Stroke survivors experienced discontinuity in their sense of self and role performance in the early stages of recovery from stroke, which impacted on their participation but with time they adopted a more proactive attitude

Objective
To understand stroke survivors' perspectives on the impact of stroke on their roles and self.
Search strategies
Searches were conducted in PubMed, CINAHL, EMBASE, PsycINFO and Cochrane Library from inception until September 2010. Reference lists of articles were searched. Sample search strategies are presented.
Selection criteria
Inclusion: Qualitative studies describing stroke survivors' perspectives on their roles, self and the process of adaptation following stroke. Exclusion: Reviews, opinion articles, studies with quantitative methodology and studies where stroke survivors' views could not be separated from those of other patient groups.
Methods of the review
A 4‐staged thematic synthesis was performed. Two authors selected and independently assessed methodological quality using the Critical Appraisal Skills Programme tool (0–10). Differences in ratings were resolved through discussion. Text labelled as ‘findings’ or ‘results’ was extracted and imported into Atlas.ti software. One author assigned free codes to meaningful segments of text that paralleled the meaning of primary data. Free codes were organised into related areas to develop descriptive themes. The process of coding and themes description was peer reviewed by a second author. Synthesis of data was achieved through use of concept maps and group discussion to develop analytical themes that offer new interpretations of the data from that presented in original studies.
Results
Thirty‐three studies, with mean quality ratings of 7.8 (range 4–10) were included. Four studies with ratings of ≤ 5.5 were included due to the richness of data presented. Studies were set in the UK (12/33), North America (9/33) and Scandinavia (8/33) and presented data from acute care, rehabilitation, discharge from hospital, and rehabilitation or nursing home. This synthesis represents perspectives of approximately 465 people (age range 19–93 years) with stroke.
Findings
Three analytical themes emerged: (i) ‘Managing discontinuity is a struggle.’ Stroke survivors describe a sense of discontinuity of their body, self and roles. They identify feelings of uncertainty following discharge from health‐care services. (ii) ‘Regaining roles: to continue or adapt?’ Stroke survivors strive to regain continuity in important life roles. Maintenance of hope was essential as they continued or adapted within these roles. (iii) ‘Context influences management of roles and self.’ Stroke survivors described being passive in the initial stages of recovery; however, they adopted a more active attitude in later stages of recovery as the context changed.
Authors' conclusions
Stroke survivors experience discontinuity and uncertainty in their self and their roles as they adjust to life after stroke. This highlights the need to address emotional adjustment and role management within rehabilitation programmes to facilitate adjustment following stroke.