Changes in everyday life after stroke : Older individuals and couples daily occupations at home during the first year after stroke

Abstract: In designing occupational therapy interventions there is a need of knowledge concerning aspects of change in everyday life through the lens of occupation. The overall aim of this thesis was to explore, describe and understand change in everyday life among older individuals and couples as a unit during the first year at home after stroke from an occupational perspective. This thesis applied multiple perspectives on changes in everyday life after stroke. Daily occupations have been studied both from the outsiders perspective in terms of objective measures and from the insiders perspective through more subjective experiences. All four studies are longitudinal with several (four to six) data gathering points during the first year after stroke. Data has been gathered by qualitative interviews and instruments. The analysis of the data gathered has, in order to answer the research questions, been multiple. Both statistics as well as more qualitative approaches ranging from visual inspections of plots generated from measurements, comparative methods, and hermeneutics have been applied. Further, the unit of analysis has been persons and couples. This thesis presents new knowledge related to changes in everyday life by examining aspects of change for older persons who have experienced stroke, their spouses, and the couple as a unit during the first year at home after stroke through the lens of occupation. Everyday life for a group of older adults (studies I-IV) and a group of older adults and their spouses (studies III and IV) was, in different ways, altered compared to before stroke after returning home from the hospital. Most participants in the four studies increased their engagement in and performance of daily occupations during the first year after stroke, even if they did not reach the same levels of engagement or performance before their stroke. The findings in study I describe four different patterns of change in functioning in everyday life. Study II found that increased awareness of disability was related to improvements in occupational performance. The findings in Study III can be interpreted as there being a risk of occupational deprivation for both partners after stroke and that daily living includes a struggle to maintain reciprocity after stroke. Study IV described two couples diverse strategies to change and the consequences of the change in daily occupations. The knowledge gained in this thesis can be used to guide occupational therapists and other professionals in their judgment of what prerequisites clients have that can support their clinical reasoning and goal-setting for intervention aiming at enabling engagement in occupation and social participation.