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功能失调的上肢对社区中风幸存者及其照顾者的影响:一项诠释现象学分析。

The effect of a dysfunctional upper limb on community-dwelling stroke survivors and their carers: An interpretative phenomenological analysis.

作者信息

Smith Rebecca, Burgess Caroline, Sorinola Isaac

机构信息

Imperial College London, London, UK.

Primary Care and Public Health Sciences, King's College London, London, UK.

出版信息

Physiother Res Int. 2018 Oct;23(4):e1726. doi: 10.1002/pri.1726. Epub 2018 Jul 8.

Abstract

OBJECTIVES

The poststroke upper limb continues to pose a myriad of physical and psychological challenges for patients and caregivers. To optimize existing services, this study firstly aimed to explore the experiences of both stroke survivors and caregivers and secondly identify their ongoing needs.

METHODS

A qualitative approach was utilized for this study. Six participants (three stroke survivors and three caregivers) were purposively sampled from community stroke groups. Semi structured interviews were utilized to collect experiential data, which were analysed using an interpretative phenomenological approach.

RESULTS

Three master themes emerged from data analysis: "Finding a way forwards from a poor start," "The battle with the upper-limb," and "Relationships with self and society." All participants, seemingly affected by disappointing services, expressed negative views of rehabilitation. Misplaced or persistent hope, losses in control, and reduced autonomy may have contributed to poor functional outcomes and perceptions of rehabilitation services. The complex physical and psychological impact of the experience of the dysfunctional upper limb was also associated with ongoing and unmet support needs for stroke survivors and carers.

CONCLUSIONS

Healthcare professionals may consider the varying impact of the dysfunctional upper limb during decision-making and treatment planning, particularly during acute rehabilitation. Future research could explore therapists' perceptions and experiences of upper-limb rehabilitation during this period.

摘要

目的

中风后的上肢问题持续给患者及其照顾者带来诸多身体和心理挑战。为优化现有服务,本研究首要目标是探究中风幸存者和照顾者的经历,其次是确定他们尚未满足的需求。

方法

本研究采用定性研究方法。从社区中风群体中有目的地抽取了六名参与者(三名中风幸存者和三名照顾者)。采用半结构化访谈收集经验数据,并运用解释现象学方法进行分析。

结果

数据分析得出三个主要主题:“从糟糕的开端中找到前进的道路”、“与上肢的斗争”以及“与自我和社会的关系”。所有参与者似乎都受到了令人失望的服务的影响,对康复表达了负面看法。不恰当或持续的希望、失去控制感以及自主性降低,可能导致了功能恢复不佳以及对康复服务的看法。功能失调的上肢经历所产生的复杂身体和心理影响,也与中风幸存者和照顾者持续存在且未得到满足的支持需求相关。

结论

医疗保健专业人员在决策和治疗规划过程中,尤其是在急性康复期间,可能需要考虑功能失调的上肢带来的不同影响。未来的研究可以探索在此期间治疗师对上肢康复的看法和经历。

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