Mapping patients’ experiences after stroke onto a patient-focused intervention framework

Abstract

Background: Stroke patients’ involvement in the rehabilitation process including decision making has made significant advances clinically over the past two decades. However, development of patient-focused interventions in stroke rehabilitation is a relatively under developed area of research. The aim of this study was to interpret the explanations that patients gave of their experience after stroke and how these may validate an already established patient-focused intervention framework – the Quest for quality and improved performance (QQUIP) (2006) that includes seven quality improvement goals. Methods: A random purposive sample of eight stroke patients was interviewed between 3 and 6 months following discharge. Patients’ reports of their experience after stroke were obtained using in-dept semi-structured interviews and analysed using Qualitative Content Analysis. Results: Explanations given by patients included both positive and negative reports of the stroke experience. Regardless of consequences as a result of physical, psychological and social impairments, there were other life style disruptions that were reported by all patients such as taking new medication and adverse effects of these, experiencing increasing fatigue, difficulties with social activities and situations and having to make changes in health behaviours and lifestyle. Some of the core themes that emerged reflected the aims of QQUIP improvement goals that include improving health literacy, clinical decision-making, self-care, patient safety, access to health advice, care experience and service development. Discussion: Further recommendations based on the findings from this study would be to consider using the QQUIP framework for developing intervention studies in stroke rehabilitation care that are person-centred. This framework provides a template that is equipped to address some of the main concerns that people have following the experience of stroke and also focuses on improving quality of care.

Implications for Rehabilitation

• Consideration for the use of established patient focused frameworks for improving the design and development of rehabilitation stroke interventions.

• Identify patients’ main concerns following the experience of stroke and its resulting consequences in developing stroke rehabilitation interventions

• Greater need to move from a provider-led model of care towards a more favourably balanced view that includes patient participation and involvement in their self management of the rehabilitation programme required

Keywords::

• Patient-centred goal setting
• patient-focused interventions
• qualitative studies
• self-management
• stroke

Declaration of Interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article. The authors wish to acknowledge Trinity College Dublin Start-up Fund, Ireland who financially supported for this study to be conducted.