A PATIENT-CENTERED STUDY OF THE CONSEQUENCES OF STROKE

Objective: To explore subjective accounts of the consequences of strok e. Design: Qualitative methods using depth interviews. Participants an d setting: Forty people sampled ten months post stroke from a hospital stroke register which was established in two adjacent health district s in North Thames Regional Health Authority. Results: interviewees rep orted a number of ways in which the stroke had affected their daily li ves, 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, a nd with confusion and deteriorating memory. In all these areas people described the loss of social contact that accompanied these changes, a nd the loss of valued roles which had been embedded in the everyday fu nctions they had previously performed. In general, people over the age of 70 were more seriously affected. Conclusion: The type of changes w hich people reported would not easily have been captured using standar dized outcome measures, pointing to the value of qualitative methods i n 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 b y reducing disability through rehabilitation and by tackling the envir onmental obstacles which can imprison people in their homes. The findi ngs 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, soc ial contacts and social roles, particularly among older people with st roke.