The experience of occupational identity disruption post stroke: a systematic review and meta-ethnography

Abstract

Purpose

After a stroke, most individuals cannot participate in some of their valued occupations, disrupting their occupational identity. The aim of this interpretive synthesis is to systematically review the existing body of research to develop an understanding of the experience of occupational identity disruption post-stroke.

Methods

A systematic review of the literature that included nine electronic databases, reference lists screening and grey literature checking was completed. Ten studies published between January 2012 and October 2018 were included. Meta-ethnography was used for the interpretive synthesis.

Findings

A three-staged process model was created. Stage 1 illustrates the four factors involved in occupational identity disruption: “A fragmented and externalized body”, “losing control, freedom and independence”, “changed social and familial interactions”, and “occupational participation loss”. Stage two explains the experience of occupational identity disruption: “Occupational identity loss”, “a de-valued self”, and “threat to identity continuity”. Stage three shows the individual’s coping strategies: “protecting one’s self”, “social isolation”, and “re-inventing one’s occupational self”.

Conclusions

Stroke impacts on an individual’s occupational identity, compromising the continuity of a stroke survivor’s sense of self. However, occupational identity is fluid; this can be used to support individuals to re-invent the occupational self. A conceptual model was developed to support the application of these results in clinical practice.

Implications for rehabilitation

• Occupational identity disruption impacts on stroke survivors’ self-value and sense of self continuity.

• Health care professionals’ understanding of stroke survivors experience of occupational identity disruption could contribute to realign stroke survivors and clinicians’ rehabilitation goals.

• Occupational participation and social interaction should be core aspects of stroke rehabilitation.

• Occupation-focus rehabilitation could provide opportunities for stroke survivors to pursue their desired occupational identity.

Keywords:

• Occupations
• stroke
• occupational therapy
• rehabilitation
• self-concept
• adjustment disorders
• identity continuity

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Maria M. Martin-Saez is funded by the National Institute for Health Research (NIHR) [Masters in Clinical Research] for this research project. This paper presents independent research. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. This manuscript was prepared during a research fellowship funded by Addenbrookes Charitable Trust and Cambridge Biomedical Research Centre.