“I’m just not a Sudoku person”: analysis of stroke survivor, carer, and healthcare professional perspectives for the design of a cognitive rehabilitation intervention

Abstract

Purpose: Exploring the views of those impacted by stroke is key to the design of an effective and appropriate cognitive rehabilitation intervention for post-stroke cognitive impairment. This qualitative study examined the perspectives and preferences of stroke survivors, carers, and healthcare professionals to inform the design of a cognitive rehabilitation intervention.

Design and methods: The research employed a qualitative study design and thematic analysis of data. In-depth semi-structured interviews were conducted with stroke survivors (n = 14), carers (n = 11), and healthcare professionals involved in providing stroke care (n = 19). Interviews were audio-recorded and transcribed. Coding was conducted and themes were developed both inductively and deductively.

Results: Themes address five broad areas relevant for the design and implementation of the intervention: (i) activities to include; (ii) when it takes place; (iii) location; (vi) format; (v) who the intervention should include.

Conclusions: Qualitative work with stroke survivors, carers and healthcare professionals provided vital information for the intervention design. Issues identified by participants as being key to intervention development included: (i) implications of post-stroke cognitive impairment survivors’ confidence; (ii) their individual capacity in terms of fatigue and metacognition; and (iii) practical issues such as intervention location. The inclusion of psychoeducation regarding consequences of stroke was recommended.

Implications for rehabilitation

• Stroke survivors, carers, and rehabilitation professionals who provide stroke care can provide valuable insights and ideas to inform the development of a cognitive rehabilitation intervention.

• A cognitive rehabilitation intervention should be tailored to patient-specified goals, incorporating both group and individualized activities.

• Information, education, and communication are required to help stroke survivors and carers understand the cognitive, emotional, and behavioral consequences of stroke.

• Intervention content should be considerate of stroke survivors’ capacity in terms of cognitive impairment and fatigue levels.

Keywords:

• Stroke
• cognition
• rehabilitation
• intervention design
• qualitative research
• thematic analysis

Acknowledgments

The authors would like to thank Professor Marie Johnston (University of Aberdeen) for feedback and commentary on an early presentation of findings.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study is funded by the Health Research Board (HRB) of Ireland under Grant No. ICE-2015–1048, and is being completed as part of the StrokeCog Study, a project that aims to model and modify the consequences of stroke-related cognitive impairment through intervention.