title: Developing a primary care-based stroke service: a review of the qualitative literature.
abstract: The aim of this review was to identify the most frequently encountered longer-term problems experienced by stroke patients and their informal carers. Systematically identified qualitative studies describing self-reported experiences of stroke-related long-term problems were independently reviewed and the findings analysed using a clustering technique. Twenty-three qualitative studies, which included approximately 500 patients and 180 carers, were identified by the search methods. Most of the studies were cross-sectional, United Kingdom-based, and employed semi-structured individual interviews. The review identified 203 problem areas, which were categorised into five domains: hospital experience; transfer of care; communication; services; and social and emotional consequences. The largest domain was the social and emotional consequences of stroke, representing 39% of all problem areas. These included problems relating to mood, social changes, attitudes to recovery, and changes in self-perception and relationships. Service deficiencies, encompassing both health and social care, was the second largest domain, accounting for 29% of the problem areas. The review provides a basis for a user-focused, longer-term stroke service. The need for responses that go beyond the traditional physical rehabilitation approach is evident, and research to identify broader treatment strategies is now required.
authors.affiliation: Bradford Elderly Care and Rehabilitation Research, St Luke's Hospital, Little Horton Lane, Bradford BD5 ONA. jenni.murray@bradfordhospitals.nhs.uk
authors.forename: Jenni
authors.initials: J
authors.lastname: Murray
authors.forename: Robert
authors.initials: R
authors.lastname: Ashworth
authors.forename: Anne
authors.initials: A
authors.lastname: Forster
authors.forename: John
authors.initials: J
authors.lastname: Young
mesh_terms: D000223:Adaptation, Psychological; D017028:Caregivers; D006301:Health Services Needs and Demand / Q000592:standards*; D006701:Home Nursing / Q000458:organization & administration*; D006801:Humans; D008134:Long-Term Care; D020380:Needs Assessment / Q000592:standards; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D020521:Stroke / Q000523:psychology; D000071939:Stroke Rehabilitation