What environmental factors influence resumption of valued activities post stroke: a systematic review of qualitative and quantitative findings.
OBJECTIVE
Identify the environmental factors that influence stroke-survivors' reengagement in personally valued activities and determine what specific environmental factors are related to specific valued activity types.


METHODS
PubMed, CINAHL and PsycINFO were searched until June 2016 using multiple search-terms for stroke, activities, disability, and home and community environments.


METHODS
An integrated mixed-method systematic review of qualitative, quantitative and mixed-design studies was conducted. Two researchers independently identified relevant studies, assessed their methodological quality and extracted relevant findings. To validly compare and combine the various findings, all findings were classified and grouped by environmental category and level of evidence.


RESULTS
The search yielded 4024 records; 69 studies were included. Most findings came from low-evidence-level studies such as single qualitative studies. All findings were consistent in that the following factors facilitated reengagement post-stroke: personal adapted equipment; accessible environments; transport; services; education and information. Barriers were: others' negative attitudes and behaviour; long distances and inconvenient environmental conditions (such as bad weather). Each type of valued activity, such as mobility or work, had its own pattern of environmental influences, social support was a facilitator to all types of activities. Although in many qualitative studies others' attitudes, behaviour and stroke-related knowledge were seen as important for reengagement, these factors were hardly studied quantitatively.


CONCLUSIONS
A diversity of environmental factors was related to stroke-survivors' reengagement. Most findings came from low-evidence-level studies so that evidence on causal relationships was scarce. In future, more higher-level-evidence studies, for example on the attitudes of significant others, should be conducted.
1 Radboud university medical center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.|2 HAN University of Applied Sciences, Institute of Health Studies, Nijmegen, The Netherlands.
Sandra
S
Jellema
3 Radboud university medical center, Department of Rehabilitation, Nijmegen, The Netherlands.
Suzanne
S
van Hees
3 Radboud university medical center, Department of Rehabilitation, Nijmegen, The Netherlands.
Jana
J
Zajec
2 HAN University of Applied Sciences, Institute of Health Studies, Nijmegen, The Netherlands.|4 Radboud university medical center, Department of Primary and Community Care, Nijmegen, The Netherlands.
Rob
R
van der Sande
1 Radboud university medical center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.|2 HAN University of Applied Sciences, Institute of Health Studies, Nijmegen, The Netherlands.|3 Radboud university medical center, Department of Rehabilitation, Nijmegen, The Netherlands.
Maria Wg
MW
Nijhuis-van der Sanden
2 HAN University of Applied Sciences, Institute of Health Studies, Nijmegen, The Netherlands.
Esther Mj
EM
Steultjens
D000223:Adaptation, Psychological; D004777:Environment; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007899:Leisure Activities; D008297:Male; D036301:Qualitative Research; D011788:Quality of Life; D020127:Recovery of Function; D012931:Social Environment; D020521:Stroke / Q000175:diagnosis* / Q000523:psychology; D000071939:Stroke Rehabilitation / Q000379:methods*; D017741:Survivors
Stroke; activities of daily living; context; social and leisure activities; systematic review
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