How is the environment integrated into post‐stroke rehabilitation? A qualitative study among community‐dwelling persons with stroke who receive home rehabilitation in Sweden

Abstract

Studies have shown a need to consider environmental factors to best support the rehabilitation and recovery process after a stroke. In addition, despite intentions to increase individuals’ participation in care and rehabilitation, patients and family members report weak participation. The aim of this study was to explore how the environment was integrated into rehabilitation at home from the perspective of patients after a stroke. We conducted as a qualitative study with 17 patients rehabilitated at home. Data on the participants’ experiences of the rehabilitation process and their perceptions of how the environment was considered in the process were collected via interviews and analysed using qualitative content analysis. The main category that was constructed from the data was “Partial integration of person‐ environment dynamics in the rehabilitation”, which was informed by three subcategories: (a) I recover in my home: Challenges and opportunities in the environment, (b) Following a generic approach to therapy: Limited integration of the environment, and (c) Informed more than involved. Our study showed that the environment was integrated in a limited manner. The participants were more informed about than involved in their planning of the rehabilitation. The results are important for informing the ongoing development of rehabilitation at home and person‐centred care strategies.

A qualitative evidence synthesis exploring people after stroke, family members, carers and healthcare professionals’ experiences of early supported discharge (ESD) after stroke

“…The selection process is outlined in Fig 1 . Eleven studies were located through database searches, one study through Google Scholar [ 40 ]; one study through the protocol of the study initially found in the database search [ 41 ] and one study retrieved from a conference abstract identified again in the database search [ 42 ].…”

“…All included studies were conducted in high income countries as indicated by The World Bank [ 43 ]. Six studies were conducted in the United Kingdom [ 40 , 42 , 44 – 47 ], three studies were conducted in Sweden [ 41 , 48 , 49 ] and one study was conducted in Denmark, Ireland, Canada, Australia and Norway respectively [ 50 – 54 ]. One study did not analyse data collected via interview, instead analysing responses to open ended survey questions [ 52 ].…”

“…One study did not analyse data collected via interview, instead analysing responses to open ended survey questions [ 52 ]. Five studies focused on HCPs and/or those managing or commissioning health services [ 45 , 46 , 48 , 49 , 53 ], two studies included both people after stroke and HCPs [ 40 , 47 ], three studies included both people after stroke and carers [ 42 , 44 , 50 ], three studies only included people after stroke [ 41 , 51 , 54 ] and one study focused solely on carers [ 52 ].…”

Patient Participation and the Environment: A Scoping Review of Instruments

“…As such, providers need to pay attention to and get involved in an iterative decision-making process that focuses also on daily life and considers the person’s physical and social environment. Earlier studies have shown that this is not the norm in clinical practice today [ 27 ]. In this review, we found one instrument by Masters and colleagues [ 67 ] that could serve as inspiration for future development of instruments in transitional as well as home and community care.…”

“…When a patient is informed rather than involved, there is a risk that important information about the patient´s environmental prerequisites will be lost [ 27 ]. For example, inadequate practices of discharge from the hospital—that is, discharge that does not include a dialogue with the patient about his or her home environment and needs post-discharge—may have adverse effects such as dependency in daily activities and social isolation [ 22 ].…”