Date Published: March 13, 2019
Publisher: Public Library of Science
Author(s): Karin Törnbom, Jörgen Lundälv, Katharina S. Sunnerhagen, Jennifer Dearborn-Tomazos.
To enhance the understanding of long-term participation in working-aged people 7–8 years after stroke.
This study had a qualitative design, using a thematic analysis methodology. Eleven individuals took part in an in depth interview 7–8 years after a first time stroke. They had received care at the Sahlgrenska University Hospital in Gothenburg, and were recruited as a heterogenic sample with respect to age, gender, stroke severity and subtype.
From the participants’ experiences four themes emerged: “Returning to work after stroke”; “Working life 7–8 years after stroke”; “Social life 7–8 years after stroke”; and “A state of reorientation in life”. Quotes about experienced participation in everyday life were summarized and presented as “Participation after stroke narratives”. Participants chose to emphasize on work- and social life when describing situations of successful participation. Being included in the wider community and having a sense of purpose, when interacting with others, were factors that these narratives had in common. Participants had gradually become accustomed to a somewhat altered life situation. Some consequences after stroke were still considered frustrating in social or work situations. However, the importance of these issues had reduced and were no longer problematized.
Participants felt content with their everyday life in general, which was a principal and positive result of this study. Reaching a stage of acceptance seemed to be a complex and continuous struggle, and an individual approach in long-term rehabilitation would be valuable to support this personal process. More knowledge about what factors that facilitate participation in people of working-age many years after stroke is needed, so that more people can reach a state of positive identity and participation.
Stroke is a leading cause of disability across the developed world, affecting an increasing number of people of working-age [1, 2]. In Sweden, around 25 000 people experience a stroke each year, and 20% are under the age of 65 years , placing special demands on rehabilitation and re-integration into society .
This study adheres to the consolidated criteria for reporting qualitative research (COREQ) guidelines . It is based on in-depth interviews about views of participation in everyday life among individuals 7–8 years after a first time stroke.
Participants’ characteristics and demographics are shown in Table 1. Through the inductive thematic analysis used, four principal themes emerged: 1) Returning to work after stroke, 2) Working life 7–8 years after stroke, 3) Social life 7–8 years after stroke, 4) A state of reorientation in life. The theme “Participation after stroke narratives” (that was analyzed deductively) is presented as an introduction to give an overall picture and better understanding of the results. Fig 1 is an illustration of all themes that are presented.
Participation in everyday life is a complex area to investigate  with subjective aspects that need to be taken into account when they are described and evaluated. Personality, preferences, environmental factors, and personal health conditions are examples of important areas that can impact on how a person describes their participation . However, our results showed that in spite of differences, obvious similarities were seen in participants’ reflections about participation in the activities of their choice.
The results show that participants had learned about how stroke impacted their lives and through trial and error they found ways to adapt in order to experience more successful participation. However, it is still not known exactly what aspects are important for facilitating the process of managing a successful participation. More knowledge about coping strategies that improves participation in activities many years after stroke is needed, so that more people can reach a state of positive identity and participation.