Developing stroke rehabilitation and community services: a meta-synthesis of qualitative literature

Abstract

Purpose: To identify the key factors that are necessary to account for in planning and developing rehabilitation and community services for stroke based on users’ perspectives. Method: A meta-synthesis of qualitative research comprising three stages: (i) systematic searching and identification of relevant reports; (ii) critical appraisal of selected reports; (iii) analysis and synthesis of included reports. Results: A total of 138 reports were identified, 101 were rejected after applying the inclusion criteria. Following critical appraisal, 18 papers were included. The main interconnecting themes relate to how the impact of stroke is influenced by: (i) the person; (ii) close social relationships; (iii) the social environment; (iv) interactions between all three. The lines-of-argument synthesis relates to the social world a person inhabits and its effect on how a person will perceive and deal with their stroke. Support will be most effective when delivered in the context of this social world. Conclusion: How stroke is perceived is highly dependent on a person’s identity. Support can be effective if delivered within the existing structures of a stroke survivor’s unique social world.

Implications for Rehabilitation

• Rehabilitation of stroke survivors needs to be considered in its broadest context and include an equal focus on the social, psychological and physical aspects.

• Traditional rehabilitation practice needs to be expanded if stroke survivors are to be supported in maintaining an active and positive presence in their unique social world.

Keywords::

• Long-term
• stroke
• support

Acknowledgements

David Wainwright, University of Bath, ran courses on qualitative research methods which were delivered to the users involved in this study, and was involved in steering group meetings. The author acknowledges Beryl Young and Marion Hayes, Royal United Hospital and Wiltshire Primary Care Trust, respectively: librarians who carried out all literature searching. Stroke survivors and carers (Ian Hodgson, Mike and Elaine Jarvis and Jane Paterson) were extensively involved in the project from inception. Involvement included representation on the steering group and presentation of the study’s results to local stakeholders. JP also contributed to the drafting, revising and approval of this article. Representatives from Swindon, Wiltshire, and Bath and North East Somerset PCTs contributed to the steering group meetings. Ethical approval for the whole study was obtained from Bath Research Ethics Committee 08/H0101/11.

Declaration of interest: The University of Bath received funding from the NIHR “Research for Patient Benefit” grants programme to carry out the study. The RfPB monitored the grant, but had no active involvement in the conduct of the study. All researchers were independent of the funding body. The authors report no other conflicts of interest. The authors alone are responsible for the content and writing of the paper.