Qualitative analysis of stroke patients' motivation for rehabilitation

Objective To explore the attitudes and beliefs of stroke patients identifie d by professionals as having either "high" or "low" motivation for rehabili tation. Design Qualitative study with semistructured interviews. Setting The stroke unit of an inner city teaching hospital. Participants 22 patients with stroke who were undergoing rehabilitation; 14 with high motivation for rehabilitation and eight with low motivation. Results All patients thought rehabilitation was important for recovery. Hig h motivation patients were more likely to view rehabilitation as the most i mportant means of recovery and to accord themselves an active role in rehab ilitation. These patients were also more likely to understand rehabilitatio n and in particular to understand the specialist role of the nursing staff, Many patients reported independence at home as a personal goal, though few low motivation patients related this goal to success in rehabilitation. In formation from professionals about rehabilitation, favourable comparisons w ith Other stroke patients, and the desire to leave hospital had a positive effect on motivation. Conversely overprotection from family members and pro fessionals, lack of information or the receipt of "mixed messages" from pro fessionals, and unfavourable comparisons with other patients had a negative effect. Conclusions There are some differences in beliefs between stroke patients i dentified as having low or high motivation for rehabilitation. These belief s seem to be influenced by the environment in which the patient is rehabili tated. Professionals and carers should be made a aware of the ways in which their behaviour can positively and negatively affect motivation.