Department of Physiotherapy, School of Health Care, Setubal Polytechnic Institute, Setúbal, Portugal.
Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK.
Disabil Rehabil. 2021 Oct;43(20):2897-2908. doi: 10.1080/09638288.2020.1722263. Epub 2020 Feb 8.
To understand how people with stroke and carers adapt over time, and how health professionals support transition to home.
A multi-perspective, prospective, qualitative, longitudinal study was conducted using in-depth semi-structured interviews one and six months after inpatient discharge. Twenty-four participants (eight triads, including people with stroke, carers and health professionals) were included. Thematic and narrative analysis facilitated identification of cross-cutting themes according to individual trajectories post-stroke.
A major theme: "regaining control of life" suggested a shift in perspective after six months at home. Four sub-themes help to understand the triads' perspectives over time: i) ii) iii) and iv) . People who were involved in supporting adaptation and rehabilitation processes were reported differently between triads and over time, showing the complexity of interrelations. A reduction in professional involvement was matched by changes in participants' goals and expectations.
Findings suggest the importance of a dyadic perspective and a gradual increase in people with stroke and carers' active engagement. Professionals' approach throughout rehabilitation should be modified according to people with stroke and carers' changing needs and expectations.IMPLICATIONS FOR REHABILITATIONDivergence in perspectives about priorities and goals between the person with stroke their carers and healthcare professionals can lead to the creation of different agendas within rehabilitation.An open dialogue and decision-making process that involves both the person with stroke and carers is highly recommended for the identification of shared rehabilitation goals and to support ongoing recovery post discharge.A tailored approach to rehabilitation is required which focusses on shared priorities and includes individual or collective support for the person with stroke and their carers.Ongoing consultation about the desires of the person with stroke about rehabilitation, priorities and goals is important in order to tailor the professional approach to the stage individuals are at with their coping and adjustment post stroke.
了解脑卒中患者及其照顾者如何随着时间的推移而适应，以及卫生专业人员如何支持其向居家过渡。
采用多视角、前瞻性、定性、纵向研究方法，在住院出院后 1 个月和 6 个月时使用深入半结构化访谈进行。共纳入 24 名参与者（8 个三人组，包括脑卒中患者、照顾者和卫生专业人员）。主题和叙述性分析有助于根据个体脑卒中后轨迹确定贯穿各主题的主题。
一个主要主题：“重新掌控生活”表明，在家 6 个月后，观点发生了转变。四个子主题有助于随着时间的推移理解三人组的观点：i）ii）iii）和 iv）。在支持适应和康复过程中涉及的人在三人组之间和随时间的变化报告不同，显示了相互关系的复杂性。专业人员参与度的降低与参与者目标和期望的变化相匹配。
研究结果表明，采用对偶观点和逐渐增加脑卒中患者和照顾者的积极参与非常重要。在整个康复过程中，专业人员的方法应根据脑卒中患者和照顾者不断变化的需求和期望进行调整。
脑卒中患者、照顾者和医疗保健专业人员之间对优先级和目标的观点分歧可能会导致康复过程中制定不同的议程。强烈建议采用开放的对话和决策过程，让脑卒中患者及其照顾者参与其中，以确定共同的康复目标，并在出院后支持持续康复。需要采用量身定制的康复方法，侧重于共同的优先事项，并为脑卒中患者及其照顾者提供个人或集体支持。持续协商脑卒中患者对康复、优先级和目标的意愿对于根据个人应对和调整后的阶段调整专业方法非常重要。
