1. How does context influence arm use after stroke? A qualitative content analysis among rural community-dwelling stroke survivors.
- Author
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Rajagopalan, Vasanthan, Natarajan, Manikandan, Alex, Johnson, and Solomon, John M.
- Subjects
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ARM physiology , *STROKE prognosis , *CONTENT analysis , *EXERCISE , *INTERVIEWING , *LIFE skills , *PHENOMENOLOGY , *RESEARCH methodology , *MOTOR ability , *RURAL conditions , *QUALITATIVE research , *PSYCHOSOCIAL factors , *TASK performance , *SOCIAL context , *INDEPENDENT living , *DATA analysis software , *STROKE rehabilitation , *STROKE patients - Abstract
• Personal and environmental context influence affected arm use of stroke survivors. • Rural stroke survivors have limited awareness and knowledge of active functional task practice. • For recovery of the affected upper extremity, many stroke survivors rely on passive recovery methods. • Self-engagement in active functional task practice is facilitated by an enriched home environment and perception of ongoing recovery. To explore the personal and environmental contextual factors that influence use of affected arm for function among stroke survivors. We conducted a qualitative phenomenological study using an interpretivist paradigm among 23 stroke survivors in their late sub-acute and chronic stages and their relatives living in the rural regions of India using maximum variation sampling. Semi-structured interviews were conducted to identify personal and environmental contextual factors relevant to arm use. Their current level of arm use, motor and functional ability were evaluated using Motor Activity Log, AbilHand and Lawton Instrumental Activities of Daily Living scales and the scores were categorized in order to describe and compare the participant's characteristics before analyzing each interview. Differences among the contextual factors of participants with high and low levels of functional arm use and exercise using paretic limb were analyzed using qualitative content analysis. Study participants followed active exercises or passive interventions to improve their arm. Their immediate social environment influenced these decisions. Lack of awareness on how to self-engage or scale down their physical environment to match their abilities demoted active functional task performance. Ability to perceive small gains in arm function helped them sustain their efforts. Context influences arm use. Addressing contextual determinants influencing arm use such as facilitating understanding about the need for active functional task engagement; identifying and addressing factors moderating motivation to sustain functional task practice and enriching objects to match their movement abilities can increase arm use and promote upper limb recovery. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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