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A patient-centred study of the consequences of stroke

Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, London

Patrick Gompertz

Department of Health Care for the Elderly, Royal London Hospital, London

Shah Ebrahim

Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, London

Objective: To explore subjective accounts of the consequences of stroke.

Design: Qualitative methods using depth interviews.

Participants and setting: Forty people sampled ten months post stroke from a hospital stroke register which was established in two adjacent health districts in North Thames Regional Health Authority.

Results: Interviewees reported a number of ways in which the stroke had affected their daily lives, including difficulty with leaving the house, doing the housework, pursuing former leisure activities, inability to walk in the way they wanted, problems with communicating, washing, bathing and dressing, and with confusion and deteriorating memory. In all these areas people described the loss of social contact that accompanied these changes, and the loss of valued roles which had been embedded in the everyday functions they had previously performed. In general, people over the age of 70 were more seriously affected.

Conclusion: The type of changes which people reported would not easily have been captured using standardized outcome measures, pointing to the value of qualitative methods in providing subjective accounts. In terms of clinical practice, there is a need to reduce people's isolation after stroke by providing home visits after discharge, particularly to those living alone, and also by reducing disability through rehabilitation and by tackling the environmental obstacles which can imprison people in their homes. The findings suggest that many people with stroke would benefit from being able to talk about the changes which have occurred. Imaginative proposals are needed to develop ways to help replace the loss of activities, social contacts and social roles, particularly among older people with stroke.

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