  F. Mold,et al.  Qualitative Studies of Stroke: A Systematic Review , 2004, Stroke.

[18]  Sandra E. Black,et al.  Quality of Life Following Stroke: Negotiating Disability, Identity, and Resources , 2005 .

[19]  A. Forster,et al.  Recovering from stroke: a qualitative investigation of the role of goal setting in late stroke recovery. , 1999, Journal of advanced nursing.

[20]  C. Cott,et al.  Client-centred rehabilitation: client perspectives , 2004, Disability and rehabilitation.

[21]  M. Bury The sociology of chronic illness: a review of research and prospects , 1991 .

[22]  S. Payne,et al.  Using stroke to explore the Life Thread Model: An alternative approach to understanding rehabilitation following an acquired disability , 2008, Disability and rehabilitation.

[23]  S. Dean,et al.  How clinicians talk about the application of goal planning to rehabilitation for people with brain injury–variable interpretations of value and purpose , 2006, Brain injury.

[24]  J. Malm,et al.  Frustrated and invisible--younger stroke patients' experiences of the rehabilitation process , 2003, Disability and rehabilitation.

[25]  S. Horn,et al.  Change in identity and self-concept: a new theoretical approach to recovery following a stroke , 2000, Clinical rehabilitation.

[26]  M. Ylvisaker,et al.  Metaphoric identity mapping: Facilitating goal setting and engagement in rehabilitation after traumatic brain injury , 2008, Neuropsychological rehabilitation.

[27]  J. Bamford,et al.  Classification and natural history of clinically identifiable subtypes of cerebral infarction , 1991, The Lancet.

[28]  Helen P. Alaszewski,et al.  Working after a stroke: Survivors' experiences and perceptions of barriers to and facilitators of the return to paid employment , 2007, Disability and rehabilitation.

[29]  S. Ebrahim,et al.  Illness in the context of older age: the case of stroke. , 1998 .

[30]  S. Ebrahim,et al.  Social and practical strategies described by people living at home with stroke. , 1999, Health & social care in the community.