An Exploration of Patient Perspectives on Factors Affecting Participation in Stroke Rehabilitation

Abstract

Though patient participation is recognized as an important element of rehabilitation, few studies have used a qualitative lens to specifically examine factors influencing patient-participation in stroke rehabilitation. Thus, the purpose of this work was to explore factors perceived by service users to influence their participation in hospital-based stroke rehabilitation activities and to use this information to generate knowledge relevant for the clinical context of stroke rehabilitation. The following research gaps provided rationale for this work: 1) no published studies from the patients’ perspective on influencers of participating in hospital-based stroke rehabilitation programs, and 2) limited studies about influences on participation in hospital-based stroke rehabilitation. The first manuscript (chapter two) was designed to specifically address these gaps while the second manuscript (chapter three) was developed to highlight important findings surrounding rehabilitation intensity from chapter two. This thesis has discussed a number of patient-perceived barriers and facilitators to participating in stroke rehabilitation, which the final chapter conceptualizes into a framework of personalized rehabilitation representing a patient-centred approach to providing rehabilitation that encourages patient participation. Together, this thesis contributes knowledge about: 1) patient perspectives on factors affecting participation in stroke rehabilitation, 2) promoting patient participation, 3) shortcomings in closing the evidence-to-practice gap with respect to therapy intensity during inpatient stroke rehabilitation, and 4) insights into an exploratory framework of personalized rehabilitation developed from service users’ perspectives of stroke rehabilitation. In addition, this work emphasizes a call to action for the delivery of user-centered stroke care, specifically in regard to rehabilitation intensity during inpatient stroke rehabilitation. The implications of this work are directed at stroke rehabilitation providers as well as policy makers and stroke health system planners in order to develop appropriate and effective services and strategies for optimal recovery and successful implementation of best practice recommendations.