Luker Julie, Lynch Elizabeth, Bernhardsson Susanne, Bennett Leanne, Bernhardt Julie
Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia; International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia.
International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia.
Arch Phys Med Rehabil. 2015 Sep;96(9):1698-708.e10. doi: 10.1016/j.apmr.2015.03.017. Epub 2015 Apr 3.
To report and synthesize the perspectives, experiences, and preferences of stroke survivors undertaking inpatient physical rehabilitation through a systematic review of qualitative studies.
MEDLINE, CINAHL, Embase, and PsycINFO were searched from database inception to February 2014. Reference lists of relevant publications were searched. All languages were included.
Qualitative studies reporting stroke survivors' experiences of inpatient stroke rehabilitation were selected independently by 2 reviewers. The search yielded 3039 records; 95 full-text publications were assessed for eligibility, and 32 documents (31 studies) were finally included. Comprehensiveness and explicit reporting were assessed independently by 2 reviewers using the consolidated criteria for reporting qualitative research framework. Discrepancies were resolved by consensus.
Data regarding characteristics of the included studies were extracted by 1 reviewer, tabled, and checked for accuracy by another reviewer. All text reported in studies' results sections were entered into qualitative data management software for analysis.
Extracted texts were inductively coded and analyzed in 3 phases using thematic synthesis. Nine interrelated analytical themes, with descriptive subthemes, were identified that related to issues of importance to stroke survivors: (1) physical activity is valued; (2) bored and alone; (3) patient-centered therapy; (4) recreation is also rehabilitation; (5) dependency and lack of control; (6) fostering autonomy; (7) power of communication and information; (8) motivation needs nurturing; and (9) fatigue can overwhelm.
The thematic synthesis provides new insights into stroke survivors' experiences of inpatient rehabilitation. Negative experiences were reported in all studies and include disempowerment, boredom, and frustration. Rehabilitation could be improved by increasing activity within formal therapy and in free time, fostering patients' autonomy through genuinely patient-centered care, and more effective communication and information. Future stroke rehabilitation research should take into account the experiences and preferences of stroke survivors.
通过对定性研究的系统评价，报告并综合中风幸存者在住院期间进行身体康复的观点、经历和偏好。
检索MEDLINE、CINAHL、Embase和PsycINFO数据库，检索时间从建库至2014年2月。同时检索相关出版物的参考文献列表。纳入所有语言的文献。
由两名评审员独立筛选出报告中风幸存者住院康复经历的定性研究。检索共获得3039条记录；对95篇全文出版物进行了资格评估，最终纳入32篇文献（31项研究）。由两名评审员使用定性研究报告统一标准独立评估文献的全面性和明确性报告。通过协商解决分歧。
由一名评审员提取纳入研究的特征数据，制成表格，另一名评审员检查准确性。将研究结果部分报告的所有文本录入定性数据管理软件进行分析。
采用主题综合法对提取的文本进行归纳编码和分析，分三个阶段进行。确定了九个相互关联的分析主题及描述性子主题，这些主题与中风幸存者认为重要的问题相关：（1）重视身体活动；（2）无聊与孤独；（3）以患者为中心的治疗；（4）娱乐也是康复；（5）依赖与缺乏控制；（6）培养自主性；（7）沟通与信息的力量；（8）动机需要培养；（9）疲劳可能使人不堪重负。
主题综合法为中风幸存者的住院康复经历提供了新的见解。所有研究均报告了负面经历，包括丧失权力、无聊和沮丧。可通过增加正规治疗和空闲时间的活动、通过真正以患者为中心的护理培养患者的自主性以及更有效的沟通和信息来改善康复。未来的中风康复研究应考虑中风幸存者的经历和偏好。
