An Ecological Approach to Activity After Stroke: It Takes a Community

Abstract

There are layers of interactions between individuals and multiple factors in their environments that influence participation. Low poststroke activity levels may be amenable to intervention. Further research should consider the following: (1) participation in activities through the lens of all levels of the socioecological model; (2) the impact of disability and aging-related stigma; (3) the results of ad hoc community navigation; and (4) the effects of restrictive health and disability policies on meaningful activity.

Uncovering Treatment Burden as a Key Concept for Stroke Care: A Systematic Review of Qualitative Research

“…Ages of participants ranged from 22 to 100 years; this was unreported in a few studies (n=7) [53],[54],[72],[105],[106],[110],[114]. Time since stroke (n=41) [7],[52],[55]–[58],[63]–[65],[68]–[71],[74],[78]–[80],[83]–[85],[87]–[89],[91]–[95],[97],[99]–[104],[107],[108],[110],[116]–[118] ranged from under 2 weeks to 16 years. Disability since stroke (n=39) [7],[54]–[56],[58],[61],[63],[65],[67]–[69],[71],[76],[77],[79]–[83],[85],[89]–[92],[95],[96],[99],[100],[102]–[104],[106],[108]–[110],[115],[117]–[119] was very variable.…”

“…Co-morbidities were seldom mentioned (n=11) [53],[67],[73],[77],[80],[86],[90],[93],[99],[100],[112] nor were medications (n=3) [7],[77],[86]. Qualitative data gathering methods: interviews (n=63)[7],[52]–[74],[76]–[91],[94]–[102],[105],[107]–[119]; focus groups (n=4) [93],[103],[104],[106]; interviews and focus groups (n=2) [75],[92]; additional field notes (n=5) [69],[87],[88],[111],[118]; additional patient observation (n=1) [95]. Data analysis: a variety of qualitative methods were used, and all sought to identify common themes raised by participants (details are described in Table S4).…”

“…They describe it as challenging to make sense of and to differentiate between the roles of different individuals and services, for example whom to contact for advice once discharged from hospital [76],[91],[95],[112]. A lack of continuity of care for patients and poor communication between services can result in patients receiving conflicting information from different parties, making it harder to understand the necessary processes that promote recovery [7],[52],[57],[67],[76],[95]:…”

What environmental factors influence resumption of valued activities post stroke: a systematic review of qualitative and quantitative findings

“…Thematic analysis revealed that valued activities could be divided into the following categories: reengagement in valued activities in general (studies about outdoor and indoor activities); 22,25,26,32,33,35–46,48,60–64,67–72 social and community reengagement (studies about social activities outside the home and in the community); 21,23,27, 28,34,47,50,52,55,58,73,74 mobility (studies about moving around as a meaningful activity) 29,51,53,54,56,57,59 and work. 24,49,65,66,75–86 Some single remaining studies on activities such as eating, exercise or leisure …”

Fall-related experiences of stroke survivors: a meta-ethnography

“…Carers have expressed concern about stroke survivors being injured or being unable to rise from the floor [2,14]. Discrepancies in understanding of risk between some stroke survivors and their spouses have also been noted [15]. The importance of self-identity and self-efficacy is frequently discussed in qualitative research exploring the experience of living with stroke [16][17][18][19].…”