title: Role of Environmental Factors on Resuming Valued Activities Poststroke: A Systematic Review of Qualitative and Quantitative Findings.
abstract: To investigate how reengagement in valued activities poststroke is influenced by environmental factors.
  
  
  
  PubMed, CINAHL, and PsycINFO were searched to June 2015 using multiple search terms for stroke, activities, disability, and home and community environments, with the following constraints: English, humans, and adults.
  
  
  
  Studies were included that contained data on how reengagement in valued activities of community-dwelling stroke survivors was influenced by the environment. Two reviewers independently selected the studies. The search yielded 3726 records; 39 studies were eventually included.
  
  
  
  Findings were extracted from qualitative, quantitative, and mixed-design studies. Two reviewers independently assessed study quality using the Oxford Critical Appraisal Skills Programme lists and independently extracted results.
  
  
  
  Thematic analysis was conducted on qualitative data, revealing 9 themes related to the iterative nature of the process of reengagement and the associated environmental factors. During the process of reengagement, environmental factors interact with personal and disease-related factors in a gradual process of shaping or abandoning valued activities. The sociocultural context in this case determines what activities are valued and can be resumed by stroke survivors. Social support; activity opportunities and obligations; familiar and accessible environments; resources and reminders; and a step-by-step return facilitate stroke survivors to explore, adapt, resume, and maintain their activities. Social support is helpful at all stages of the process and particularly is important in case stroke survivors are fearful to explore their activity possibilities. The quantitative data identified largely endorsed these findings. No quantitative data were found in respect to the iterative nature of the process, familiar environments, or accessibility.
  
  
  
  Reengagement in valued activities is a gradual process. In each stage of the process, several environmental factors play a role. During rehabilitation, professionals should pay attention to the role physical and social environmental factors have in reengagement poststroke and find ways to optimize stroke survivors' environments.
authors: IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Faculty of Health and Social Studies, Institute of Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands. Electronic address: sandra.jellema@han.nl.
authors: Sandra
authors: S
authors: Jellema
authors: Faculty of Health and Social Studies, Institute of Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands; Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: Rob
authors: R
authors: van der Sande
authors: Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: Suzanne
authors: S
authors: van Hees
authors: Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: Jana
authors: J
authors: Zajec
authors: Faculty of Health and Social Studies, Institute of Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands.
authors: Esther M
authors: EM
authors: Steultjens
authors: IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Faculty of Health and Social Studies, Institute of Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands; Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors: Maria W
authors: MW
authors: Nijhuis-van der Sanden
mesh_terms: D000223:Adaptation, Psychological; D001107:Architectural Accessibility; D001290:Attitude; D004777:Environment; D006801:Humans; D064702:International Classification of Functioning, Disability and Health; D007398:Interpersonal Relations; D007899:Leisure Activities; D036301:Qualitative Research; D012656:Self-Help Devices; D058992:Social Participation; D012944:Social Support; D012959:Socioeconomic Factors; D000071939:Stroke Rehabilitation
keywords: Environment; Human activities; Rehabilitation; Review [publication type]; Social participation; Stroke