Objectives: To investigate how contextual factors, as described by the World Health Organisation’s International Classification of Functioning, Disability and Health (ICF), impact on stroke survivors’ functioning and how needs are perceived in the long term after stroke.
Methods: Semi-structured interviews were conducted with 35 participants between 1 and 11 years after stroke. Data were analysed thematically using the ICF conceptual framework.
Results: Long-term needs related to activities of daily living, social participation, mobility aids, home adaptations, housing, financial support, rehabilitation, information and transport. Participants identified a range of ICF environmental and personal factors including ‘support and relationships,’ ‘products and technology,’ ‘services, systems and policies,’ ‘attitudes,’ life experiences, social position and personal attitudes. Interactions between these contextual factors shaped functioning and how long-term needs were perceived. Social support from family and friends was a key facilitator of functioning for most participants, buffering the impact of disabilities and mediating perceived needs. Needs were not always stroke specific as many participants experienced other health problems.
Discussion: The ICF framework was useful to investigate how contextual factors shaped functioning and mediated perceived long-term needs. Development of services to meet long-term needs among stroke survivors should consider the range of environmental and personal factors affecting how needs are perceived.
FeiginVLLawesCMMBennettDAAndersonCS. Stroke epidemiology: A review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol2003; 2(1): 43–53.
2.
SumathipalaKCrichtonSMohanKWolfeCMcKevittC. Long-term management of stroke. In: KalraLWolfeCRuddA (eds). A practical guide to comprehensive stroke care: Meeting population needs, 1st ed. Singapore: World Scientific Publishing Company Incorporated, 2010.
3.
Royal College of Physicians Intercollegiate Stroke Working Party. National clinical guidelines for strokeLondon: Royal College of Physicians, 2008.
4.
Department of Health. National stroke strategy London: Department of Health, 2007.
5.
MurrayJYoungJForsterAAshworthR. Developing a primary care-based stroke model: The prevalence of longer-term problems experienced by patients and carers. Br J Gen Pract2003; 53(493): 803–807.
6.
McKevittCRedfernJMoldFWolfeC. Qualitative studies of stroke: A systematic review. Stroke2004; 35(6): 1499–1505.
7.
Bradshaw J. A taxonomy of social need. In: McLaghlan G (ed). Problems and progress in medical care. Oxford: Oxford University Press; 1972.
8.
DemainSWilesRRobertsL. and McPherson K. Recovery plateau following stroke: Fact or fiction?Disabil Rehabil2006; 28(13–14): 815–821.
9.
KendallERogersA. Extinguishing the social? state sponsored self-care policy and the Chronic Disease Self-management Programme. Disabil Soc2007; 22(2): 129–143.
10.
ReedMHarringtonRDugganAWoodVA. Meeting stroke survivors' perceived needs: A qualitative study of a community-based exercise and education scheme. Clin Rehabil2010; 24(1): 16–25.
11.
BendzM. The first year of rehabilitation after a stroke—from two perspectives. Scand J Caring Sci2003; 17(3): 215–222.
12.
TalbotLRViscogliosiCDesrosiersJVincentCRousseauJRobichaudL. Identification of rehabilitation needs after a stroke: An exploratory study. Health Qual Life Outcomes2004; 2: 53–53.
13.
McKevittCFudgeNRedfernJSheldenkarACrichtonSRuddAR. Self-reported long-term needs after stroke. Stroke2011; 42(5): 1398–1403.
14.
World Health Organization. International Classification of Functioning, Disability and Health Geneva: WHO, 2001.
15.
O'HalloranRWorrallLHicksonL. Environmental factors that influence communication between patients and their healthcare providers in acute hospital stroke units: An observational study. Int J Lang Commun Disord2010; 46(11): 30–47.
16.
AlgurénBLundgren-NilssonAStibrant SunnerhagenK. Facilitators and barriers of stroke survivors in the early post-stroke phase. Disabil Rehabil2009; 31(19): 1584–1591.
17.
WolfeCDCrichtonSHeuschmannPUMcKevittCToschkeAMGrieveAP. Estimates of outcomes up to ten years after stroke: Analysis from the prospective South London Stroke Register. PLoS Med2011; 8(5): e1001033–e1001033.
18.
The English Indices of Deprivation 2007. Queen's Printer and Controller of Her Majesty's Stationery Office 2008.
MahoneyFIBarthelDW. Functional evaluation: The Barthel Index. Md State Med J1965; 14: 61–65.
21.
WilesRAshburnAPayneSMurphyC. Patients' expectations of recovery following stroke: A qualitative study. Disabil Rehabil2002; 24(16): 841–850.
22.
BuckDJacobyAMasseyASteenNSharmaAFordGA. Development and validation of NEWSQOL, the Newcastle Stroke-Specific Quality of Life Measure. Cerebrovasc Dis2004; 17(2-3): 143–152.
23.
DuncanPWWallaceDLai MinSJhonsonSEmbretsonSLasterLJ. The Stroke Impact Scale Version 2.0: Evaluation of reliability, validity and sensitivity to change. Stroke1999; 30(10): 2131–2140.
24.
Ch'NgAMFrenchDMcleanN. Coping with the Challenges of Recovery from Stroke Long Term Perspectives of Stroke Support Group Members. J Health Psychol2008; 13(8): 1136–1146.
25.
GlassTAMatcharDBBelyeaMFeussnerJR. Impact of social support on outcome in first stroke. Stroke1993; 24(1): 64–70.
26.
BourdieuP. The forms of capital. In: Richardson'sJG (ed). Handbook for theory and research for the sociology of education, New York: Greenwood, 1986; 241–258.
27.
GreenwoodNMackenzieACloudGCWilsonN. Informal primary carers of stroke survivors living at home-challenges, satisfactions and coping: A systematic review of qualitative studies. Disabil Rehabil2009; 31(5): 337–351.
28.
RochetteATribbleDSDesrosiersJBravoGBourgetA. Adaptation and coping following a first stroke: A qualitative analysis of a phenomenological orientation. Int J Rehabil Res2006; 29(3): 247–249.
29.
GeyhSPeterCMüllerRBickenbachJEKostanjsekN. Ustün BT, et al. The personal factors of the international classification of functioning, disability and health in the literature—a systematic review and content analysis. Disabil Rehabil2011; 33(13–14): 1089–1102.
