Table 1. Summary of the included systematic review’s aim and key findings.
| Author, Year, No. studies included | Review aim | Populations studied | Brief summary of key findings (NB not all reviews identified themes a or similar) |
|---|---|---|---|
| Lamb 2008 27 | To appraise and synthesise the best available evidence on the psychosocial spiritual experience of elderly individuals recovering from stroke. | Patients aged 65 or over who had experienced at least one stroke. | Four main themes arising from165 study findings: 1. A sudden unexpected event—stroke survivors perceive the stroke experience as having a sudden onset, generating shock, fear and confusion. 2. Life-altering event—individuals perceive their stroke as having life-altering consequences. 3. Connectedness—the importance of connectedness (relationships to others and to HCPs, spiritual connectedness and the lack of isolation) in the process of recovery. 4. Reconstructing life—individuals describe the recovery process as reconstructing their lives following stroke. They are engaged in the recovery which involves considerable physical and psychological work. |
| Lui b 2005 2 | To identify and review studies that have examined the effectiveness of teaching problem solving skills to caregivers in stroke care to improve patient outcomes, highlight gaps in the evidence base, and recommend avenues for additional research. | Stroke patients, caregivers and specialist nurses. | No specific themes identified but the study sheds light on the problem of unrealistic goal setting and the difference in expectations between caregivers and stroke patients. It supports the view that the goal setting process is complex, and the authors suggest there is a need to develop clearer guidelines to help nurses and family caregivers to set realistic and achievable goals. |
| McKevitt200495 | To identify the scope of published qualitative studies of stroke, consider their relevance to development and delivery of services for people with stroke, and make recommendations for future work. | Stroke patients, caregivers and various groups of HCPs. | No specific themes identified; principally a mapping of qualitative research in the field rather than an overarching synthesis. Findings were discussed in four main categories: 1. Acute stroke; 2. Rehabilitation therapies; 3. Life after the acute event; 4. Community services Concludes that these studies’ contribution includes an emphasis on recording the “human” experience of stroke and the identification of needs perceived by patients and their families, differences in priorities between patients and HCPs, and barriers to best-quality care. Suggests significant problems remain in ensuring the delivery of best-quality stroke care. |
| Murray2003 23 | To identify the most frequently encountered longer-term problems experienced by stroke patients and their informal carers. To provide a platform for the development of a patient-centred, primary care-based stroke service. | Stroke patients and their caregivers after discharge home following stroke. | The review identified 203 problem areas, which were categorised into five themes a : 1. Hospital experience; 2. Transfer of care; 3. Communication; 4. Services; 5. Social and emotional consequences. The largest theme was the social and emotional consequences of stroke, representing 39% of all problem areas, including problems relating to mood, social changes, and attitudes to recovery, relationships and changes in self-perception. Service deficiencies, encompassing both health and social care, were the second largest theme, accounting for 29% of the problem areas. |
| Peoples 201112 | To obtain the best available knowledge on stroke survivors’ experiences of rehabilitation. | Stroke patients | One overarching theme, “Power and Empowerment” with six sub-themes were identified: 1. Coping with a new situation; successful coping with the new situations (eg hospitalisation) was an important step towards the empowerment of the patient; 2. Informational needs; there was a need for sufficient, individualised need for information throughout rehabilitation; 3. Physical and non-physical needs; there was an over-emphasis on physical needs and a failure to address non-physical needs; 4. Being personally valued and treated with respect was extremely important to patients; 5. Collaboration with health care professionals; here participants’ experiences were diverse and ambivalent; 6. Assuming responsibility and seizing control was important to patients and was achieved through awareness of their situation and being involved in independent activities. |
| Reed201218 | To identify the key factors to account for in planning and developing rehabilitation and community services for stroke based on users’ perspectives. | Stroke patients, caregivers and HCPs. | The main interconnected themes, or third-order constructs, relate to how the impact of stroke is influenced by: 1. the person, (stroke is a highly personalise experience, patient compare their situation with their pre-stroke selves); 2. Close social relationships; 3. The social environment (divided into the home and outside the home); and 4. The interactions between all three. The key factors to be considered in supporting stroke survivors and helping them maintain an active and positive presence in their unique social world are to: 1. identify personally relevant goals of stroke survivors and their carers, to enable personal control and independence; 2. provide practical adaptations and source appropriate levels of support to enable stroke survivors to remain in their own homes; 3. provide guidance on how to overcome the physical, economic, and psychological barriers in stroke survivors’ external worlds; and 4. enhance internal confidence by supporting positive social interaction. |
| Salter20089 | To examine the contribution of the published qualitative literature to our understanding of the experience of living with stroke. | Stroke patients | Five inter-related themes were identified as follows: 1. Change, Transition and Transformation, stroke was characterised as a sudden overwhelming catastrophe which changed life irrevocably; 2. Loss, included loss of identity and loss of the pre-stroke self; 3. Uncertainty; 4. Social Isolation, the importance of relationships;5. Adaptation and Reconciliation; ideas of resilience and adaptation. |
HCP = health care professional,
a for consistency “domains”, “categories” and “third order constructs” are considered to be synonymous with “themes” in this table,
b a mixed review with quantitative and qualitative studies, only qualitative studies reported here.