Stroke Survivors' Experiences of Physical Rehabilitation: A Systematic Review of Qualitative Studies

Julie Luker; Elizabeth Lynch; Susanne Bernhardsson; Leanne Bennett; Julie Bernhardt

doi:10.1016/j.apmr.2015.03.017

Stroke Survivors' Experiences of Physical Rehabilitation: A Systematic Review of Qualitative Studies

Arch Phys Med Rehabil. 2015 Sep;96(9):1698-708.e10. doi: 10.1016/j.apmr.2015.03.017. Epub 2015 Apr 3.

Authors

Julie Luker¹, Elizabeth Lynch², Susanne Bernhardsson³, Leanne Bennett², Julie Bernhardt⁴

Affiliations

¹ Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia; International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia. Electronic address: Julie.luker@unisa.edu.au.
² International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia.
³ International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia; Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden; Närhälsan Hönö/Öckerö Rehabilitation, Region Västra Götaland, Sweden.
⁴ Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.

PMID: 25847387
DOI: 10.1016/j.apmr.2015.03.017

Abstract

Objective: To report and synthesize the perspectives, experiences, and preferences of stroke survivors undertaking inpatient physical rehabilitation through a systematic review of qualitative studies.

Data sources: MEDLINE, CINAHL, Embase, and PsycINFO were searched from database inception to February 2014. Reference lists of relevant publications were searched. All languages were included.

Study selection: Qualitative studies reporting stroke survivors' experiences of inpatient stroke rehabilitation were selected independently by 2 reviewers. The search yielded 3039 records; 95 full-text publications were assessed for eligibility, and 32 documents (31 studies) were finally included. Comprehensiveness and explicit reporting were assessed independently by 2 reviewers using the consolidated criteria for reporting qualitative research framework. Discrepancies were resolved by consensus.

Data extraction: Data regarding characteristics of the included studies were extracted by 1 reviewer, tabled, and checked for accuracy by another reviewer. All text reported in studies' results sections were entered into qualitative data management software for analysis.

Data synthesis: Extracted texts were inductively coded and analyzed in 3 phases using thematic synthesis. Nine interrelated analytical themes, with descriptive subthemes, were identified that related to issues of importance to stroke survivors: (1) physical activity is valued; (2) bored and alone; (3) patient-centered therapy; (4) recreation is also rehabilitation; (5) dependency and lack of control; (6) fostering autonomy; (7) power of communication and information; (8) motivation needs nurturing; and (9) fatigue can overwhelm.

Conclusions: The thematic synthesis provides new insights into stroke survivors' experiences of inpatient rehabilitation. Negative experiences were reported in all studies and include disempowerment, boredom, and frustration. Rehabilitation could be improved by increasing activity within formal therapy and in free time, fostering patients' autonomy through genuinely patient-centered care, and more effective communication and information. Future stroke rehabilitation research should take into account the experiences and preferences of stroke survivors.

Keywords: Activities of daily living; Motor activity; Patient preference; Qualitative research; Rehabilitation; Stroke.

Publication types

Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Boredom
Communication
Exercise
Fatigue
Humans
Motivation
Patient-Centered Care / organization & administration
Personal Autonomy
Physical Therapy Specialty / organization & administration*
Qualitative Research
Stroke / psychology*
Stroke Rehabilitation*
Survivors