Considering Client and Caregiver Experience after Stroke: A Systematic Review of Qualitative Studies to Enhance Quantitative Research

Objective: The purpose of this study was to examine the literature on the process of recovery through the perspective of both clients who have experienced stroke and their informal caregivers, in order to discover to what extent the findings of qualitative research enrich those of the quantitative type as to rehabilitation effectiveness. Method: A systematic review of the salient qualitative research within EBSCOHOST, MEDLINE, AJOT, BJOT, and CJOT resulted in 50 articles identified. Of the articles initially identified, 41 met the inclusion criteria for further examination and critical appraisal. Themes that emerged from this review were compared with the results of a similar review performed by Peoples, Stanick, and Steultjens (2011). Results: The overarching theme revealed was expectation versus reality, with six subthemes also evident: need for meaningful goal-setting, need for long-term support, need for improved education, need for more comprehensive support, need for more family/informal caretaker involvement, and a desire for a sense of control. Overlap between themes discovered here and in Peoples et al. (2011) included the need for improved information-sharing and the need for a long-term view of recovery. Final themes surrounding perspectives on the recovery process were considered in comparison to the quantitative findings of Ma and Trombly (2002) and Trombly and Ma (2002). The articles and this review agree that meaningful, realistic, client-centered goal-setting creates the best opportunity for not only improved function, but also for an improved sense of self. Conclusion: Including qualitative literature in evidence-based practice can lead to an enriched understanding of the experience of stroke, leading to improved decision-making regarding the direction of therapeutic intervention