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Šaňáková Š, Gurková E, Štureková L, Bartoníčková D, Machálková L, Mazalová L. How to return? experiences of patients in working age after first Ischaemic stroke: an interpretative phenomenological analysis of patient´s perspective at 12 - 24 months post-stroke. Int J Qual Stud Health Well-being 2024; 19:2398249. [PMID: 39229807 PMCID: PMC11376287 DOI: 10.1080/17482631.2024.2398249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 08/26/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Limited evidence of young adult patient-reported outcomes and experiences after ischaemic stroke has been conducted. AIM To investigate the meaning of the lived experiences of stroke patients in working age 12-24 months after their first IS. MATERIAL AND METHODS The exploratory qualitative study used an interpretative phenomenological analysis (IPA) design. Nine ischaemic stroke patients (with age ranges from 41 to 50 years) took part in semi-structured qualitative interviews. RESULTS Even with mild residual neurological deficit, IS negatively impacted the quality of life daily and social life. Six subthemes and three interconnected group experiential themes were generated: (i) From confusion to understanding (ii) Triggers for rebuilding; and (iii) Challenges and benefits. CONCLUSION The study highlights the current gaps and limitations in supporting the needs of stroke patients in working age in long-term post-stroke care. The findings are crucial for healthcare professionals to develop improved age- and mild- impairment-appropriate strategies or tailor self-management interventions for stroke patients of working age.ClinicalTrials.gov: NCT04839887.
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Affiliation(s)
- Šárka Šaňáková
- Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| | - Elena Gurková
- Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| | - Lenka Štureková
- Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| | - Daniela Bartoníčková
- Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| | - Lenka Machálková
- Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| | - Lenka Mazalová
- Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
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Schwab SM, Silva PL. Intellectual Humility: How Recognizing the Fallibility of Our Beliefs and Owning Our Limits May Create a Better Relationship Between the Physical Therapy Profession and Disability. Phys Ther 2023; 103:pzad056. [PMID: 37265361 DOI: 10.1093/ptj/pzad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/09/2023] [Accepted: 05/27/2023] [Indexed: 06/03/2023]
Abstract
Despite the many advancements over the history of the profession, physical therapy remains in a somewhat paradoxical relationship with disability. The physical therapist profession values disability as diversity but continues to focus on the normalization of body functions as the primary means to promote functionality in people with disability. This focus, consistent with a medicalized view of disability, may prevent physical therapists from empowering individuals with disability to explore alternative, yet effective, perceptual-motor strategies to achieve their functional goals. Additionally, recent research documents implicit, negative biases of physical therapists and physical therapist assistants toward people with disability, again consistent with the medicalized view that disability is the product of an imperfectly functioning body. Dominant underlying beliefs in any profession are often difficult to counter because they are so pervasive, and those beliefs can be reinforced and made stronger when challenged. The purpose of this Perspective article is to introduce physical therapists to a rising construct in psychology-intellectual humility-that may help to facilitate the profession's relationship with disability. Intellectual humility is predicated on recognizing the fallibility of one's beliefs and related practices. Intellectual humility is a promising construct for physical therapy to address the disability paradox and confront implicit attitudes that have served as the basis for many dominant ideas about disability. This Perspective synthesizes views and evidence from the behavioral and social sciences, philosophy, and critical disability studies to contribute to the ongoing evolution of the profession with respect to disability. IMPACT The development of enhanced intellectual humility in physical therapy may help to challenge long-held beliefs among physical therapists about disability-many of which are unnoticed, unquestioned, and difficult to counter.
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Affiliation(s)
- Sarah M Schwab
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Paula L Silva
- Department of Psychology, Center for Cognition, Action, & Perception, University of Cincinnati, Cincinnati, Ohio, USA
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Lo TLT, Lee JLC, Ho RTH. Recovery beyond functional restoration: a systematic review of qualitative studies of the embodied experiences of people who have survived a stroke. BMJ Open 2023; 13:e066597. [PMID: 36759032 PMCID: PMC9923291 DOI: 10.1136/bmjopen-2022-066597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE To synthesise the qualitative evidence of embodied experiences of people who have survived a stroke, the experiences of making sense of oneself, others and the world in the poststroke bodies.DesignQualitative systematic review. DATA SOURCES Five electronic databases, PsycINFO, PubMed, MEDLINE, CINAHL Plus and Cochrane Library, were employed to search for qualitative studies published up to February 2022. INCLUSION CRITERIA Literature in English that employed qualitative methods to investigate the embodied experiences of people who have survived a stroke. QUALITY APPRAISAL Two reviewers independently appraised the quality of the included studies based on the tool developed by Salter et al in 2008. It consists of seven questions assessing the credibility and relevance of the studies. Discrepancies were resolved until a consensus was reached. DATA EXTRACTION AND SYNTHESIS Thematic synthesis was applied to synthesise the related findings from all the included studies. Two reviewers were involved in the process. RESULTS 1482 records were identified. After the screening process, 34 studies were included in this review. Three analytical themes and their related descriptive themes emerged. Analytical themes included 'disconnection between oneself, others and the world,' 'the transitional period: exploring and negotiating,' and 'reconnecting with oneself, others and the world'. CONCLUSION The findings demonstrated that the embodied experiences of people who have survived a stroke progressed from feeling disconnected to reconnecting with themselves, others and the world. Stroke recovery should not only be limited to functional restoration. Approaching 're-embodiment', the realignment between oneself and one's body, is crucial in reintegrating with others and the world on the trajectory toward recovery. PROSPERO REGISTRATION NUMBER CRD42020183125.
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Affiliation(s)
- Temmy Lee Ting Lo
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Janet Lok Chun Lee
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR
| | - Rainbow Tin Hung Ho
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong, Hong Kong SAR
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong SAR
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Haslam BS, Butler DS, Moseley GL, Kim AS, Carey LM. "My Hand Is Different": Altered Body Perception in Stroke Survivors with Chronic Pain. Brain Sci 2022; 12:brainsci12101331. [PMID: 36291266 PMCID: PMC9599659 DOI: 10.3390/brainsci12101331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Chronic pain and body perception disturbance are common following stroke. It is possible that an interaction exists between pain and body perception disturbance, and that a change in one may influence the other. We therefore investigated the presence of body perception disturbance in individuals with stroke, aiming to determine if a perceived change in hand size contralateral to the stroke lesion is more common in those with chronic pain than in those without. METHODS Stroke survivors (N = 523) completed an online survey that included: stroke details, pain features, and any difference in perceived hand size post-stroke. RESULTS Individuals with stroke who experienced chronic pain were almost three times as likely as those without chronic pain to perceive their hand as now being a different size (OR = 2.895; 95%CI 1.844, 4.547). Further, those with chronic pain whose pain included the hand were almost twice as likely to perceive altered hand size than those whose pain did not include the hand (OR = 1.862; 95%CI 1.170, 2.962). This was not influenced by hemisphere of lesion (p = 0.190). CONCLUSIONS The results point to a new characteristic of chronic pain in stroke, raising the possibility of body perception disturbance being a rehabilitation target to improve function and pain-related outcomes for stroke survivors.
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Affiliation(s)
- Brendon S. Haslam
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne 3010, Australia
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne 3086, Australia
- Correspondence:
| | - David S. Butler
- IMPACT in Health, University of South Australia, Kaurna Country, Adelaide 5001, Australia
- Neuro-Orthopaedic Institute, Adelaide 5001, Australia
| | - G. Lorimer Moseley
- IMPACT in Health, University of South Australia, Kaurna Country, Adelaide 5001, Australia
- Neuro-Orthopaedic Institute, Adelaide 5001, Australia
| | - Anthony S. Kim
- Weil Institute of Neurosciences, Department of Neurology, University of California, San Francisco, CA 94143, USA
| | - Leeanne M. Carey
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne 3010, Australia
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne 3086, Australia
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Teng CH, Phonyiam R, Davis LL, Anderson RA. Adaptation to poststroke fatigue in stroke survivors and their care partners: a scoping review. Disabil Rehabil 2022:1-15. [PMID: 35723869 DOI: 10.1080/09638288.2022.2084775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Fatigue is a long-term symptom for stroke survivors. This scoping review synthesized how survivors achieve fatigue adaptation. METHODS Four databases were searched for studies between 2012 and 2021. Qualitative studies or qualitative findings from mixed-methods studies were included if they described survivors' experiences with fatigue and/or care partners' experiences in helping survivors adapt to fatigue. Studies were excluded if they were poster abstracts, reviews, or editorials. RESULTS Thirty-six articles were analyzed. Survivors with fatigue described different adaptive challenges - fatigue made them less productive, brought emotional distress, and was indiscernible to others. To respond to these challenges, stroke survivors did adaptive work including conserving energy, changing mindset, and restructuring normality. Care partners, employers, and colleagues showed adaptive leadership by adjusting daily routines or role responsibilities. Most survivors described that the current clinical practice did not meet their needs to address fatigue. CONCLUSIONS Stroke survivors had many types of challenges and strategies for fatigue adaptation. Survivors received family, employer, and colleague support but how care partners help survivors develop new skills is unknown. Stroke survivors expressed that healthcare professionals need to teach survivors and care partners basic knowledge of fatigue that meet their personal needs and provide adaptive interventions for survivors. Implications for rehabilitationThe challenges of poststroke fatigue are multifaceted because fatigue influences stroke survivors' physical, cognitive, mental, and social aspects of recovery.Stroke survivors need support from their care partners such as helping them adapt to the fatigue, adapt to new life routine, and adjust role responsibilities.Healthcare professionals, stroke survivors, and care partners need to work together to develop strategies about poststroke fatigue that meet stroke survivors' personal needs.
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Affiliation(s)
- Chiao-Hsin Teng
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ratchanok Phonyiam
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leslie L Davis
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ruth A Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Serrada I, Hordacre B, Hillier S. Recovery of Body Awareness After Stroke: An Observational Study. Front Neurol 2021; 12:745964. [PMID: 34912283 PMCID: PMC8666978 DOI: 10.3389/fneur.2021.745964] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Body awareness (BA) is a process that involves sensory awareness originating from the body's physiological states, processes and actions, and is shaped by one's attitudes, perceptions, beliefs and experience of social and cultural context. Impairments in body awareness after stroke are believed to be common and may be an important influence on recovery outcomes. However, recovery of body awareness is poorly understood and receives little consideration in rehabilitation. Aims: To investigate if body awareness changes over time following stroke; and identify if body awareness after stroke is associated with sensation, motor impairment, self-efficacy and quality of life. Methods: An exploratory longitudinal observational study was performed. Participants with a stroke diagnosis and associated motor impairment were recruited from an acute stroke unit. An assessment battery consisting of sensory and motor impairment and function, body awareness, self-efficacy and quality of life measures were used at baseline, 1, 3 and 6 months. Results: A total of 105 people with stroke were recruited. Most recovery in sensation and body awareness occurred within the first month after stroke (all p < 0.01). Sensation and body awareness were correlated with other clinical outcomes (motor impairment, self-efficacy and quality of life), demographics, and stroke specific clinical characteristics (all p < 0.01). Conclusions: This is the first study to track recovery of body awareness after stroke and investigate the relationship it may have in recovery of sensation, motor impairment and function, self-efficacy and quality of life. Further research is now warranted to continue investigation of body awareness and to develop effective stroke-specific assessment and intervention strategies.
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Affiliation(s)
- Ines Serrada
- Allied Health and Human Performance, Innovation, Implementation and Clinical Translation in Health, University of South Australia, Adelaide, SA, Australia
| | - Brenton Hordacre
- Allied Health and Human Performance, Innovation, Implementation and Clinical Translation in Health, University of South Australia, Adelaide, SA, Australia
| | - Susan Hillier
- Allied Health and Human Performance, Innovation, Implementation and Clinical Translation in Health, University of South Australia, Adelaide, SA, Australia
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Stott H, Cramp M, McClean S, Turton A. 'Somebody stuck me in a bag of sand': Lived experiences of the altered and uncomfortable body after stroke. Clin Rehabil 2021; 35:1348-1359. [PMID: 33706575 PMCID: PMC8358539 DOI: 10.1177/02692155211000740] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study explored stroke survivors' experiences of altered body perception, whether these perceptions cause discomfort, and the need for clinical interventions to improve comfort. DESIGN A qualitative phenomenological study. SETTING Participants' homes. PARTICIPANTS A purposive sample of 16 stroke survivors were recruited from community support groups. Participants (median: age 59; time post stroke >2 years), were at least six-months post-stroke, experiencing motor or sensory impairments and able to communicate verbally. INTERVENTIONS Semi-structured, face-to-face interviews were analysed using an interpretive phenomenological approach and presented thematically. RESULTS Four themes or experiences were identified: Participants described (1) a body that did not exist; (2) a body hindered by strange sensations and distorted perceptions; (3) an uncontrollable body; and (4) a body isolated from social and clinical support. Discomfort was apparent in a physical and psychological sense and body experiences were difficult to comprehend and communicate to healthcare staff. Participants wished for interventions to improve their comfort but were doubtful that such treatments existed. CONCLUSION Indications are that altered body perceptions cause multifaceted physical and psychosocial discomfort for stroke survivors. Discussions with patients about their personal perceptions and experiences of the body may facilitate better understanding and management to improve comfort after stroke.
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Affiliation(s)
| | - Mary Cramp
- University of the West of England, Bristol, UK
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Sadanandan S, D'Silva F, Renjith V. Body Cathexis among Stroke Survivors: A Cross-Sectional Study. J Neurosci Rural Pract 2021; 12:33-38. [PMID: 33531757 PMCID: PMC7846317 DOI: 10.1055/s-0040-1716807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background
Stroke results in functional dependence and poor quality of life. Body cathexis is a measure of one’s perceived body image. Stroke survivors often experience stress, anxiety, and disturbances in body image.
Objectives
The objective of the study was to explore the body cathexis of stroke survivors.
Materials and Methods
The cross-sectional survey was conducted at two rural community settings of Kozhikode district, Kerala. Using a purposive sampling, 151 stroke survivors were recruited.
Results
The mean age of the participants was 64.58 years. About 53.6% participants were males and majority of the participants had ischemic stroke (76.2%). About one-third of participants had moderately severe disability. Among the participants, the body cathexis scale (BCS) ranged from 176 to 202. The overall mean (standard deviation) BCS score was 190.09 (5.04). Satisfaction or dissatisfaction toward each body part was analyzed and found that significant areas of dissatisfaction were energy level (98%), wrist (88.1%), elimination (86.1%), fingers (76.2%), and arms (73.5%). The BCS scores compared with the sides of lesion, gender differences, and duration of stroke showed no significant differences in the mean (p>0.05).
Conclusions
Stroke survivors are found to experience disturbances in body image. Low energy level, poor functioning of upper extremities, and disturbed elimination patterns add primarily to body image disturbances. Body cathexis does not differ with side of lesion, gender differences, and duration of stroke.
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Affiliation(s)
- Soumya Sadanandan
- Department of Medicine, Government Medical College, Kozhikode, Kerala, India
| | - Fatima D'Silva
- Nitte Usha Institute of Nursing Sciences, Constituent College of Nitte (Deemed to be University), Deralakattee, Karnataka, India
| | - Vishnu Renjith
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland-Bahrain (RCSI Bahrain), Bahrain
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Pedersen SG, Anke A, Aadal L, Pallesen H, Moe S, Arntzen C. Experiences of quality of life the first year after stroke in Denmark and Norway. A qualitative analysis. Int J Qual Stud Health Well-being 2020; 14:1659540. [PMID: 31547779 PMCID: PMC6781187 DOI: 10.1080/17482631.2019.1659540] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose: This study aims to explore quality of life (QOL) during the first year of recovery after stroke in North Norway and Central Denmark. Method: Individual in-depth interviews with 11 stroke survivors were performed twelve months after stroke onset. An interpretative, inductive approach shaped the interview process and the processing of data. Results: We found that QOL reflected the individuals' reconstruction of the embodied self, which was identified by three intertwined and negotiating processes: a familiar self, an unfamiliar self, and a recovery of self. Further, we found that reconstruction of the embodied self and QOL could be framed as an ongoing and interrelated process of "being, doing, belonging and becoming". Enriching social relations, successful return to work, and continuity and presence in professional support during recovery enhanced the experience of QOL. Fatigue and sustained reduced function hindered participation in meaningful activities and influenced the perceived QOL negatively. Conclusions: The two countries differed in descriptions of continuity and support in the professional follow-up during the recovery process, influencing the degree of encouragement in reconstructing the embodied self. Reconstruction of the embodied self is a means of understanding stroke survivors' QOL during the first year of recovery, supporting an individualized and tailored rehabilitation practice.
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Affiliation(s)
- Synne G Pedersen
- Department of Rehabilitation, University Hospital of North Norway , Tromsø , Norway.,Department of Health and Care Sciences, Faculty of Health Sciences, UiT, the Arctic University of Norway , Tromsø , Norway
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway , Tromsø , Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT, the Arctic University of Norway , Tromsø , Norway
| | - Lena Aadal
- Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University , Aarhus , Denmark
| | - Hanne Pallesen
- Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University , Aarhus , Denmark
| | - Siri Moe
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT, the Arctic University of Norway , Tromsø , Norway
| | - Cathrine Arntzen
- Department of Rehabilitation, University Hospital of North Norway , Tromsø , Norway.,Department of Health and Care Sciences, Faculty of Health Sciences, UiT, the Arctic University of Norway , Tromsø , Norway
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Yap KH, Warren N, Reidpath DD, Allotey P. Interpretations of self-rated health in stroke survivors from a semi-rural community in South East Asia. Int J Qual Stud Health Well-being 2020; 14:1613875. [PMID: 31120385 PMCID: PMC6534198 DOI: 10.1080/17482631.2019.1613875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose: Stroke survivors report poorer self-rated health (SRH) compared to the general population but there is limited understanding on what contributes to SRH. This ethnographic study examined the individual and contextual factors that shape stroke survivors’ SRH in a rural middle income country situated in South East Asia. Methods: Ethnographic methods which encompasses various data collection methods from different data sources were used in this study to describe the socio-cultural context of 16 stroke survivors living in a rural village. Within this context, the experiences of these participants were then interpreted in terms of what contributed to their perception of health and recovery, juxtaposed with objectively measure physical and cognitive states. Results: SRH reflected the post stroke adjustment of stroke survivors. Better SRH was influenced by good post-stroke adjustment that was achieved by a combination of physical functioning, cognitive functioning, emotional well-being and family support. Poorer SRH appear to reflect poor post-stroke adjustment regardless of the objective physical and cognitive states of the stroke survivors. It was also observed that cognitive deficits, though its presence was acknowledged by participants, were usually not taken into account when rating SRH. However, while physical functioning was perceived by participants to directly impact SRH, the presence of cognitive deficits (often in tandem with depressive symptoms) indirectly complicated the recovery of physical functions treasured by participants. Conclusion: Stroke survivors reporting poorer SRH warrant further attention and intervention from health practitioners supporting the longer-term needs of stroke survivors in similar settings.
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Affiliation(s)
- Kwong Hsia Yap
- a Jeffrey Cheah School of Medicine and Health Sciences , Monash University Malaysia , Bandar Sunway , Malaysia
| | - Narelle Warren
- b School of Social Sciences, Clayton Campus , Monash University , Melbourne , Australia
| | - Daniel D Reidpath
- a Jeffrey Cheah School of Medicine and Health Sciences , Monash University Malaysia , Bandar Sunway , Malaysia.,c South East Asia Community Observatory (SEACO) , Monash University , Segamat , Malaysia
| | - Pascale Allotey
- a Jeffrey Cheah School of Medicine and Health Sciences , Monash University Malaysia , Bandar Sunway , Malaysia.,d International Institute for Global Health , United Nations University , Kuala Lumpur , Malaysia
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Kitzmüller G, Mangset M, Evju AS, Angel S, Aadal L, Martinsen R, Bronken BA, Kvigne K, Bragstad LK, Hjelle EG, Sveen U, Kirkevold M. Finding the Way Forward: The Lived Experience of People With Stroke After Participation in a Complex Psychosocial Intervention. QUALITATIVE HEALTH RESEARCH 2019; 29:1711-1724. [PMID: 30862270 DOI: 10.1177/1049732319833366] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Stroke patients' well-being is threatened after stroke. A psychosocial intervention was developed for Norwegian stroke patients living in the community. Eight individual sessions between people with stroke and a trained health care professional were conducted 1 to 6 months post-stroke with one group of participants and 6 to 12 months post-stroke with another group. Subsequently, 19 of these stroke patients were interviewed to gain an in-depth understanding of their lived experience of the influence of the intervention on their adjustment process. Interview texts were analyzed using Ricoeur's interpretation theory. Two participants did not personally find the intervention useful. The remaining participants greatly appreciated dialogues with the empathetic intervention personnel, feeling free to discuss their fears and worries. The intervention raised these participants' awareness of their needs and resources. They were guided to resume their everyday life and adopt a future-oriented attitude. The intervention facilitated their meaning-making endeavors and post-stroke adjustment.
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Affiliation(s)
| | | | - Anne S Evju
- UiT The Arctic University of Norway, Narvik, Norway
| | - Sanne Angel
- Aarhus University, Aarhus, Denmark
- Molde University College, Molde, Norway
| | - Lena Aadal
- Aarhus University, Aarhus, Denmark
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
| | - Randi Martinsen
- Inland Norway University of Applied Sciences, Elverum, Norway
| | - Berit A Bronken
- Inland Norway University of Applied Sciences, Elverum, Norway
| | - Kari Kvigne
- Inland Norway University of Applied Sciences, Elverum, Norway
- Nord University, Sandnessjøen, Norway
| | - Line K Bragstad
- Oslo University Hospital, Oslo, Norway
- University of Oslo, Oslo, Norway
| | | | - Unni Sveen
- Oslo University Hospital, Oslo, Norway
- Oslo Metropolitan University, Oslo, Norway
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Martin-Saez MM, James N. The experience of occupational identity disruption post stroke: a systematic review and meta-ethnography. Disabil Rehabil 2019; 43:1044-1055. [PMID: 31373246 DOI: 10.1080/09638288.2019.1645889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE After a stroke, most individuals cannot participate in some of their valued occupations, disrupting their occupational identity. The aim of this interpretive synthesis is to systematically review the existing body of research to develop an understanding of the experience of occupational identity disruption post-stroke. METHODS A systematic review of the literature that included nine electronic databases, reference lists screening and grey literature checking was completed. Ten studies published between January 2012 and October 2018 were included. Meta-ethnography was used for the interpretive synthesis. FINDINGS A three-staged process model was created. Stage 1 illustrates the four factors involved in occupational identity disruption: "A fragmented and externalized body", "losing control, freedom and independence", "changed social and familial interactions", and "occupational participation loss". Stage two explains the experience of occupational identity disruption: "Occupational identity loss", "a de-valued self", and "threat to identity continuity". Stage three shows the individual's coping strategies: "protecting one's self", "social isolation", and "re-inventing one's occupational self". CONCLUSIONS Stroke impacts on an individual's occupational identity, compromising the continuity of a stroke survivor's sense of self. However, occupational identity is fluid; this can be used to support individuals to re-invent the occupational self. A conceptual model was developed to support the application of these results in clinical practice.Implications for rehabilitationOccupational identity disruption impacts on stroke survivors' self-value and sense of self continuity.Health care professionals' understanding of stroke survivors experience of occupational identity disruption could contribute to realign stroke survivors and clinicians' rehabilitation goals.Occupational participation and social interaction should be core aspects of stroke rehabilitation.Occupation-focus rehabilitation could provide opportunities for stroke survivors to pursue their desired occupational identity.
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Affiliation(s)
- Maria M Martin-Saez
- Occupational Therapy Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Neil James
- School of Health Sciences, University of East Anglia, Norwich, UK
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Abstract
Purpose: This study compared Internet use post-stroke in people with aphasia (n = 25) and without aphasia (n = 17). The purpose was to understand how people with aphasia were using the Internet and to investigate the impact of aphasia on their use.Materials and methods: A face-to-face supported questionnaire explored the use of technologies, types of Internet use, traditional and Internet communication, the perception of abilities, and possible barriers to acquiring or improving Internet skills. Descriptive and inferential statistics were used to analyze the data.Results: Internet use ranged from fully independent to by proxy across both groups. Most participants perceived their aphasia as a barrier, but for the majority, it was not the sole reason for failing to acquire or improve skills. Aphasia was related to difficulties with technology-based written communication. Educational attainment was related to participant's feelings about their own skills. Whilst aphasia was important, analysis revealed that age was a stronger predictor of Internet use per se.Conclusions: It is clear that aphasia often negatively affects Internet use and proficiency. However, this research clearly demonstrates that it is important to consider the influence of factors such as age, proxy use, education, and previous technology use and experience.Implications for rehabilitationPost-stroke aphasia contributes negatively to Internet use, particularly in the use of online communication tools such as email and messaging services.Sub-groups of people with aphasia are likely to be more vulnerable to exclusion from the benefits of the Internet; specifically, older people and those with lower levels of educational attainment.It is common for both older adults with and without aphasia to use the Internet via a proxy. Independent use may not always be the desired goal within rehabilitation.People with aphasia may perceive their age and disability as barriers to using the Internet and may lack confidence in their own ability or potential.
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Affiliation(s)
- Fiona Menger
- Speech and Hearing Sciences, Queen Margaret University, Edinburgh, UK
| | - Julie Morris
- Speech and Language Sciences, Newcastle University, Newcastle, UK
| | - Christos Salis
- Speech and Language Sciences, Newcastle University, Newcastle, UK
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MacKenzie S, Marsh I. The Philosopher of Ambiguity: Exploring Stories of Spirituality of People with Aphasia Through the Lens of Merleau-Ponty. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23312521.2018.1509762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sophie MacKenzie
- Family Care and Mental Health, University of Greenwich, London, United Kingdom
- Allied Health, Canterbury Christ Church University, Canterbury, United Kingdom
| | - Ian Marsh
- Allied Health, Canterbury Christ Church University, Canterbury, United Kingdom
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Bell SL, Tyrrell J, Phoenix C. A day in the life of a Ménière's patient: understanding the lived experiences and mental health impacts of Ménière's disease. SOCIOLOGY OF HEALTH & ILLNESS 2017; 39:680-695. [PMID: 27910108 DOI: 10.1111/1467-9566.12527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Concepts of social practice are increasingly being used to understand experiences of everyday life, particularly in relation to consumption and healthy lifestyles. This article builds on this in the context of lives disrupted and reshaped by chronic illness. It uses social practice theory to examine the lived experiences of individuals with Ménière's disease; a long-term progressive vestibular disorder, defined by episodes of severe and debilitating vertigo, aural fullness, tinnitus and sensorineural hearing loss. Drawing on the findings of 20 in-depth narrative interviews with Ménière's patients, and eight spousal/partner interviews, we explore the impacts of the condition on sensory, temporal, spatial and social dimensions of the body. In doing so, we highlight the intensely embodied sensory and emotional work required to maintain connections between the 'competences', 'materials' and 'meanings' that constitute and sustain the performance of both mundane and meaningful social practices over time. As connections between these elements of social practice are disrupted during more active phases of the condition, affected individuals may be defected from old practices and recruited to new ones, often requiring both time and social support to find meaning or pleasure in these alternative ways of being in the world.
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Affiliation(s)
- Sarah L Bell
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Jessica Tyrrell
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
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Hutton L, Ownsworth T. A qualitative investigation of sense of self and continuity in younger adults with stroke. Neuropsychol Rehabil 2017; 29:273-288. [PMID: 28274180 DOI: 10.1080/09602011.2017.1292922] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Younger adults are more likely to survive after stroke and their life trajectory is often disrupted. This qualitative study aimed to explore the experience of sense of self and continuity in younger adults after stroke. In-depth semi-structured interviews were conducted with 10 adults (3 male, 7 female) with stroke onset between 18 and 55 years of age. Their interview transcripts were analysed using a phenomenological approach that involved idiographic and nomothetic stages of analysis. Two major themes emerged: (1) centrality of stroke; and (2) impacts of stroke on self. The first theme relates to how central the stroke is in participants' lives. The second theme depicts ways in which stroke influences participants' sense of self. In general, participants who perceived their stroke as having lower centrality also experienced continuity of self, whereas participants who viewed their stroke as higher in centrality experienced interruption of self which often co-existed with growth of self. However, perceptions of stroke centrality and the impacts on self shifted over time and context. These findings extend conceptualisations of post-stroke adjustment by indicating that the impact of stroke on sense of self during early to middle adulthood is linked to how central people perceive their stroke to be within their life story. Younger adults may simultaneously experience their sense of self as continuous, interrupted, and grown after stroke.
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Affiliation(s)
- Lauren Hutton
- a School of Applied Psychology and Menzies Health Institute Queensland , Brisbane , Australia
| | - Tamara Ownsworth
- a School of Applied Psychology and Menzies Health Institute Queensland , Brisbane , Australia
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Transitions in the Embodied Experience After Stroke: Grounded Theory Study. Phys Ther 2016; 96:1565-1575. [PMID: 27103225 DOI: 10.2522/ptj.20150419] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 04/14/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The body is central to the practice of physical therapy, but clinical theory largely neglects the body as a concept. A better understanding of the embodied experience could enhance delivery of physical therapy. OBJECTIVES The purpose of this study was to gain an in-depth understanding of embodiment for people after stroke while transitioning from the hospital to the home. DESIGN AND METHODS Seven people with stroke, aged 66 to 89 years, were interviewed 1 month after discharge from a stroke rehabilitation unit. Interviews were analyzed using grounded theory methods, and a theoretical model was developed. RESULTS Two main themes in the embodied experience of stroke were: (1) "a divergent body-self," where participants referred to an objective physical body, separate from their sense of self, and (2) "a cohesive body-self," reflecting a sense that "it's all me." The theme "a divergent body-self" included subthemes of a body that was "strange," "unpredictable," and "effortful." In contrast, the theme "a cohesive body-self" comprised the subthemes "freedom," "control," and "self-identity," reflecting experiences of bodily movement, personal independence, and self-identity. Participants fluxed between these perspectives, within moments and over time, with these perspectives influenced by "anchors," including their environment, knowledge, and attitude. CONCLUSIONS The bodily experience of stroke is intimately connected with a person's sense of self. A person's social and physical environment, as well as his or her personal attributes, can serve to "anchor" that person more comfortably within his or her embodied experience of stroke. Theory that acknowledges the integral connection between body and self could enhance physical therapist practice. This study supports the need for physical therapists to be adequately informed to integrate the embodied experience in their practice when working with people after stroke.
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Meijering L, Nanninga CS, Lettinga AT. Home-making after stroke. A qualitative study among Dutch stroke survivors. Health Place 2016; 37:35-42. [DOI: 10.1016/j.healthplace.2015.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 11/24/2015] [Accepted: 11/26/2015] [Indexed: 11/16/2022]
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Tavener M, Thijsen A, Hubbard IJ, Francis JL, Grennall C, Levi C, Byles J. Acknowledging How Older Australian Women Experience Life After Stroke: How Does the WHO 18-Item Brief ICF Core Set for Stroke Compare? Health Care Women Int 2015; 36:1311-26. [DOI: 10.1080/07399332.2015.1055747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Slatman J. Multiple dimensions of embodiment in medical practices. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2014; 17:549-557. [PMID: 24449288 DOI: 10.1007/s11019-014-9544-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In this paper I explore the various meanings of embodiment from a patient's perspective. Resorting to phenomenology of health and medicine, I take the idea of 'lived experience' as starting point. On the basis of an analysis of phenomenology's call for bracketing the natural attitude and its reduction to the transcendental, I will explain, however, that in medical phenomenological literature 'lived experience' is commonly one-sidedly interpreted. In my paper, I clarify in what way the idea of 'lived experience' should be revisited and, subsequently, what this reconsideration means for phenomenological research on embodiment in health and medicine. The insight that the body is a condition of possibility for world-disclosing yet, at the same time, itself conditioned by this world forces us to not only zoom in on the body's subject-side, but also on its object-side. I argue that in order to render account for this double body ontology, phenomenology should include empirical sociological analyses as well. I thus argue in favor of the idea of a socio-phenomenology. Drawing on material from my own research project on embodied self-experiences after breast surgery, I show how this approach can be fruitful in interpreting the impact of disfigurements on a person's embodied agency, or a person's 'I can'.
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Affiliation(s)
- Jenny Slatman
- Department of Health, Ethics and Society, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands,
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Pluta A, Ulatowska H, Gawron N, Sobanska M, Lojek E. A thematic framework of illness narratives produced by stroke patients. Disabil Rehabil 2014; 37:1170-7. [PMID: 25195545 DOI: 10.3109/09638288.2014.957789] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The present study aims at elucidating the impact of stroke on psychosocial functioning of stroke survivors. METHODS Data were investigated using interpretative thematic analysis of illness stories produced by 29 patients. RESULTS Eight themes emerged from the data: Medical Information; Interpersonal Changes; Cognitive, Physical and Emotional Functioning; Strategies of Coping; Social Support; and Information Irrelevant to the Question. The most frequent organization of the themes followed the course of medical intervention and rehabilitation. Narrations of individual patients varied in terms of the presence of particular themes, the amount of information on each topic and organization. CONCLUSIONS The results suggest that the analysis of non-guided illness narratives can be effectively used to identify the thematic areas important to individual stroke patients. The thematic content analysis of stroke stories can allow health professionals to better understand the patient's state of knowledge related to illness as well as his or her socio-psychological functioning which may be useful in the course of planning further assessment and rehabilitation of patients with stroke. Implications for Rehabilitation Experience of illness and life changes following stroke should be recognized as central to the provision of targeted rehabilitation. To understand the subjective perspective a content analysis of the content narrative is recommended. Our study highlights seven general thematic categories that may be regarded as key. The categories may be useful for clinicians to help individuals to clarify their main concerns following a stroke.
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Affiliation(s)
- A Pluta
- Institute of Physiology and Pathology of Hearing , Warsaw , Poland
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Nanninga CS, Meijering L, Schönherr MC, Postema K, Lettinga AT. Place attachment in stroke rehabilitation: a transdisciplinary encounter between cultural geography, environmental psychology and rehabilitation medicine. Disabil Rehabil 2014; 37:1125-34. [DOI: 10.3109/09638288.2014.955136] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Turabián JL, Pérez-Franco B. [Journey to what is essentially invisible: pysochosocial aspects of disease]. Semergen 2013; 40:65-72. [PMID: 23759314 DOI: 10.1016/j.semerg.2013.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 03/03/2013] [Accepted: 03/10/2013] [Indexed: 11/30/2022]
Abstract
Physicians may be well equipped for the biological aspects of disease, but not for its psychosocial dimensions, an issue that has been absent in family medicine. The psychosocial aspects of the disease are the factors involved in how patients react to the disease, play a role in the expression of symptoms and disease, and have implications on the lives of patients. Moreover, the biological effects (specific) and psychosocial effects (non-specific) are not simply additive but interactive. Physicians should be aware of this hidden, essentially invisible patient psychosocial morbidity, and must incorporate bio-psychosocial interventions into routine medical care to be more effective. In addition, to consider these aspects in the context of care contributes to the distinctive elements of family medicine.
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Affiliation(s)
- J L Turabián
- Medicina de Familia y Comunitaria, Centro de Salud Polígono Industrial, Toledo, España.
| | - B Pérez-Franco
- Medicina de Familia y Comunitaria, Centro de Salud La Estación, Talavera de la Reina, Toledo, España
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