Social reintegration after stroke: the first stages in the development of the Subjective Index of Physical and Social Outcome (SIPSO)

Abstract

Objective: To ensure at outset the content validity of a measure (to be developed) of social integration following stroke. Design: Qualitative study, using in-depth interviews with patients at least six months following stroke. Setting: Community setting, Bristol, UK. Subjects: Thirty survivors of stroke, discharged at least six months previously from a neurological rehabilitation unit in a district general hospital. Results: Patients reported a change, usually for the worse, in their levels of integration following stroke. More specifically they alluded to a decrease in both the quantity and quality of activities, especially with regard to leisure and those activities occurring outside the home. Social interaction was reduced in most patients, in terms of frequency and quality of contact. From the data, six dimensions of change in quality of interaction emerged. Finally, changes in patients' physical and financial environments were reported. Based on the findings, four diagrams were developed, providing a structure for questionnaire development. Conclusions: The results of this study confirm the findings of previously reported research. An individual's level of social integration can be affected by stroke in a wide variety of areas and along many different dimensions. Data from this study have highlighted the importance of the patient's subjective impression of the quality of both functional and social performance. This has provided the opportunity to develop a questionnaire based on the patient's perspective, rather than that of health professionals.