What environmental factors influence resumption of valued activities post stroke: a systematic review of qualitative and quantitative findings.
Sandra Jellema, Suzanne van Hees, Jana Zajec and 3 others
PMID 27681480WHAT IT FOUND
Environmental factors reported to help stroke survivors resume valued activities included adapted equipment, accessible transport, home changes, information and social support.
Negative attitudes, long distances and unstable conditions were reported to hinder them. Evidence is mostly qualitative.
Key findings
01Adapted equipment, accessible environments, high-quality transport, services, educational opportunities, money and social support were reported as facilitators, while negative attitudes and long distances were reported as barriers.
02Social support was reported as a facilitator for all main types of valued activities, and adequate transport and unsupportive attitudes were reported as affecting most types.
03No findings from controlled trials or systematic reviews of randomised controlled trials were identified, and the review says causal relationships remain unknown.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Most findings came from qualitative and cross-sectional studies, and no controlled trials or systematic reviews of randomised controlled trials were found, so the review cannot show that an environmental factor causes better or worse reengagement. The included studies measured reengagement in different ways, so their findings are not directly comparable. The review excluded single case studies and studies about professional health services, so information about service-level environmental factors is incomplete. Some findings conflicted between qualitative and quantitative studies, especially about family, friends and rural living. The ICF environmental categories were not detailed enough for some factors, such as time and specific skills or attitudes of other people. The included studies had varied populations, ages and times after stroke, so not all findings apply to every stroke survivor.
The easy way to misread this
Do not treat these environmental factors as proven causes of better or worse reengagement. The review found mostly low-level qualitative and cross-sectional evidence, and no controlled-trial or systematic-review-of-RCT evidence, so it cannot show that changing one factor will improve reengagement.