'Getting back to real living': a qualitative study of the process of community reintegration after stroke

Objectives: To examine the process of community reintegration over the first year following stroke, from the patient's perspective. Design: Qualitative, longitudinal, grounded theory study involving ten participants. During the first year post discharge from inpatient rehabilitation, 46 one-on-one semi-structured interviews were conducted with ten participants. Interviews were completed with participants before discharge from inpatient stroke rehabilitation and in their homes at two weeks, three months, six months and one year post discharge. Analysis was guided by grounded theory methods described by Corbin and Strauss. Subjects: Four women and six men (mean age 59.6 +/- 18.0, all with left hemiparesis and without aphasia) who had sustained their first hemispheric stroke and were returning to the community following inpatient rehabilitation. Results: The process of community reintegration after stroke involved transitioning through a series of goals: gaining physical function, establishing independence, adjusting expectations and getting back to real living. The ultimate challenge for stroke survivors during this process of community reintegration was to create a balance between their expectations of themselves and their physical capacity to engage in meaningful roles. Conclusions: Over the first year after stroke, participants reported that the process of community reintegration was marked by ongoing changes in their goals. Formal and informal caregivers need to work with stroke survivors living in the community to facilitate realistic and achievable goal setting. Tools which identify meaningful activities should also be incorporated to provide stroke survivors with the opportunity to contribute and engage with others in the community.