Disability acceptance has been conceptualized as an internalization of oneself as a person experiencing disability and associated with better coping and motivation for rehabilitation. This is particularly pertinent to individuals experiencing stroke because many are initially not fully aware of their stroke-related impairments, which affects the acceptance process. This qualitative metasynthesis aimed to synthesize qualitative findings regarding disability acceptance in stroke and identify barriers and facilitators associated with it. Eighteen studies published from 2003 to 2022, conducted in Asia, Europe, and Australasia, were included in our review. A thematic synthesis was carried out through line-by-line coding and identification of descriptive and analytical themes. Three analytical themes emerged from the analysis: “understanding impairments,” “flexibility and active engagement,” and “disability acceptance as a non-linear process.” Healthcare professionals may facilitate this process by guiding individuals experiencing stroke to recognize that they can manage their limitations and still lead meaningful lives.
AdamczukDRoszkowska-BlaimMLeszczyńskaB, et al. (2019) Life activity, disease acceptance and quality of life in patients treated with renal replacement therapy since childhood. Advances in Clinical and Experimental Medicine28(7): 871–878.
2.
AhujaSClarkSMorahanE, et al. (2013) The journey to recovery: Experiences and perceptions of individuals following stroke. New Zealand Journal of Physiotherapy41(1): 36–43.
3.
ArntzenCBorgTHamranT (2015) Long-term recovery trajectory after stroke: An ongoing negotiation between body, participation and self. Disability and Rehabilitation37(18): 1626–1634.
4.
AttawongTKovindhaA (2005) The influencing factors of acceptance of disablility in spinal cord injured patients. Nepal Journal of Neuroscience2(1): 67–70.
5.
Balasooriya-SmeekensCBatemanAMantJ, et al. (2016) Barriers and facilitators to staying in work after stroke: Insight from an online forum. BMJ Open6(4): e009974.
6.
BarrettAM (2010) Rose-colored answers: Neuropsychological deficits and patient-reported outcomes after stroke. Behavioural Neurology22(1-2): 17–23.
7.
BassettSF (2015) Bridging the intention-behaviour gap with behaviour change strategies for physiotherapy rehabilitation non-adherence. New Zealand Journal of Physiotherapy43(3): 105–111.
8.
BerglundBMattiassonACNordströmG (2003) Acceptance of disability and sense of coherence in individuals with Ehlers-Danlos syndrome. Journal of Clinical Nursing12: 770–777.
9.
BraunVClarkeV (2006) Using thematic analysis in psychology. Qualitative Research in Psychology3(2): 77–101.
10.
CarcelloKMcLennonS (2022) “Personal road map for recovery”: Examining the therapeutic use of weblogs by stroke survivors with aphasia. Disability and Rehabilitation44(10): 1933–1938.
11.
ChaoHLTsaiTYLivnehH, et al. (2010) Patients with colorectal cancer: Relationship between demographic and disease characteristics and acceptance of disability. Journal of Advanced Nursing66(10): 2278–2286.
12.
ChiangHHLivnehHGuoHR, et al. (2015) Effects of acceptance of disability on death or dialysis in chronic kidney disease patients: A 3-year prospective cohort study. BMC Nephrology16: 202.
13.
ChiuSYLivnehHTsaoLL, et al. (2013) Acceptance of disability and its predictors among stroke patients in Taiwan. BMC Neurology13: 175.
14.
Ch’ngAMFrenchDMcLeanN (2008) Coping with the challenges of recovery from stroke: Long term perspectives of stroke support group members. Journal of Health Psychology13(8): 1136–1146.
15.
Ellis-HillCSHornS (2000) Change in identity and self-concept: A new theoretical approach to recovery following a stroke. Clinical Rehabilitation14: 279–287.
16.
FeiginVLNorrvingBMensahGA (2017) Global burden of stroke. Circulation Research120(3): 439–448.
17.
GiorgiA (1975) An Application of Phenomenological Method in Psychology. Pittsburgh, PA: Duquesne University Press.
18.
GraysonM (1951) Concept of “acceptance” in physical rehabilitation. Journal of the American Medical Association145(12): 893–896.
19.
GroomesDLinkowskiD (2007) Examining the structure of the revised Acceptance Disability Scale. Journal of Rehabilitation73(3): 3–9.
20.
HuttonLOwnsworthT (2019) A qualitative investigation of sense of self and continuity in younger adults with stroke. Neuropsychological Rehabilitation29(2): 273–288.
21.
JanzNKBeckerMH (1984) The health belief model: A decade later. Health Education Quarterly11(1): 1–47.
22.
JenkinsonPMPrestonCEllisSJ (2011) Unawareness after stroke: A review and practical guide to understanding, assessing, and managing anosognosia for hemiplegia. Journal of Clinical and Experimental Neuropsychology33(10): 1079–1093.
23.
JiaoJHeyneMMLamCS (2012) Acceptance of disability among Chinese individuals with spinal cord injuries: The effects of social support and depression. Psychology03(09): 775–781.
24.
JooHGeorgeMGFangJ, et al. (2014) A literature review of indirect costs associated with stroke. Journal of Stroke and Cerebrovascular Diseases23(7): 1753–1763.
25.
KatzNFlemingJKerenN, et al. (2002) Unawareness and/or denial of disability: Implications for occupational therapy intervention. Canadian Journal of Occupational Therapy69(5): 281–292.
26.
KeanyKCGlueckaufRL (1993) Disability and value change: An overview and reanalysis of acceptance of loss theory. Rehabilitation Psychology38(3): 199–210.
27.
KerstenPMcPhersonKMKayesNM, et al. (2015) Bridging the goal intention–action gap in rehabilitation: A study of if-then implementation intentions in neurorehabilitation. Disability & Society37(12): 1073–1081.
28.
KristensenHKTistadMKochLV, et al. (2016) The importance of patient involvement in stroke rehabilitation. PLoS One11(6): e0157149.
29.
KvaleSBrinkmannS (2009) Interviews: Learning the Art of Qualitative Research Interviewing. London: Sage.
30.
KwasnickaDPresseauJWhiteM, et al. (2013) Does planning how to cope with anticipated barriers facilitate health-related behaviour change? A systematic review. Health Psychology Review7(2): 129–145.
LapadatuIMorrisR (2019) The relationship between stroke survivors’ perceived identity and mood, self-esteem and quality of life. Neuropsychological Rehabilitation29(2): 199–213.
33.
LargeRSamuelVMorrisR (2020) A changed reality: Experience of an acceptance and commitment therapy (ACT) group after stroke. Neuropsychological Rehabilitation30(8): 1477–1496.
34.
LittooijEDekkerJVloothuisJ, et al. (2018) Global meaning and rehabilitation in people with stroke. Brain Impairment19(2): 183–192.
35.
LivnehHAntonakRF (1997) Psychosocial Adaptation to Chronic Illness and Disability. Gaithersburg, MD: Aspen Publishers.
36.
LivnehHAntonakRF (2005) Psychosocial adaptation to chronic illness and disability: A primer for counselors. Journal of Counseling & Development83(1): 12–20.
37.
LukerJLynchEBernhardssonS, et al. (2015) Stroke survivors’ experiences of physical rehabilitation: A systematic review of qualitative studies. Archives of Physical Medicine and Rehabilitation96(9): 1698–1708, e1610.
38.
MairamiFFWarrenNAlloteyPA, et al. (2020) Contextual factors that shape recovery after stroke in Malaysia. Disability and Rehabilitation42(22): 3189–3198.
39.
MavaddatNSadlerELimL, et al. (2021) What underlies the difference between self-reported health and disability after stroke? A qualitative study in the UK. BMC Neurology21(1): 315.
40.
MelamedSGroswasserZSternMJ (1992) Acceptance of disability, work involvement and subjective rehabilitation status of traumatic brain-injured (TBI) patients. Brain Injury6(3): 233–243.
41.
MohammedMAMolesRJChenTF (2016) Meta-synthesis of qualitative research: The challenges and opportunities. International Journal of Clinical Pharmacy38(3): 738–704.
42.
MukherjeeDLevinRLHellerW (2006) The cognitive, emotional, and social sequelae of stroke: Psychological and ethical concerns in post-stroke adaptation. Topics in Stroke Rehabilitation13(4): 26–35.
43.
MurrayCDHarrisonB (2004) The meaning and experience of being a stroke survivor: An interpretative phenomenological analysis. Disability and Rehabilitation26(13): 808–816.
NichollsELehanTPlazaSL, et al. (2012) Factors influencing acceptance of disability in individuals with spinal cord injury in Neiva, Colombia, South America. Disability and Rehabilitation34(13): 1082–1088.
46.
PageMMcKenzieJBossuytP, et al. (2021b) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ372: n71.
47.
PageMJMcKenzieJEBossuytPM, et al. (2021a) The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. PLoS Medicine18(3): e1003583.
48.
PallesenH (2014) Body, coping and self-identity. A qualitative 5-year follow-up study of stroke. Disability and Rehabilitation36(3): 232–241.
49.
ParkE-YKimJ-H (2021) Interaction of socio-demographic characteristics on acceptance of disability among individuals with physical disabilities. Frontiers in Psychiatry12: 597817.
50.
PerryLMcLarenS (2003) Coping and adaptation at six months after stroke: Experiences with eating disabilities. International Journal of Nursing Studies40(2): 185–195.
51.
PoltawskiLAllisonRBriscoeS, et al. (2016) Assessing the impact of upper limb disability following stroke: A qualitative enquiry using internet-based personal accounts of stroke survivors. Disability and Rehabilitation38(10): 945–951.
52.
Ramos-LimaMJMBrasileiroICLimaTL, et al. (2018) Quality of life after stroke: Impact of clinical and sociodemographic factors. Clinics73: e418.
53.
ReddyLFLlerenaKKernRS (2016) Predictors of employment in schizophrenia: The importance of intrinsic and extrinsic motivation. Schizophrenia Research176(2-3): 462–466.
54.
ReligioniUCzerwABadowska-KozakiewiczAM, et al. (2020) Assessment of pain, acceptance of illness, adjustment to life, and strategies of coping with illness among patients with gastric cancer. Journal of Cancer Education35(4): 724–730.
55.
SchwarzerR (2008) Modeling health behavior change: How to predict and modify the adoption and maintenance of health behaviors. Applied Psychology57(1): 1–29.
56.
ScobbieLBradyMCDuncanEAS, et al. (2021) Goal attainment, adjustment and disengagement in the first year after stroke: A qualitative study. Neuropsychological Rehabilitation31(5): 691–709.
57.
SinghPJayakaranPManiR, et al. (2022) The experiences of Indian people living in New Zealand with stroke. Disability and Rehabilitation44(14): 3641–3649.
58.
SomeyaATanakaM (2022) The process by which patients become aware of unilateral spatial neglect: A qualitative study. Neuropsychological Rehabilitation32(9): 2370–2391.
59.
TagakiM (2016) Research development from acceptance to the meaning of acquired disability in people with impaired mobility in Japan. Japanese Psychological Research58: 85–109.
60.
TaylorTNDavisPHTornerJC, et al. (1996) Lifetime cost of stroke in the United States. Stroke27(9): 1459–1466.
61.
TelfordKKralikDKochT (2006) Acceptance and denial: Implications for people adapting to chronic illness: Literature review. Journal of Advanced Nursing55(4): 457–464.
62.
ThomasCMAllisonRLatourJM (2018) Using blogs to explore the lived-experience of life after stroke: "A journey of discovery I never wanted to take. Journal of Advanced Nursing74(3): 579–590.
63.
ThomasJHardenA (2008) Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology8: 45.
64.
ThompsonSCSobolew-ShubinAGrahamMA, et al. (1989) Psychosocial adjustment following a stroke. Social Science & Medicine28(3): 239–247.
65.
TownendETinsonDKwanJ, et al. (2010) Feeling sad and useless’: An investigation into personal acceptance of disability and its association with depression following stroke. Clinical Rehabilitation24(6): 555–564.
66.
TurnbullOHJonesKReed-ScreenJ (2002) Implicit awareness of deficit in anosognosia? An emotion-based account of denial of deficit. Neuropsychoanalysis4(1): 69–87.
67.
VisvanathanAMeadGDennisM, et al. (2019) Maintaining hope after a disabling stroke: A longitudinal qualitative study of patients’ experiences, views, information needs and approaches towards making treatment decisions. PLoS One14(9): e0222500.
68.
VuilleumierP (2004) Anosognosia: The neurology of beliefs and uncertainties. Cortex40(1): 9–17.
WrightBA (1960) Physical Disability–A Psychological Approach. New York, NY: Harper & Row Publishers.
71.
YeheneELichtensternGHarelY, et al. (2020) Self-efficacy and acceptance of disability following mild traumatic brain injury: A pilot study. Applied Neuropsychology. Adult27: 468–477.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
