Factors Affecting the Ability of the Stroke Survivor to Drive Their Own Recovery outside of Therapy during Inpatient Stroke Rehabilitation

Aim. To explore factors affecting the ability of the stroke survivor to drive their own recovery outside of therapy during inpatient rehabilitation. Method. One-on-one, in-depth interviews with stroke survivors ( ) and their main carer ( ), along with two focus groups with clinical staff ( ). Data was thematically analysed according to group. Results. Stroke survivors perceived “dealing with loss,” whilst concurrently “building motivation and hope” for recovery affected their ability to drive their own recovery outside of therapy. In addition, they reported a “lack of opportunities” outside of therapy, with subsequent time described as “dead and wasted.” Main carers perceived stroke survivors felt “out of control … at everyone’s mercy” and lacked knowledge of “what to do and why” outside of therapy. Clinical staff perceived the stroke survivor’s ability to drive their own recovery was limited by the lack of “another place to go” and the “passive rehab culture and environment.” Discussion. To enable the stroke survivor to drive their own recovery outside of therapy, there is a need to increase opportunities for practice and promote active engagement. Suggested strategies include building the stroke survivor’s motivation and knowledge, creating an enriched environment, and developing daily routines to provide structure outside of therapy time. 1. Introduction Stroke is the world’s third most common cause of long-lasting disability [1]. Accordingly, the need for effective and efficient inpatient rehabilitation for stroke survivors cannot be underestimated. Intensity of practice has been consistently highlighted as a critical component of therapy provided during inpatient rehabilitation [2]. A higher intensity, in terms of minutes or repetitions of practice, has been found to promote greater functional gains during inpatient rehabilitation than less intensive therapy [3–5]. This has led researchers and therapists to direct greater attention to the creation of opportunities for intensive practice to drive recovery during therapy time, such as alternate models of care for example, group circuit classes or seven-day therapy service [6], and the use of technology including virtual reality and gaming [7] and robotic therapy [8]. However, less attention has been directed to the creation of opportunities to drive recovery outside of therapy. Studies to date indicate that stroke survivors may not use time outside of therapy optimally during inpatient rehabilitation. A recent systematic review [9] of observational studies from around the world (including Europe,