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Role of Environmental Factors on Resuming Valued Activities Poststroke: A Systematic Review of Qualitative and Quantitative Findings

  • Sandra Jellema
    Correspondence
    Corresponding author Sandra Jellema, MSc, HAN University of Applied Sciences, Institute of Health Studies, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands.
    Affiliations
    IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands

    Faculty of Health and Social Studies, Institute of Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
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  • Rob van der Sande
    Affiliations
    Faculty of Health and Social Studies, Institute of Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands

    Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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  • Suzanne van Hees
    Affiliations
    Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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  • Jana Zajec
    Affiliations
    Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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  • Esther M. Steultjens
    Affiliations
    Faculty of Health and Social Studies, Institute of Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
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  • Maria W. Nijhuis-van der Sanden
    Affiliations
    IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands

    Faculty of Health and Social Studies, Institute of Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands

    Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
    Search for articles by this author
Published:February 05, 2016DOI:https://doi.org/10.1016/j.apmr.2016.01.015

      Abstract

      Objective

      To investigate how reengagement in valued activities poststroke is influenced by environmental factors.

      Data Sources

      PubMed, CINAHL, and PsycINFO were searched to June 2015 using multiple search terms for stroke, activities, disability, and home and community environments, with the following constraints: English, humans, and adults.

      Study Selection

      Studies were included that contained data on how reengagement in valued activities of community-dwelling stroke survivors was influenced by the environment. Two reviewers independently selected the studies. The search yielded 3726 records; 39 studies were eventually included.

      Data Extraction

      Findings were extracted from qualitative, quantitative, and mixed-design studies. Two reviewers independently assessed study quality using the Oxford Critical Appraisal Skills Programme lists and independently extracted results.

      Data Synthesis

      Thematic analysis was conducted on qualitative data, revealing 9 themes related to the iterative nature of the process of reengagement and the associated environmental factors. During the process of reengagement, environmental factors interact with personal and disease-related factors in a gradual process of shaping or abandoning valued activities. The sociocultural context in this case determines what activities are valued and can be resumed by stroke survivors. Social support; activity opportunities and obligations; familiar and accessible environments; resources and reminders; and a step-by-step return facilitate stroke survivors to explore, adapt, resume, and maintain their activities. Social support is helpful at all stages of the process and particularly is important in case stroke survivors are fearful to explore their activity possibilities. The quantitative data identified largely endorsed these findings. No quantitative data were found in respect to the iterative nature of the process, familiar environments, or accessibility.

      Conclusions

      Reengagement in valued activities is a gradual process. In each stage of the process, several environmental factors play a role. During rehabilitation, professionals should pay attention to the role physical and social environmental factors have in reengagement poststroke and find ways to optimize stroke survivors' environments.

      Keywords

      List of abbreviations:

      ICF (International Classification of Functioning, Disability and Health), MeSH (Medical Subject Headings)
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