ABSOLUTELY FUCKING USELESS! You deliver EXACT REHAB PROTOCOLS! Don't you know anything about survivor requirements? 'Perceived' has nothing to do with getting recovered. DELIVER RECOVERY!
Perceived importance of walking among hospitalized patients with stroke: a thematic analysis
Abstract
Introduction:
Improved walking ability is a common rehabilitation goal for individuals following a stroke.(WRONG! They want back to normal; 100% recovery! You're fired for using the tyranny of low expectations to dumb down survivor goals!) However, the reasons why hospitalized individuals with stroke consider walking to be important are not yet fully understood. This study aimed to elucidate the perceived importance of walking among hospitalized patients with stroke.
Methods:
This qualitative study employed thematic analysis. Hospitalized individuals with stroke undergoing gait rehabilitation were purposively sampled to capture variation in sex, age, and walking ability. The participants underwent in-person semi-structured interviews regarding the importance of walking, which were audio-recorded, transcribed verbatim, and systematically coded to generate themes.
Results:
A total of 19 patients participated in the study. Thematic analysis revealed six major themes. (1) Resumption of daily life: walking was perceived as essential for returning to pre-stroke activities and routines. (2) Health promotion and prevention of functional decline: participants viewed walking as important for maintaining health and preventing deterioration. (3) Uncomfortable walking: participants described physical and environmental challenges associated with walking. (4) Relationships with others: concerns were expressed about how walking difficulties might affect relationships with family and others. (5) Labeling of decreased walking ability: participants were conscious of how their walking was perceived by others. (6) Social environment: walking was linked to broader social factors such as work and transportation.
Conclusion:
The importance of walking for hospitalized patients with stroke ranges from impersonal and generalizable reasons to highly individualized and diverse factors, with implications for individualized walking rehabilitation.
1 Introduction
Stroke is a sudden-onset condition, with approximately 80% of people who have experienced stroke experiencing impaired walking ability (1), with gait disturbance as one of the most critical issues (2). Currently, many stroke rehabilitation programs focus on enhancing the biomechanical and neurological aspects of individuals post-stroke (3). While such approaches offer structured methods for functional recovery, the use of standardized assessments and interventions may inadvertently limit the extent to which the preferences and values of people post-stroke are incorporated into their rehabilitation (4). Schoeb and Bürge (5) reported that individuals undergoing physical therapy desire to more actively express their opinions, goals, and preferences. For example, even when a person post-stroke sets “improving walking ability” as a goal, there may be underlying intentions, such as a desire to walk independently, safely, or with a more natural gait. This suggests a potential gap between clinical priorities and patients’ own hopes for recovery (6), indicating the possibility that even among healthcare professionals involved in gait rehabilitation, the perspectives of individuals post-stroke may not be fully captured. Therefore, for post-stroke gait recovery, it is necessary to not only examine the factors that affect walking ability, such as independence, speed, endurance, and quality, but also the relationship between walking performance and the environment (7), and to provide rehabilitation that considers the opinions and preferences of individuals regarding their gait post-stroke.
A report by Bohannon et al. (8) is frequently cited in studies on the importance of and preference for walking among individuals post-stroke. This study found that individuals post-stroke considered walking independence the most critical factor, followed by distance, appearance, and speed. In addition, Combs et al. (9) reported that individuals with chronic stroke tend to prioritize walking distance over walking speed during outdoor activities. Furthermore, a qualitative analysis of the reasons for preference for specific walking elements revealed that, in terms of walking distance, some participants desired engagement in community activities and social participation, whereas others wished to walk longer distances, even at a slower speed. Some participants prioritized walking speed because they wanted to reach their destination more quickly. These findings suggest that the perceived importance of walking among people post-stroke may vary depending on background factors, such as the lifestyle roles they wish to resume and the range of their desired activity. Although Bohannon et al. (8) identified which walking elements individuals post-stroke prioritize, the reasons behind these choices were not the main focus of the study. Similarly, although Combs et al. (9) highlighted walking distance and speed, the motivations for prioritizing other walking factors remain open for further investigation. Building on these valuable insights, additional research is needed to better understand why individuals consider walking important after stroke and how their individual backgrounds affect these preferences.
The subacute phase, commonly defined as the period from approximately 7 days to 6 months after stroke onset (10), is the primary period during which hospitalized people with stroke receive intensive rehabilitation. During this phase, the incorporation of walking training is recommended in clinical practice guidelines (11), and the assessment of multiple walking-related outcomes is also considered necessary (12). During this period, it is essential to support individuals in achieving the highest possible functional level through interventions focused on improving physical function, sensorimotor impairments, and activities of daily living (13, 14). In addition, individuals post-stroke seek to reconstruct their identities and roles in preparation for reintegration into society after hospital discharge (6). Thus, the period of inpatient rehabilitation for people post-stroke is positioned as a critical phase not only for focusing on physical recovery but also for exploring post-discharge life and reconstructing a way of life, considering the individual’s social context. Based on these findings, in addition to interventions aimed at improving the walking ability, approaches that incorporate the psychosocial aspects (15) of individuals post-stroke are required for gait rehabilitation. However, knowledge of such approaches is limited. Exploring the perceptions of walking among people post-stroke during this stage of rehabilitation could help improve the understanding of the broader meaning of walking ability, which may produce rehabilitation interventions that align with individual preferences and their perceived importance.
The importance of walking varies among stroke survivors, making qualitative methods well suited to exploring their values and experiences. Therefore, this study aimed to clarify why hospitalized individuals post-stroke perceive walking to be important during inpatient rehabilitation.
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