Monday, April 6, 2015

Stroke survivors’ experiences of physical rehabilitation: a systematic review of qualitative studies

Why would you expect any positive experiences from stroke rehab? Your doctor has NO stroke protocols to give you and you waste 90% of the waking hours doing nothing for your recovery.
You could more effectively and accurately just tell them, 'You're F*cking screwed'.
http://www.archives-pmr.org/article/S0003-9993%2815%2900290-7/abstract
Publication stage: In Press Accepted Manuscript

Abstract

Objective

The objective of this systematic review of qualitative studies was to report and synthesise the perspectives, experiences and preferences of stroke survivors undertaking inpatient physical rehabilitation.

Data Sources

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

Study Selection and Appraisal

Qualitative studies reporting stroke survivors’ experiences of inpatient stroke rehabilitation were selected independently by two 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 two reviewers using the COREQ framework. Discrepancies were resolved by consensus.

Data Extraction

Data regarding characteristics of the included studies were extracted by one 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 analysed in three phases using thematic synthesis. Nine interrelated analytical themes, with descriptive subthemes, were identified that related to issues of importance to stroke survivors: physical activity is valued; bored and alone; patient-centred therapy; recreation is also rehabilitation; dependency and lack of control; fostering autonomy; power of communication and information; motivation needs nurturing; 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-centred care, and more effective communication and information. Future stroke rehabilitation research should take into account the experiences and preferences of stroke survivors.

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