Returning to Leisure Activity Post-Stroke: Barriers and Facilitators to Engagement

Abstract

Objectives: To identify barriers and facilitators to engagement when returning to, or participating in, leisure activity post-stroke or Transient Ischemic Attack (TIA). Design: Sequential explanatory, mixed methods study. Setting: 21 hospital sites across England, Wales and Northern Ireland. Participants: Adults with a clinical diagnosis of first/recurrent stroke or TIA. Patients approaching end of life were excluded. Participants were recruited as in-patients or at first clinic appointment and a baseline questionnaire was completed. A 6-month follow-up questionnaire was sent to participants for self-completion. Open-text questions were asked about barriers and facilitators when returning to, or participating in, leisure activity. Responses were thematically analysed and explored by participant characteristics, including type of leisure activity undertaken. Characteristics also included measures of socioeconomic deprivation, mood, fatigue and disability. Results: 2000 participants returned a 6-month follow-up questionnaire (78% stroke, 22% TIA); 1045 participants responded to a question on barriers and 820 on facilitators. Twelve themes were identified and the proportion of responses were reported (%). Barriers: physical difficulties (69%), lower energy levels (17%), loss of independence (11%), psychological difficulties (10%), hidden disabilities (7%), and delay or lack of healthcare provision (3%). Facilitators: family support (35%), healthcare support (27%), well-being and fitness (22%), friendship support (20%), self-management (19%), and returning to normality (9%). ‘Physical difficulties’ was the most reported barrier across all participant characteristics and activity types. Family support was the most reported facilitator except for those with greater disability, where it was healthcare support and those without fatigue where it was well-being and exercise. Conclusions: Physical difficulties and lack of energy are problematic for stroke and TIA survivors who want to return to or participate in leisure activity. Healthcare support alone cannot overcome all practical and emotional issues related to leisure activity engagement. Family support and improving well-being are important facilitators and future research should explore these mechanisms further.

Investigating cognitive impairment, biopsychosocial barriers, and predictors of return to daily life among older stroke survivors

“…Poststroke fatigue notably affects quality of life and limits individuals’ participation in various daily activities ( 43 ). Research has also indicated that stroke survivors with both reduced physical abilities and fatigue have more difficulties returning to previous leisure activities ( 22 ). Promoting physical activity, particularly aerobic exercise, is a promising treatment for reducing poststroke fatigue ( 42 ).…”

“…There is also limited research exploring which factors are associated with a successful return to daily life for older persons with PSCI. Previous studies investigating factors associated with return to daily life and leisure activities after stroke have shown that cognitive ability, age, and mobility are important factors ( 21 , 22 ). However, most related studies have focused on younger stroke survivors ( 23 , 24 ).…”

Impact of early refined nursing program on prognosis of middle-aged and elderly patients with cognitive dysfunction combined with cerebral infarction

“…These factors are considered to be associated with an increased risk of vascular cognitive impairment[ 6 ]. Cognitive impairment has a significant impact on the ability to perform daily activities and engage in social life in patients with cerebral infarction, leading to a decrease in quality of life for these patients[ 7 ]. Additionally, cognitive impairment is associated with decreased adherence to treatment and medication, resulting in an impact on treatment efficacy.…”