Socio‐ecological perspective on factors influencing acute recovery of younger stroke survivors: A mixed methods study

Abstract

Aims Stroke is affecting an increasing number of young and middle‐aged adults. Given the substantial diversion from anticipated life trajectories that younger stroke survivors experience as a result of their stroke deficits, their health‐related quality of life (HRQOL) is likely to be negatively impacted during the immediate post‐acute recovery period. The aim of this study was to generate a comprehensive understanding of the influences on HRQOL and acute recovery during the first three months following stroke for younger adults using a socio‐ecological perspective. Design Longitudinal, convergent mixed methods design. Methods HRQOL survey data, assessed using the Patient Generated Index (N = 31), and qualitative interview data about survivors’ recovery experiences (N = 20) were collected. Simple linear regression and effect size results were integrated with themes and sub‐themes identified from conventional content analysis using joint data displays. Results Depression and fatigue negatively affected recovery at the individual level. At the family and societal level, family functioning, social support including being married, having insurance, working, adequate income and being unemployed post‐stroke all positively impacted recovery. Qualitative findings revealed determination, coping, and accessing healthcare to positively affect recovery though a meta‐inference could not be drawn as no quantitative data addressed these concepts. Conclusion A variety of factors intersecting across socio‐ecological levels were perceived by young stroke survivors to influence acute recovery experiences and outcomes. Impact This study identified individual‐, family‐ and societal‐level factors in younger adults’ environments that may affect the acute stroke recovery experience. Findings underscore the need for research and clinical approaches that consider environmental factors at multiple levels of influence when supporting stroke recovery for younger adults.

Perspectives of choice and control in daily life for people following brain injury: A qualitative systematic review and meta‐synthesis

“…They resented others having to ‘do things for me (them)’, 48,61,71 or ‘just let(ting) things happen’ 44 and having little choice or freedom 37,58,60 . There were reports of participants feeling distressed, embarrassed and unkempt 10,32,53,61 …”

“…They reflected that when recovering in hospital, they ‘couldn't leave when I [they] wanted to’, 64 were in ‘jail’ 36 and ‘not my own person’ 36 . Health professionals who did not listen to requests or consider personal goals in therapy planning reduced autonomy 42,54,61,66,67,70,73,76 . Choices about service delivery were limited 56,63 meaning no preference for carer gender, 53 cultural needs not being met 63,68 and loss of ability to exercise personal routines 43 .…”

“…Participants experienced ‘unpredictable’ 35 and often ‘invisible’ 30,57 after‐effects following their ABI 25,26,28,29,31,32,34,35,39‐42,47,52,53,57‐59,61,63,65,69,72,73 . Those with communication issues felt particularly constrained in their choices due to difficulty expressing their needs 53,55,58,77 .…”

“…Acceptance also meant finding the strength to work out what to do now 10 often leading to accomplishments, such as library work, 57 scrapbooking, 78 photography, 62 driving, dancing or regaining a valued role 10,56 . Gains (physical, psychological and cognitive) enabled productive and fulfilled lives—oftentimes giving back to the community 10,25,29,32,38,48,56,57,61,73,74 . There was perseverance and pride in the progress made, 44 going from feeling overwhelmed to regaining control through seeking independence ‘to go where I want, when I want’ 71 (P1).…”

“…Some participants felt more content when they lived in the moment without placing pressure on themselves, 10,29,34 others chose to be forward thinking 25,30,32,74 at the same time as being kind to themselves 29,32,37,71 . Participants began to identify with being a person who is dependent on others, 26,27,65,73 who has constraints on ability 29,37,56,57 and who has a changed future and relations 25,45,57,61 . With increasing control and flexibility over their choices and opportunities, participants became more future‐oriented 26,29,35,37,71,74 …”