The meaning and experience of being a stroke survivor: an interpretative phenomenological analysis

Acceptance of disability in stroke: A qualitative metasynthesis

Disability acceptance has been conceptualized as an internalization of oneself as a person experiencing disability and associated with better coping and motivation for rehabilitation. This is particularly pertinent to individuals experiencing stroke because many are initially not fully aware of their stroke-related impairments, which affects the acceptance process. This qualitative metasynthesis aimed to synthesize qualitative findings regarding disability acceptance in stroke and identify barriers and facilitators associated with it. Eighteen studies published from 2003 to 2022, conducted in Asia, Europe, and Australasia, were included in our review. A thematic synthesis was carried out through line-by-line coding and identification of descriptive and analytical themes. Three analytical themes emerged from the analysis: "understanding impairments," "flexibility and active engagement," and "disability acceptance as a non-linear process." Healthcare professionals may facilitate this process by guiding individuals experiencing stroke to recognize that they can manage their limitations and still lead meaningful lives.

Unique Needs and Challenges Experienced by Young People With Stroke: An International Qualitative Analysis

Background and Objectives

Stroke in young adults has a lifelong impact on activities of daily life, including driving, leisure, and community-based activities; social participation; and reduced productivity. The needs of young people with stroke (YPwS) are likely to vary across different countries, and the development of age-adapted information and interventions is therefore critical in addressing those needs. This study aims to (1) identify the unmet needs of people with stroke aged 18 to 55 years across countries with varied income levels and cultural backgrounds and (2) determine their preferred means to access knowledge and information about stroke in the young.

Methods

This international needs analysis used a phenomenologic qualitative design to gain in-depth perspectives about the experiences of YPwS. Participants were recruited from 9 countries of varied socioeconomic status. We interviewed 44 participants with stroke (men: 22; women: 21; transman: 1; mean age: 44.2 ± 8.5 years) living in the community (range of time since stroke: 0.5-10 years). The semistructured interview focused on lived stroke experience, unmet needs, helpful strategies to meet individual needs, hopes, and dreams. The interview was recorded, conducted in the participants' native language, and transcribed verbatim. Data were analyzed using inductive thematic analysis.

Results

Four main themes emerged from the interviews: (1) heterogeneity of unmet needs specific to YPwS, (2) invisible disability, (3) lack of age-specific stroke information, and (4) call for accessible information resources available in different formats. The results highlighted the need to provide long-term and contextually tailored support to YPwS, aligned with their recovery goals and age-specific needs. Initiatives such as peer-support groups, self-management or peer-mentoring programs, information resources in various formats, and participation in research projects could help address the unique needs of this population.

Discussion

Our results emphasize the importance of raising awareness of stroke in the young and the unique challenges of this population. Future research could focus on the development of stroke care pathways specific to YPwS.

Young Adults Rehabilitation experiences and Needs following Stroke (YARNS): A scoping review of the rehabilitation care experiences and outcomes of young adults post-stroke

BACKGROUND

Stroke is one of the leading disabling conditions in the United Kingdom. While an increasing focus on the rehabilitation care for stroke survivors has been noted, practice guidelines, targets and services tend to be tailored for the elderly population rather than young adults.

OBJECTIVES

This scoping review aimed to map the existing literature on the rehabilitation care experiences and outcomes of young adults post-stroke aged between 18 and 45 years within acute and social care settings.

METHODS AND ANALYSIS

A scoping review was conducted to identify existing practice and published academic and evidence-based literature related to the topic. Arksey and O'Malley's framework guided the review and reporting followed the PRISMA-ScR checklist. Electronic databases and grey literature were searched to capture the potentially recent and relevant literature available in English from year 2000-2022. The databases included CINAHL, MEDLINE, EMBASE, PsycINFO, ASSIA, AMED, PEDro, Cochrane Library and Web of Science. Grey literature was searched from the following sources: Google Scholar, websites of networks, organisations and charities related to stroke. Hand searches were performed on the reference lists of the included articles and grey literature to find relevant references. Data were extracted on young adults' experiences of stroke and rehabilitation care and their outcomes and experiences of a particular stroke rehabilitation programme in acute and social care settings.

RESULTS

Eighty-five articles were included in this review. In most instances, stroke was reported to negatively impact young adults, although positive consequences were also documented. The focus and the outcomes of stroke rehabilitation were predominantly physical especially in the areas of movement, communication and memory. Young adults experienced a lack of age-adapted stroke rehabilitation in acute and social care settings.

CONCLUSION

Our results highlight the unmet needs of young adults in their stroke recovery journey. Effective rehabilitation programmes and interventions should be developed to support young adults following stroke and meet their age-specific needs.

Music Upper Limb Therapy - Integrated (MULT-I) supports a positive transformation in sense of self post stroke: a thematic analysis

PURPOSE

To understand how the experience of Music Upper Limb Therapy - Integrated (MULT-I) interconnects with the experience of stroke.

METHODS

Thematic analysis of semi-structured interviews and video-recorded MULT-I sessions from a larger mixed-methods study. Thirty adults with post-stroke hemiparesis completed pre-intervention interviews, of whom fifteen participated in MULT-I. Thirteen of the participants in MULT-I completed post-intervention interviews.

RESULTS

The experience of stroke was characterized by five themes: (1) sudden loss of functional abilities, (2) disrupted participation, (3) desire for independence, (4) emotional distress and the need for support, and (5) difficulty negotiating changes in sense of self. The experience of MULT-I was characterized by three themes: (1) MULT-I activated movement and empowered personal choice, (2) MULT-I created a safe place to process emotional distress and take on challenges, and (3) MULT-I fostered a sense of belonging and a positive transformation in sense of self. These themes combined create a framework which illustrates the process by which MULT-I addressed each challenge described by survivors of stroke, facilitating a positive transformation in sense of self.

CONCLUSION

MULT-I promotes physical, emotional, and social wellbeing following a stroke. This integrated approach supports a positive transformation in sense of self. These findings have implications for improving psychosocial well-being post stroke.

Measures and Influencers of Reintegration for the Stroke Patient: A Systematic Review

ABSTRACT

BACKGROUND: Stroke survivors may experience continued difficulties with reintegration, including challenges participating in social roles and performing activities of daily living across settings (eg, home, work). This article assessed the reintegration measures currently used in this clinical population, defining factors that most influence reintegration for these persons. METHODS: A systematic review of PubMed, Scopus, and the Cumulative Index to Nursing and Allied Health Literature databases explored reintegration measures and factors influencing reintegration in stroke populations. Study inclusion criteria for this review were as follows: data-based articles (quantitative and qualitative), studies measuring reintegration or examining outcomes of reintegration, participants being adult stroke populations, and studies published in English. The resulting articles were critically analyzed, and common themes regarding barriers, facilitators, and influencers of reintegration were established. RESULTS: A total of 24 articles met the inclusion criteria and were synthesized for use in this systematic review. Across stroke populations, 13 reintegration tools were used. A few factors, including residual stroke impairments, unmet needs, social support, and sociodemographic characteristics, are currently known to influence reintegration for this population. CONCLUSION: Reintegration must be uniformly defined and measured to best support stroke survivors, and further investigation into influential factors is critical to advance this goal. This review defines current assessments and factors influencing reintegration within stroke populations. Achieving these goals is critical to optimizing reintegration efforts and designing quality-of-life-improving nursing interventions for affected persons.

Experiences of loss and grief in adults with acquired brain injury (ABI): A systematic review and meta synthesis of qualitative studies

OBJECTIVE

To synthesise the qualitative research related to the processes of loss and grief experienced by adults who have sustained a moderate to severe ABI.

METHOD

We conducted a systematic review and thematic synthesis of the experiences of loss and grief in adults with moderate to severe ABI. Five electronic database searches (PubMed, CINAHL, EMBASE, PsycINFO and Scopus) were conducted, identifying 2434 studies, of which 25 met inclusion criteria.

FINDINGS

Thematic synthesis generated four overarching analytical themes: the loss within me; devaluation of social roles and social identity; acceptance of grief and loss as an active process; and an ambivalent experience of loss. Our findings indicate that the experiences of grief and loss following brain injury are dynamic processes, requiring significant adjustment to and reappraisal of the sense of self, an often uncomfortable reconstruction and sometimes reluctant acceptance of new personal and social identities, and development of tolerance for the ambiguity of one's experience.

CONCLUSION

Findings suggest that people with moderate to severe ABI go through a significant process of change and adaptation in relation to grief and loss and their sequelae. Given the enduring nature of the injury and changing needs of the individual, rehabilitation may need to be increasingly personalised and responsive.

Exploring the experience of cognitive changes among community-dwelling stroke survivors: a qualitative study

PURPOSE

Cognitive deficits are common among stroke survivors and impact their functional independence. Despite the prevalence of cognitive deficits after stroke, cognitive function is largely overlooked in post-stroke care. The aim of this qualitative study was to explore the experiences of individuals living with post-stroke cognitive changes to understand the impact of these changes on their daily lives.

MATERIALS AND METHODS

Semi-structured interviews were conducted with a purposeful sample of thirteen community-dwelling adults 50 years and older with chronic stroke who self-identified cognitive changes post-stroke. Interviews were transcribed and an inductive thematic analysis was completed.

RESULTS

Four key themes were identified: 1) inability to maintain everyday activities; 2) experiencing emotional responses to living with post-stroke cognitive changes; 3) a shrinking social world and; 4) seeking care for cognitive health post-stroke.

CONCLUSIONS

Post-stroke cognitive changes were described by participants as a driving force behind negative shifts in their daily lives, emotional health, and social connections after stroke. Despite seeking care for their post-stroke cognitive changes, many participants were unable to find support in mainstream healthcare. There is a demonstrated need to further elucidate the gaps in care for post-stroke cognitive deficits and implement community interventions targeting cognitive health post-stroke.

Post-stroke limitations in daily activities: experience from a tertiary care hospital in Ethiopia

BACKGROUND

The disability of stroke patients remains an important global health problem; yet information on the extent of restriction from basic and instrumental activities of daily living is limited, particularly in lower-and middle-income (LMIC) countries. Therefore, we examined the issue under the caption, since it is the first step in planning several rehabilitation services.

METHOD

A facility-based cross-sectional study was done to assess the magnitude and predictors of post-stroke limitations in basic activities of daily living (BADL) using the Barthel Index (BI) scale and instrumental activities of daily living (IADL) using the Frenchay Activities Index (FAI) scale among patients who visited Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia, Neurology Clinic from April-October, 2022. All patients having a diagnosis of stroke for more than six months duration were enrolled. Descriptive and inferential statistical analyses were done, and measures of estimated crude and adjusted odds ratio with 95% CI were constructed and a p-value less than 0.05 was considered statistically significant. The results are presented in figures and tables.

RESULTS

A total of 150 stroke patients were enrolled in the present study. The mean age of participants was 53 (14.9) years with slight male preponderance (51.3%). Ischemic stroke was present in 106 (70.7%) of them, while 44 (29.3%) had hemorrhagic stroke. Of this, 57 (38%) and 115 (79.3%) of them had limitations in basic and instrumental ADL, respectively. Comorbid cardiac disease (AOR = 6.9; 95%CI = 1.3-37.5) and regular substance use (AOR = 11.1; 95%CI = 1.1-115) were associated with limitations in BADL, while an increase in age (AOR = 1.1; 95%CI = 1.04-1.15) was associated with severe limitations in BADL. Initial stroke severity (AOR = 7.3; 95%CI = 1.2-44.7) was associated with limitations in IADL, whereas depression (AOR = 5.1; 95%CI = 1.1-23.2) was identified as a predictor of severe limitation in IADL.

CONCLUSION

Limitation in activities of daily living (ADL) after stroke is common among Ethiopian patients. Therefore, screening for post-stroke limitations in daily activities is essential for further management and rehabilitative plans.

Assessing the Social and Environmental Impact of Healthcare Technologies: Towards an Extended Social Return on Investment

Stroke is the third leading cause of death and disability overall worldwide. Upper limb impairment is a common consequence for stroke survivors, having negative impact on their quality of life. Robotic rehabilitation, through repetitive and monitored movements, can improve their status. Developed by a team of researchers at Politecnico di Milano, AGREE is an exoskeleton for upper limb rehabilitation at the stage gate between translational research and clinical validation. Since the cost of this device is particularly high, the present study aimed to provide a framework for assessing its value. The Social Return on Investment (SROI) method, able to grasp the economic, social and environmental impact of an activity, was applied, using expert opinions of a pool of clinical engineers and healthcare professionals from different Italian hospitals to obtain information. Environmental impacts were estimated through Life Cycle Assessment in terms of CO₂ emissions and incorporated in the analysis. Considering a 5-year period, the SROI for a single exoskeleton was 3.75:1, and the SROI for the number of exoskeletons projected to be sold was 2.868:1, thus resulting largely in value for money. This study provides a model for combining economic, social and environmental outcomes that, besides contributing to theory, could be useful for decision-making.

Recovery beyond functional restoration: a systematic review of qualitative studies of the embodied experiences of people who have survived a stroke

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.

Contribution of participation and resilience to quality of life among persons living with stroke in Sweden: a qualitative study

PURPOSE

Resilience contributes to positive adaptation after many health conditions, but little is known about its contribution to long-term recovery after stroke. This study investigated the lived experience of resilience and participation and their relationship to quality of life after stroke in Sweden.

MATERIAL AND METHOD

Semi-structured telephone interviews were conducted with 19 informants (10 male, 9 female), aged from 44-89 years and between 1 and 19 years post-stroke. Stroke severity ranged from mild (n = 8), moderate (n = 9) to severe (n = 2). Interviews were analysed using content analysis.

RESULTS

The analysis resulted in an overarching theme; Life with stroke has been adapted to but not accepted, built on five subthemes: 1) Adapting and adjusting life, 2) Meaningful values in life, 3) Inner resources, 4) Support and treatment from social relations, and 5) Support and treatment from external resources.

CONCLUSION

Participants described a tension between adapting and accepting life after stroke. Resilience was a useful framework, highlighting the contribution of inner, social and societal resources to recovery and quality of life, both directly and as enhanced through increased participation. Important factors for adaptation are meaningful values in life, individual strategies for adaptation and support from both social relationship and the society.

The Patient Lived-Experience of Ventral Capsulotomy for Obsessive-Compulsive Disorder: An Interpretive Phenomenological Analysis of Neuroablative Psychiatric Neurosurgery

Ventral Capsulotomy (VC) is a surgical intervention for treatment-resistant Obsessive-Compulsive Disorder (OCD). Despite clinical studies, little is known about patient perception and lived experience after neurosurgery for severe OCD. To examine the lived experiences of patients who have undergone VC for severe, treatment-resistant OCD through qualitative analysis. We conducted semi-structured interviews with six participants treated with VC for OCD. Interviews were analyzed using Interpretive Phenomenological Analysis. The following themes emerged: (1) After years of conventional treatments, patients felt neurosurgery was their “last hope” and described themselves as “desperate,” (2) While some described the surgery as a “supernatural experience,” patients also demonstrated understanding of the scientific procedure, its risks and potential benefits, (3) The surgical experience itself was positive or neutral, which was linked to trust in the clinical team, (4) Post-surgery, participants described months of heightened fear as they awaited lesion formation and functional improvement. (5) Patients consistently contextualized outcome in the context of their own life goals. Patients undergoing VC have positive views of this neurosurgical intervention, but psychiatric neurosurgical teams should anticipate patient discomfort with the time needed to achieve behavioral improvement following surgery and emphasize the importance of post-operative psychiatric care.

Factors associated with the longer-term unmet supportive care needs of stroke survivors in Ethiopia: a multicentre cross-sectional study

OBJECTIVES

To assess the magnitude of the longer-term unmet supportive care needs and associated factors among adult stroke survivors.

DESIGN

Institutional-based multicentre cross-sectional study.

SETTING

Between 1 March 2020 and 31 May 2020, in Addis Ababa, Ethiopia.

PARTICIPANTS

Adult stroke survivors (aged ≥18 years, n=422), diagnosed with a stroke at least 6 months before the study period and who started regular follow-up at the neurology outpatient clinics in Addis Ababa, Ethiopia.

MAIN OUTCOME MEASURES

Self-reported longer-term supportive care needs.

RESULTS

Two hundred and twenty-six (53.6%) stroke survivors had longer-term unmet supportive care needs, and 196 (46.4%) survivors had no longer-term unmet supportive care needs. Information need about stroke was reported by 416 (98.6%), and how to travel on public transportation was reported by 340 (80.6%) survivors. These were the most frequently reported unmet needs. Stroke survivors' longer-term unmet supportive care needs were significantly associated with being hypertensive with (adjusted OR (AOR) 4.59; 95% CI 2.61 to 8.07), having heart disease with (AOR 1.94; 95% CI 1.19 to 3.82), moderate and above level of disability according to the modified Rankin Scale score with (AOR 26.4; 95% CI 8.61 to 80.92) and unable to use the physiotherapy service with (AOR 2.85; 95% CI of 1.63 to 4.99).

CONCLUSIONS

There are significant longer-term unmet supportive care needs among adult stroke survivors. The factors associated with longer-term unmet supportive care needs were; having comorbidities, moderate and above level of disability according to the modified Rankin Scale score and unable to use the physiotherapy service. The development of appropriate services to address the longer-term unmet supportive care needs of stroke survivors is warranted.

Young Adults Rehabilitation Needs and Experiences following Stroke (YARNS): A review of digital accounts to inform the development of age-appropriate support and rehabilitation

AIMS

To explore younger adults' experiences of stroke rehabilitation to inform practice, education and future health policy.

DESIGN

Qualitative analysis of digital and other media sources on public platforms.

METHODS

Between March and June 2020, the experiences of younger adult stroke survivors aged 18 to 45 at the time of the stroke were collected. Data were gathered from publicly available sources, including social media, and from English-speaking users. In total, 117 accounts from 103 participants were identified from films, autobiographical books, blogs, websites, videos, Twitter and Instagram. Data analysis followed narrative and multimodal analysis with a focus on rehabilitation needs.

RESULTS

Younger adult stroke survivors make sense of their experience by reflecting on how stroke has impacted their lives. Accounts reflected an emotional journey between the past self, the present self and evolving self, as well as associated challenges such as the impact on relationships and careers. The majority of accounts presented transitions as problematic, including the receipt of the initial diagnosis, or sometimes misdiagnosis, to returning home and achieving long-term rehabilitation goals. Specialist stroke nurses were considered essential in the rehabilitation process.

CONCLUSION

A complex process of recovery follows stroke for younger adult stroke populations. Challenges to the rehabilitation process need to be better understood and the role of nursing highlighted in future service provision. A series of age-related challenges were highlighted that require attention to improve the care and support offered.

IMPACT

This article informs clinicians, educators, and policymakers of the age-related needs of young adult stroke survivors. Focusing on the individual and the development of age-appropriate person-centred stroke care is important. The study highlights the role of stroke nursing and challenges the current policy focus on older stroke populations as well as arguing for greater awareness of age-appropriate stroke rehabilitation in younger adults following stroke.

The experience of close personal relationships after stroke: scoping review and thematic analysis of qualitative literature

Background and Purpose:

Psychosocial difficulties, including changed relationships are among the most pervasive and concerning issues following stroke. This study aimed to collate and thematically analyse qualitative literature describing the experience of close personal relationships from the perspective of stroke survivors.

Method:

Using a scoping review methodology, four databases (CINAHL/EBSCO, MEDLINE/Pubmed, Embase, Psychinfo) were systematically searched, yielding 3100 citations. Following exclusion of duplicates and screening against inclusion criteria at title/abstract and full text levels, 53 articles were included in the review. Data were charted and thematically analysed.

Results:

While research has increased since 2000, longitudinal designs are few. Four overarching themes and 12 subthemes were identified. ‘Social disruption’ described changing social worlds, lost social opportunities and shrinking networks. ‘Changed relationships’ included changed family and spousal relationships and changed parenting relationships. The third theme ‘relationships help’ highlighted positive aspects including belonging, support and a life worth living. The final theme was ‘coping with an altered social world’ and described adjustment and emotional responses.

Conclusions:

Relationships are an important aspect of life post stroke but are subject to changes and challenges. This article brings together a breadth of qualitative data to describe lived experiences. Further research, in particular, longitudinal research is required.

Abdul Majeed A. The classification of EEG-based winking signals: a transfer learning and random forest pipeline

Brain Computer-Interface (BCI) technology plays a considerable role in the control of rehabilitation or peripheral devices for stroke patients. This is particularly due to their inability to control such devices from their inherent physical limitations after such an attack. More often than not, the control of such devices exploits electroencephalogram (EEG) signals. Nonetheless, it is worth noting that the extraction of the features and the classification of the signals is non-trivial for a successful BCI system. The use of Transfer Learning (TL) has been demonstrated to be a powerful tool in the extraction of essential features. However, the employment of such a method towards BCI applications, particularly in regard to EEG signals, are somewhat limited. The present study aims to evaluate the effectiveness of different TL models in extracting features for the classification of wink-based EEG signals. The extracted features are classified by means of fine-tuned Random Forest (RF) classifier. The raw EEG signals are transformed into a scalogram image via Continuous Wavelet Transform (CWT) before it was fed into the TL models, namely InceptionV3, Inception ResNetV2, Xception and MobileNet. The dataset was divided into training, validation, and test datasets, respectively, via a stratified ratio of 60:20:20. The hyperparameters of the RF models were optimised through the grid search approach, in which the five-fold cross-validation technique was adopted. The optimised RF classifier performance was compared with the conventional TL-based CNN classifier performance. It was demonstrated from the study that the best TL model identified is the Inception ResNetV2 along with an optimised RF pipeline, as it was able to yield a classification accuracy of 100% on both the training and validation dataset. Therefore, it could be established from the study that a comparable classification efficacy is attainable via the Inception ResNetV2 with an optimised RF pipeline. It is envisaged that the implementation of the proposed architecture to a BCI system would potentially facilitate post-stroke patients to lead a better life quality.

A qualitative exploration of the sociology of poststroke visual impairments and the associated health inequalities

INTRODUCTION

Inequalities have been found to exist within the visually impaired stroke population on an individual level, in relation to demographic differences, unequal access to vision services, transport, employment, and financial repercussions. The long-term impact of living with poststroke visual impairments must be explored, in order to identify complications accessing NHS services and to inform possible changes to service planning and delivery in order to tackle such complications.

AIM

To explore the extent of health inequalities within visually impaired stroke survivors in the northwest of England and discuss potential solutions to these.

METHODS

Focus groups and individual interviews (n = 13 stroke survivors and n = 1 spouse) were conducted between October 2016 and January 2017. Transcription and thematic analysis of the transcripts was undertaken, using line-by-line coding, underpinned with social constructionism.

RESULTS

The findings draw on lived experiences of stroke survivors across their journey from prestroke to life after stroke. The three overarching experiences of stroke and visual impairment that emerged in respondent accounts were constructed in terms of "loss," concerning (a) the physical being, (b) the psychosocial being and, (c) the systematic organization of health care.

CONCLUSION

The stroke survivors frequently reported a complete lack of visual care, with many recounting apathetic experiences, often resonating power imbalance in the healthcare system. Where suitable care is being offered after stroke, a desire for a personalized approach to rehabilitation, with adapted communication methods specific to individual needs, featured strongly in many of the respondent accounts. The findings emphasize a need to ensure vision rehabilitation is offered to all stroke survivors suffering from poststroke visual impairment, and to educate stroke clinicians and patients of the bigger picture of life after stroke, highlighting all forms of available support.

Impact of Memory Problems Post-stroke on Patients and Their Family Carers: A Qualitative Study

Background: Memory problems post-stroke are common and for some, these problems could then progress to a dementia illness. Once in the community, stroke-survivors are looked after by their family doctors although there is evidence that these patients may struggle to access appropriate help in the community for these problems. Although a stroke-survivor may be physically capable of performing daily tasks, they and their families may have to learn to manage and adapt to their new memory deficits. There is often less focus on cognitive recovery post-stroke from clinical services perhaps because of the lack of awareness and evidence of these adaptations. There is also good evidence that organized stroke care improves physical recovery but no equivalent evidence for the effectiveness of cognitive rehabilitation. The aim of this qualitative study was to report the impact of memory problems on the stroke-survivor and their family once they are living in the community.

Methods: Semi-structured interviews were conducted with patients and family carers to gain an in-depth understanding of their experiences. Participants were invited to take part in an interview at around six and 12-months post-stroke. A topic guide was developed to explore participant's care experiences post-stroke when they have also presented with memory difficulties. Data collection and analysis were iterative; all transcripts were anonymized. The data were thematically analyzed.

Results: Twenty-two interviews were conducted. Five family carers and ten stroke-survivors were interviewed at six-months post-stroke, of these eight stroke-survivors and four family carers agreed to a 12-month follow-up interview. They identified several areas of impact: (1) impact on daily life; (2) emotional impact; and (3) compensating strategies implemented in response to impact.

Conclusion: Living with stroke combined with memory impairment can have negative effects on the stroke-survivor and their family once in the community. Health professionals and services in the community need to recognize the burden of managing symptoms post-stroke for these individuals and their families. Understanding the impact can enable more effective community and specialist support to be provided particularly if we were to also identify those who may then be at risk of a future dementia illness.

The experience of upper-limb dysfunction after stroke: a phenomenological study

BACKGROUND

Stroke can bring about a profound disruption to people's lives, but what is less understood is the effect that specific dysfunctions can have. The aim of this study was to explore stroke survivors' experiences of upper-limb dysfunction over time.

METHODS

13 adult stroke survivors engaged in a series of up to four semi-structured interviews over an 18-month period after stroke. Data were interpreted through a method based on framework analysis. An interpretive phenomenological approach guided the research.

RESULTS

Upper-limb dysfunction brought substantial challenges for people, identified in a main theme of an altered way of life. Subordinate themes that contributed to this alteration were challenges in personal care, participating in meaningful and valued activities, and managing life roles and relationships. The second main theme was the disrupted self, with subordinate themes of feeling devalued, disrupted self-image and changes in identity.

CONCLUSION

The impact of upper-limb dysfunction on people's lives after stroke should be understood and acknowledged by rehabilitation professionals. Restoring some functional upper-limb activity could play an important role in enabling a person to regain a meaningful life and a coherent sense of self after stroke.IMPLICATIONS FOR REHABILITATIONUpper-limb dysfunction after stroke, and the loss of bimanual hand function, can profoundly alter a person's life, rendering them unable to manage simple tasks of personal care, participate in valued activities and fulfil important life roles.These functional and social limitations can then disrupt their sense of self, with feelings of low self-worth, and changes in self-image and identity.It is important that these changes in stroke survivors' lives are acknowledged and understood by rehabilitation professionals. More prolonged periods of therapy for recovery of upper-limb function, or for developing compensatory strategies, should be considered so that people can regain some meaning in life and maintain a coherent sense of self.

Why is music therapeutic for neurological disorders? The Therapeutic Music Capacities Model

Music has cognitive, psychosocial, behavioral and motor benefits for people with neurological disorders such as dementia, stroke, Parkinson's disease (PD) and Autism Spectrum Disorder (ASD). Here we discuss seven properties or 'capacities' of music that interact with brain function and contribute to its therapeutic value. Specifically, in its various forms, music can be engaging, emotional, physical, personal, social and persuasive, and it promotes synchronization of movement. We propose the Therapeutic Music Capacities Model (TMCM), which links individual properties of music to therapeutic mechanisms, leading to cognitive, psychosocial, behavioral and motor benefits. We review evidence that these capacities have reliable benefits for people with dementia, stroke, PD and ASD when employed separately or in combination. The model accounts for the profound value that music affords human health and well-being and provides a framework for the development of non-pharmaceutical treatments for neurological disorders.

Experiences of transient ischaemic attack diagnosis and secondary prevention: a qualitative review

Background:

A transient ischaemic attack (TIA) diagnosis is a serious, early sign that a person is at high risk of stroke. However, little is known about patients' experiences, perceptions and behaviours regarding TIA symptoms, diagnosis and secondary prevention.

Aim:

To explore patients' experiences of TIA symptoms, diagnosis and treatment, and secondary prevention.

Methods:

A qualitative review was conducted using a meta-aggregation approach. Five major databases were searched to identify eligible papers. Findings were extracted and grouped into categories to generate synthesised findings.

Findings:

Four papers (69 participants) were included. Three synthesised findings were developed: The first 24 hours; Impact and effect on quality of life; and Reducing the risk. Following TIA diagnosis, patients may experience persistent anxiety and fatigue, and many patients do not understand the importance of secondary prevention.

Conclusion:

There is a lack of awareness of TIA symptoms and of the importance of seeking immediate help and engaging with secondary prevention.

"My life after stroke through a camera lens"- A photovoice study on participation in Sweden

Background

An increasing number of people with stroke live in their communities, yet the understanding of how their reintegration into society can best be facilitated is incomplete. If needs are not sufficiently met and difficulties overcome, it may result in limited participation and decreased life satisfaction for this group. We aimed to understand life after stroke through the lens of participants’ cameras, and hence their views and experiences guided this study.

Methods

By the means of photovoice, an action research method, this study was conducted in a collaborative format with six women and five men after stroke. Participants photographed in everyday life for up to four weeks and then met to discuss all images in a focus group setting. Subsequently, participants gave feedback on the method and discussed the upcoming photography exhibition. All photos and the three focus group discussions were analyzed using a thematic analysis with an inductive approach.

Results

In the focus group discussions, life after stroke were conceptualized through five main themes: a driving force to participate in society; managing everyday life through inventiveness and persistent training; insufficient healthcare and rehabilitation in the long-term perspective; finding meaningful relationships and activities in daily life. Participants’ voices are made clear through selected photos, which aim to present each theme and make results easier to understand.

Conclusions

Participants found new ways to approach everyday life situations and had thereby regained a sense of control in life. However, it was evident that psychological processes towards adaptation were hindered by depression and that some individuals felt alone in an ongoing struggle. Additionally, available interventions a long time after stroke were not flexible enough to address all participants’ needs.

Experiences of living with dystonia

PURPOSE

Dystonia is a chronic and incurable movement disorder. This qualitative study aimed to enhance understanding of the condition by exploring the experience of living with dystonia.

METHOD

Interpretative phenomenological analysis was used to analyse data gathered through semi-structured interviews. Eight participants were recruited via a UK-based dystonia charity.

RESULTS

Three superordinate themes emerged from the data: (1) dealing with ignorance and uncertainty: navigating health services with a rare, poorly understood condition; (2) the challenge of social isolation: overcoming barriers to positive social identity; and (3) fear of psychological explanations: the impact of stigmatised attitudes towards psychological explanations for dystonia symptoms.

CONCLUSION

Coping with a rare and chronic condition led to participants feeling isolated and stigmatised by health care services and their communities. Participants were able to overcome this challenge to their identities through the use of social support, particularly from other people with dystonia. Recommendations for reducing the stigmatising experiences of people with dystonia can help to ease the process of adjustment to the illness and enable people to pursue meaningful lives and positive identities. Recommendations for research are aimed at increasing knowledge about these processes.IMPLICATIONS FOR REHABILITATIONDystonia has a pervasive, negative impact on the lives of people with the condition.The struggle for diagnosis marks the beginning of a period of psychological adjustment, the difficulty of which is compounded by social isolation and stigma.Support groups and peer interaction help people to integrate dystonia into their concept of a meaningful life and identity.Health professionals should play a pivotal role in assisting patients during the process of adjustment and on-going self-management through sensitive communication and signposting to wider support services.

The longitudinal relationship between acceptance and anxiety and depression in people who have had a stroke

OBJECTIVES

The role that acceptance may play in anxiety and depression has received little attention in stroke, unlike other chronic conditions. This study aimed to clarify whether acceptance of a stroke is related to anxiety and depression post-stroke when controlling for social support.

DESIGN

A longitudinal design was employed with 35 participants completing measures at two time points: three-month and nine-month post-stroke.

METHODS

Forty-one stroke patients, who were three-month post-stroke, were recruited from a stroke service register. Participants completed measures of anxiety, depression, social support and acceptance at two time points, six months apart.

RESULTS

Acceptance was moderately and negatively correlated with anxiety and depression at three- and nine-month post-stroke. Acceptance showed a moderate and positive correlation with emotional and practical social support at Time 1 but not at Time 2. Acceptance at Time 1 was a stronger predictor of both anxiety and depression at Time 2 than emotional or practical social support.

CONCLUSIONS

Acceptance is an important area to consider in relation to rehabilitation and adjustment following a stroke.

How is sexuality after stroke experienced by stroke survivors and partners of stroke survivors? A systematic review of qualitative studies

Objective:

To synthesise how post-stroke sexuality is experienced by stroke survivors and partners of stroke survivors.

Methods:

MEDLINE, PubMed, SCOPUS, CINAHL and PsycINFO were searched from inception to May 2018 using a combination of relevant Medical Subject Headings and Free Text Terms. Only papers published in English reporting original qualitative research were included. Methodological quality was assessed using the Critical Appraisal Skills Programme Qualitative Research Checklist. All text presented as ‘results’ or ‘findings’ in the included studies was extracted and subjected to a thematic analysis and synthesis which was discussed and agreed by the research team.

Results:

The initial search yielded 136 unique papers with a further 8 papers identified through reference checking. Following full-text review, 43 papers were included in the final synthesis. Two analytical themes were identified: sexuality is silenced and sexuality is muted and sometimes changed, but not forgotten. These themes were made up of six descriptive themes: struggle to communicate within relationships, health professionals don’t talk about sexuality, sexuality and disability is a taboo topic, changes to pre-stroke relationships, changed relationship with the stroke survivor’s own body and resuming sexual intimacy – adaptation and loss.

Conclusion:

Stroke has a profound impact on how sexuality is experienced by both stroke survivors and partners of stroke survivors. Despite this, post-stroke sexuality is rarely discussed openly. Stroke survivors and partners value sexuality and may benefit from strategies to support adjustment to post-stroke sexuality.

Documenting the impact of stroke in a middle-income country: a Malaysian case study

Purpose: Stroke is an abrupt event that often leaves survivors with long term disabilities, causing role changes, and financial strains on households. The profound impact of stroke on survivors may lead to a decline in quality of life due to the physical, psychological, and social difficulties they experience. Taking Malaysia as an example, this study aimed to explore the impact of stroke on survivors and how health services influence their recovery in low and middle-income countries (LMIC).Method: An ethnographic approach with data obtained primarily through in-depth interviews was used. Twenty-seven participants identified as having suffered a stroke were drawn from a health and demographic surveillance system in Malaysia.Results: The physical and social disruption of the lives of stroke survivors was intensified by the resultant financial constraints placed upon individuals, families and households, compounded by inadequate support from the health, and welfare systems. Despite the disruption to their lives, most participants were, at least in part, able to reestablish their lives through various factors that include a strong family support and active coping strategies.Conclusion: In LMIC, recovery can be shaped by the family unit and through active coping strategies especially those in relation to spirituality.Implications for rehabilitationThe impact of stroke on survivors and lack of specialized stroke care compromise the recovery process and quality of life for stroke survivors in low and middle-income countries.Support from the family and reinforcement of religious coping were judged to successfully aid recovery.Physical and emotional impairments as well as psychosocial wellbeing of survivors in the context of environmental factors need to be addressed.

Double Jeopardy: Plight of Female Students with Disabilities in Botswana’s Higher Education

Although substantial recent research addresses the importance of higher education (HE) for students with disabilities, this sector has remained under-researched in Botswana. The struggle of female students with disabilities to access and participate in HE remains an issue of great concern for disability activists and researchers. The purpose of this phenomenological study was to explore and describe the lived experiences of female students with disabilities in their struggle to access and participate in three HE institutions in Botswana. Seven female students with disabilities participated in this research. Multiple methods, such as focus group discussions, photovoice and solicited journals, were used to collect data. The data were analysed using Atlas.ti 7.5 qualitative data analysis software. Three themes emerged, and they are (a) socio-cultural issues and disability identity, (b) access and participation in HE and (c) empowerment of female students. These findings served to inform Botwana’s HE institutions that include female students with disabilities, to help them to promote participation as well as quality of experiences.

The effect of a dysfunctional upper limb on community-dwelling stroke survivors and their carers: An interpretative phenomenological analysis

OBJECTIVES

The poststroke upper limb continues to pose a myriad of physical and psychological challenges for patients and caregivers. To optimize existing services, this study firstly aimed to explore the experiences of both stroke survivors and caregivers and secondly identify their ongoing needs.

METHODS

A qualitative approach was utilized for this study. Six participants (three stroke survivors and three caregivers) were purposively sampled from community stroke groups. Semi structured interviews were utilized to collect experiential data, which were analysed using an interpretative phenomenological approach.

RESULTS

Three master themes emerged from data analysis: "Finding a way forwards from a poor start," "The battle with the upper-limb," and "Relationships with self and society." All participants, seemingly affected by disappointing services, expressed negative views of rehabilitation. Misplaced or persistent hope, losses in control, and reduced autonomy may have contributed to poor functional outcomes and perceptions of rehabilitation services. The complex physical and psychological impact of the experience of the dysfunctional upper limb was also associated with ongoing and unmet support needs for stroke survivors and carers.

CONCLUSIONS

Healthcare professionals may consider the varying impact of the dysfunctional upper limb during decision-making and treatment planning, particularly during acute rehabilitation. Future research could explore therapists' perceptions and experiences of upper-limb rehabilitation during this period.

The efficacy of problem solving therapy to reduce post stroke emotional distress in younger (18-65) stroke survivors

PURPOSE

To investigate the efficacy of problem solving therapy for reducing the emotional distress experienced by younger stroke survivors.

METHOD

A non-randomized waitlist controlled design was used to compare outcome measures for the treatment group and a waitlist control group at baseline and post-waitlist/post-therapy. After the waitlist group received problem solving therapy an analysis was completed on the pooled outcome measures at baseline, post-treatment, and three-month follow-up.

RESULTS

Changes on outcome measures between baseline and post-treatment (n = 13) were not significantly different between the two groups, treatment (n = 13), and the waitlist control group (n = 16) (between-subject design). The pooled data (n = 28) indicated that receiving problem solving therapy significantly reduced participants levels of depression and anxiety and increased quality of life levels from baseline to follow up (within-subject design), however, methodological limitations, such as the lack of a control group reduce the validity of this finding.

CONCLUSION

The between-subject results suggest that there was no significant difference between those that received problem solving therapy and a waitlist control group between baseline and post-waitlist/post-therapy. The within-subject design suggests that problem solving therapy may be beneficial for younger stroke survivors when they are given some time to learn and implement the skills into their day to day life. However, additional research with a control group is required to investigate this further. This study provides limited evidence for the provision of support groups for younger stroke survivors post stroke, however, it remains unclear about what type of support this should be. Implications for Rehabilitation Problem solving therapy is no more effective for reducing post stroke distress than a wait-list control group. Problem solving therapy may be perceived as helpful and enjoyable by younger stroke survivors. Younger stroke survivors may use the skills learnt from problem solving therapy to solve problems in their day to day lives. Younger stroke survivors may benefit from age appropriate psychological support; however, future research is needed to determine what type of support this should be.

Using blogs to explore the lived-experience of life after stroke: "A journey of discovery I never wanted to take"

AIMS

To explore the lived-experiences of stroke survivors as expressed in blogs and to discover the role the blogs play in the writers' lives.

BACKGROUND

Stroke can be a devastating, life changing event. Previous qualitative studies tend to examine one aspect of life after stroke. As stroke often has multiple effects, it is necessary to look widely at its lived-experience. New resources which can enable researchers to explore the lived-experience of stroke are blogs.

DESIGN

Phenomenological exploration using an interpretive thematic analysis.

METHODS

The Internet was searched for stroke survivors' blogs (January-March 2016) using pre-set criteria, seeking blogs with entries over an extended time (>1 year). Suitable blogs were identified and codes of meaning were identified and developed into categories, subthemes and themes.

FINDINGS

Eight blogs were identified for analysis. Of the 40 categories, eight subthemes were assimilated; internal dialogue, emotions, transition, stroke effects, health care, "in the world", relationships, rehabilitation. Two main themes were identified related to perspectives of lived-experience; Internal relationship with "self" and External relationship with "the world". Participants expressed loss and initially strove to regain their "old" lives, their focus being recovery and independence.

CONCLUSION

Stroke survivors must transition from their previous life to a new and initially unwelcome way of being. Rehabilitation should respect this process and support stroke survivors as they undertake this individual journey.

Envisioning the future as expressed within family health conversations by families of persons suffering from stroke

BACKGROUND

The whole family is affected when a person suffers from stroke, but few studies have focused on families' expectations following the stroke.

OBJECTIVE

The aim of this study was to illuminate what persons with stroke and their family members talk about in Family Health Conversations (FamHCs) with focus on the future and how nurses leading these conversations apprehended the families' future shown in closing letters based on these conversations.

METHOD

In this study, seven families with a member ≤65 years who had suffered a stroke participated in FamHC in their homes after the person with stroke had been discharged from the rehabilitation clinic. The FamHC comprised a series of three conversations conducted every other week and a closing letter sent by the nurses to the family to conclude the series. In this study, the third conversations were recorded and they and the closing letters were transcribed and analysed using qualitative content analysis.

RESULT

The family members including the persons with stroke were found to be able to tell their stories and express their feelings, worries, losses, hopes and wishes for the future within the context of the Family Health Conversations. Support within the family was highlighted as essential to the satisfactory management of future situations.

CONCLUSION

The persons with stroke and their belonging family members' vision of the future was reflected over in the light of theories about beliefs, possible selves, hope and suffering, and the findings highlight the need for broader use of family conversations to support persons with stroke and their families to manage the future.

Misconceptions about Stroke: Causal Attributions for Stroke-Related Symptoms Reflect the Age of the Survivor

With visible disabilities, observers tend to overgeneralise from the disability. In contrast, with invisible disabilities such as traumatic brain injury and stroke, observers often fail to allow for challenges resulting from the disability. Persons who have suffered a stroke claim that people misunderstand their symptoms and stigmatise them as a result of these symptoms. This misunderstanding, which happens particularly with young survivors of stroke, may reflect people's causal attributions for symptoms that follow a stroke. Using a scenario design, this cross-sectional study examined whether people attribute ambiguous symptoms that may result from stroke to other causes (the stroke survivor's personality and age) and whether these attributions reflect the age of the stroke survivor. Participants (N = 120) read scenarios describing a male who was aged either 22, 72, or whose age was unstated and who showed four symptom changes: fatigue, depression, irritability and reduced friendships. For each symptom change, participants rated three causal attributions: the person's age, his personality and stroke. The age of the person in the scenario affected attributions; when the person in the scenario was 22, participants attributed his symptoms significantly more to his personality than to his age or stroke, whereas when he was 72, participants attributed his symptoms more to his age than to his personality or stroke and when his age was unstated, they attributed his symptoms equally to age, stroke and personality. Because misattributions for stroke symptoms hinder rehabilitation, therapy can target people's misattributions to enhance rehabilitation for survivors of stroke.

The relationship between stroke survivors' perceived identity and mood, self-esteem and quality of life

OBJECTIVES

To examine change in identity after stroke and to elucidate its relationship with mood and quality of life. To test Higgins' theory of the impact of identity (self-discrepancy) on anxiety and depression. To examine the role of self-esteem in mediating the relationship between identity and outcomes.

METHOD

Sixty-five community-living first-time stroke survivors, mean age 61.58 and time since stroke 5.60 years, were recruited from stroke charities. A cross-sectional study used the Head Injury Semantic Differential Scale, the Hospital Anxiety and Depression Scale, the Rosenberg Self-Esteem Scale, the Stroke-Specific Quality of Life Questionnaire (adapted) and the Barthel Index.

RESULTS

Identity was rated more negatively after stroke than before (t(64) = 6.46, p < .00). Greater discrepancy in identity was associated with anxiety (r = .38, p < .00), depression (r = .59, p < .00), self-esteem (r = -.48, p < .00) and quality of life (r = -.54, p < .00). Overall positivity of identity after stroke predicted outcomes even better than discrepancy. The association between discrepancy and mood and quality of life was mediated by self-esteem (β = .30, p < .01; β = -.24, p < .01, respectively). Specific types of discrepancy defined by Higgins did not show differential relationships with anxiety and depression as predicted.

CONCLUSIONS

Identity changes after stroke and identity and self-esteem are associated with important outcomes for stroke survivors.

Transitions in the Embodied Experience After Stroke: Grounded Theory Study

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.

The meaning of participation to stroke survivors: a qualitative study

Background/Aims:

The effect of stroke can be all encompassing, and has an impact on significant roles in life. Assessing someone's level of participation is seen as essential to understanding the social impact of a disability on a person's life, and tailoring support accordingly. This study aimed to examine the meaning of participation to stroke survivors, in order to provide insight into the meaning of participation in the context of a stroke.

Methods:

A qualitative approach drawing on methods of phenomenology was used, with data collected via semi-structured interviews and a follow-up focus group. Analysis was undertaken using techniques of interpretative phenomenological analysis.

Findings:

Six stroke survivors and six carers were interviewed, and four stroke survivors attended a focus group. Three main themes in relation to the meaning of participation were identified in the data: ‘being actively involved’; ‘making meaningful choices’; and ‘being me’.

Conclusions:

The work confirms the findings of previous studies on participation, and adds to current understandings by developing the meaning of ‘involvement’ beyond a social concept. It highlights that ‘involvement’ can include active engagement in life through being alone. It also identifies a specific link between stroke survivors’ sense of self, and participation.

A qualitative study of the experience of psychological distress post-stroke

There is little qualitative data on the emotional effect of stroke upon which to base hypotheses for psychological interventions. We used Interpretative Phenomenological Analysis of semi-structured interviews with 10 individuals in the clinical range for psychological distress on the Hospital Anxiety and Depression Scale to explore their experiences of psychological distress. Three super-ordinate themes (the fear of stroke, loss of self and sense of isolation and aloneness) emerged. Processes involving a lack of acceptance and self-compassion underlined these themes. Internal isolation was found as a great problem. These themes may indicate targets for directed psychological interventions in people following stroke.

Exploring the Experiences of Living With Stroke Through Narrative: Stroke Survivors' Perspectives

Chronic illness models are normally used to explain and predict the experience of living with a long-term condition. The aim of this study was to present the findings of narrative interviews with stroke survivors and their family carers to understand their experiences of stroke. We interviewed five people with stroke and three family carers from the United Kingdom. We used thematic analysis to generate themes from their narrative accounts and then linked them to broader theoretical perspectives while influenced by the concept of reinterpretation of life. The narrative accounts of participants are mainly structured based on how their changed bodies poststroke changed their identities and roles and consequently their relationships with others. In this study, we underline the need for using methods like narrative to explain strategies that people use to make sense of their experiences of living with a long-term condition such as stroke.

After critical care: patient support after critical care. A mixed method longitudinal study using email interviews and questionnaires

PURPOSE

To explore experiences and needs over time, of patients discharged from ICU using the Intensive Care Experience (ICE-q) questionnaire, Hospital Anxiety and Depression Scale (HADS) and EuroQoL (EQ-5D), associated clinical predictors (APACHE II, TISS, Length of stay, RIKER scores) and in-depth email interviewing.

METHODS

A mixed-method, longitudinal study of patients with >48hour ICU stays at 2 weeks, 6 months, 12 months using the ICE-q, HADS, EQ-5D triangulated with clinical predictors, including age, gender, length of stay (ICU and hospital), APACHE II and TISS. In-depth qualitative email interviews were completed at 1 month and 6 months. Grounded Theory analysis was applied to interview data and data were triangulated with questionnaire and clinical data.

RESULTS

Data was collected from January 2010 to March 2012 from 77 participants. Both mean EQ-5D visual analogue scale, utility scores and HADS scores improved from 2 weeks to 6 months, (p=<0.001; p=<0.001), but between 6 and 12 months, no change was found in data from either questionnaire, suggesting improvements level off. These variations were reflected in qualitative data themes: rehabilitation/recovery in the context of chronic illness; impact of critical care; emotional and psychological needs (including sub-themes of: information needs and relocation anxiety). The overarching, core theme related to adjustment of normality.

CONCLUSIONS

Patient recovery in this population appears to be shaped by ongoing illness and treatment. Email interviews offer a convenient method of gaining in-depth interview data and could be used as part of ICU follow-up.

A qualitative case study of poststroke sexuality in a woman of childbearing age

OBJECTIVE

To explore perceptions of poststroke sexuality in a woman of childbearing age.

DESIGN

Qualitative case study.

SETTING

Community.

PARTICIPANT

A 36-year-old married mother of two children with a history of acute ischemic stroke 7 months prior to interview.

METHODS

A semistructured interview guide was used to gather data during a single face-to-face interview. Data consisted of an audio-recorded interview and verbatim transcription, field notes, and demographic information. The inductive approach of qualitative content analysis was used to analyze the data.

RESULTS

Four main categories, Slow to Get Back to the Sexual Life, The Vulnerable Body, Crushed by the Stroke and The Inadequate Self, were used to describe how the emotional trauma of having a stroke at a young age affected the participant's sense of self. Issues with sexuality were related to her perception of her poststroke body as vulnerable. Stage of life informed the participant's perceptions of pre- and poststroke sexuality.

CONCLUSION

A stroke during childbearing years may affect a woman's perception of herself as a sexual being and her ability to carry out gender roles.

Health state descriptions to elicit stroke values: do they reflect patient experience of stroke?

Background

To explore whether stroke health state descriptions used in preference elicitation studies reflect patients’ experiences by comparing published descriptions with qualitative studies exploring patients’ lived experience.

Methods

Two literature reviews were conducted: on stroke health state descriptions used in direct preference elicitation studies and the qualitative literature on patients’ stroke experience. Content and comparative thematic analysis was used to identify characteristics of stroke experience in both types of study which were further mapped onto health related quality of life (HRQOL) domains relevant to stroke. Two authors reviewed the coded text, categories and domains.

Results

We included 35 studies: seven direct preference elicitation studies and 28 qualitative studies on patients’ experience. Fifteen coded categories were identified in the published health state descriptions and 29 in the qualitative studies. When mapped onto domains related to HRQOL, qualitative studies included a wider range of categories in every domain that were relevant to the patients’ experience than health state descriptions.

Conclusions

Variation exists in the content of health state descriptions for all levels of stroke severity, most critically with a major disjuncture between the content of descriptions and how stroke is experienced by patients. There is no systematic method for constructing the content/scope of health state descriptions for stroke, and the patient perspective is not incorporated, producing descriptions with major deficits in reflecting the lived experience of stroke, and raising serious questions about the values derived from such descriptions and conclusions based on these values.