Barnsley Lara, McCluskey Annie, Middleton Sandy
Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney, New South Wales, Australia.
Aust Occup Ther J. 2012 Feb;59(1):71-8. doi: 10.1111/j.1440-1630.2011.00935.x. Epub 2011 Jun 3.
BACKGROUND/AIM: Reduced walking ability and loss of confidence are common after stroke. Many people cannot drive or use public transport, which can restrict participation. This qualitative study aimed to explore the experiences and attitudes of people following stroke to travelling outdoors early after hospital discharge.
Two semi-structured interviews were conducted with 19 people post-stroke, all of whom were receiving rehabilitation to increase outdoor travel. Mean age was 68.6 years (SD 11.7years). Eight significant others also participated. Interviews were conducted at home (median 21 days post-discharge), with a second interview three months later. Questions focussed on common destinations, modes of travel including driving when relevant and factors that influenced outdoor travel. Qualitative data were analysed using constant comparative (grounded theory) methods, resulting in themes and categories.
People with stroke were categorised as either a hesitant or confident explorer, in relation to walking, catching public transport and driving. Factors influencing outdoor travel included their emotional disposition, having meaningful destinations, expectations of recovery and the sphere of influence, including family and therapists. These factors could have an enabling or restricting effect. A pre-stroke walking habit also positively contributed to outdoor travel. Gate-keeping by therapists, general practitioners and family members seemed to adversely affect travel.
This emerging theory offers insights into the experiences and attitudes to outdoor travel of people who were ambulant and participating in community rehabilitation following a stroke. Future research could explore the experiences of people with more severe mobility, cognitive and communication problems.
背景/目的:中风后行走能力下降和信心丧失很常见。许多人无法开车或使用公共交通工具,这可能会限制他们的出行。这项定性研究旨在探讨中风患者出院后早期到户外出行的经历和态度。
对19名中风后患者进行了两次半结构化访谈,他们都在接受康复治疗以增加户外出行。平均年龄为68.6岁(标准差11.7岁)。另外8名重要他人也参与了访谈。访谈在患者家中进行(出院后中位数为21天),三个月后进行第二次访谈。问题集中在常见的出行目的地、出行方式(包括在相关情况下开车)以及影响户外出行的因素。定性数据采用持续比较(扎根理论)方法进行分析,得出主题和类别。
中风患者在行走、乘坐公共交通工具和开车方面被归类为犹豫型或自信型探索者。影响户外出行的因素包括他们的情绪状态、有意义的出行目的地、对康复的期望以及影响范围,包括家人和治疗师。这些因素可能产生促进或限制作用。中风前的行走习惯也对户外出行有积极贡献。治疗师、全科医生和家庭成员的把关似乎对出行有不利影响。
这一新兴理论为中风后能够行走并参与社区康复的患者户外出行的经历和态度提供了见解。未来的研究可以探索行动能力、认知和沟通问题更严重的患者的经历。