Stroke patients' and informal carers' experiences with life after stroke: an overview of qualitative systematic reviews

Purpose To provide a systematic overview of current qualitative systematic reviews and metasyntheses of patients' and informal carers' experiences with rehabilitation and life after stroke following discharge. Method A systematic literature search was performed based on PRISMA guidelines. Nine databases were systematically searched by a university librarian. The search yielded 1093 unique entries and screening by title/abstract identified 60 reviews for potential inclusion. After full-text assessment by two independent observers, 11 reviews satisfied the inclusion criteria. Following quality appraisal, four studies were excluded. Results Seven qualitative reviews (containing 108 primary studies) were included: five reviews of patients' experiences and two reviews of carers' experiences. Stroke causes profound disruption of life as known, and both patients and carers must engage in a process of adapting and rebuilding a post-stroke life and identity. This process of rehabilitation is described as temperamental and unstable rather than progressive. From the reviews, five key experiences in this process are identified: autonomy, uncertainty, engagement, hope and social relations. Conclusions The need for broad, qualitative syntheses of stroke patients' experiences is currently fulfilled. Future qualitative reviews could focus more on implications for practice, e.g., by grading the quality of the metafindings. Implications for Rehabilitation Stroke is a profound disruption of life as known, and patients and carers value information that helps them prepare for and adjust to this new situation. Optimal rehabilitation is a main concern and goal for patients and carers, and thus carers may be a valuable asset to professionals in the rehabilitation process. Practical and emotional support is important for patients and carers, and rehabilitation professionals should be aware of the increased risk of social isolation post-stroke. Hope is a strong motivational factor and coping strategy for patients and carers. However, as hope may wane in the case of continued residual impairment, rehabilitation professionals should prepare patients and carers for this situation.