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

Author:

Jellema Sandra12,van Hees Suzanne3,Zajec Jana3,van der Sande Rob24,Nijhuis- van der Sanden Maria WG123,Steultjens Esther MJ2

Affiliation:

1. Radboud university medical center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands

2. HAN University of Applied Sciences, Institute of Health Studies, Nijmegen, The Netherlands

3. Radboud university medical center, Department of Rehabilitation, Nijmegen, The Netherlands

4. Radboud university medical center, Department of Primary and Community Care, Nijmegen, The Netherlands

Abstract

Objective: Identify the environmental factors that influence stroke-survivors’ reengagement in personally valued activities and determine what specific environmental factors are related to specific valued activity types. Data sources: PubMed, CINAHL and PsycINFO were searched until June 2016 using multiple search-terms for stroke, activities, disability, and home and community environments. Review methods: An integrated mixed-method systematic review of qualitative, quantitative and mixed-design studies was conducted. Two researchers independently identified relevant studies, assessed their methodological quality and extracted relevant findings. To validly compare and combine the various findings, all findings were classified and grouped by environmental category and level of evidence. Results: The search yielded 4024 records; 69 studies were included. Most findings came from low-evidence-level studies such as single qualitative studies. All findings were consistent in that the following factors facilitated reengagement post-stroke: personal adapted equipment; accessible environments; transport; services; education and information. Barriers were: others’ negative attitudes and behaviour; long distances and inconvenient environmental conditions (such as bad weather). Each type of valued activity, such as mobility or work, had its own pattern of environmental influences, social support was a facilitator to all types of activities. Although in many qualitative studies others’ attitudes, behaviour and stroke-related knowledge were seen as important for reengagement, these factors were hardly studied quantitatively. Conclusion: A diversity of environmental factors was related to stroke-survivors’ reengagement. Most findings came from low-evidence-level studies so that evidence on causal relationships was scarce. In future, more higher-level-evidence studies, for example on the attitudes of significant others, should be conducted.

Funder

HAN University of Applied Sciences

Publisher

SAGE Publications

Subject

Rehabilitation,Physical Therapy, Sports Therapy and Rehabilitation

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