The impact of environmental factors on resuming valued activities post-stroke: A systematic review of qualitative and quantitative findings

Publication date: Available online 5 February 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Sandra Jellema, Rob van der Sande, Suzanne van Hees, Jana Zajec, Esther M.J. Steultjens, Maria W.G. Nijhuis-van der Sanden
ObjectiveInvestigate how reengagement in valued activities post-stroke is influenced by environmental factors.Data SourcesPubMed, CINAHL and PsycINFO were searched to June 2015 using multiple search terms for stroke, activities, disability and home and community environments, with the following constraints: English, Humans, Adults.Study SelectionStudies were included that contained data on how reengagement in valued activities of community-dwelling stroke-survivors, was influenced by the environment. Two reviewers independently selected the studies. The search yielded 3,726 records; 39 studies were eventually included.Data ExtractionFindings were extracted from qualitative, quantitative and mixed-design studies. Two reviewers independently assessed study quality using the Oxford Critical Appraisal Skills Programme lists and independently extracted results.Data SynthesisThematic analysis was conducted on qualitative data, revealing nine themes related to the iterative nature of the process of reengagement and the associated environmental factors. During the process of reengagement, environmental factors interact with personal and disease-related factors in a gradual process of shaping or abandoning valued activities. The sociocultural context in this case determines what activities are valued and can be resumed by stroke-survivors. Social support, activity opportunities and obligations; familiar and accessible environments; resources and reminders and a step-by-step return, facilitate stroke-survivors to explore, adapt, resume and maintain their activities. Social support is helpful at all stages of the process and particularly is important in case stroke-survivors are fearful to explore their activity possibilities. Quantitative data identified, largely endorsed above findings. No quantitative data were found in respect to the iterative nature of the process, familiar environments or accessibility.ConclusionsReengagement in valued activities is a gradual process. In each stage of the process, several environmental factors play a role. During rehabilitation, professionals should pay attention to the role physical and social environmental factors have in reengagement post-stroke and find ways to optimize stroke-survivors' environments.



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