to the community.
While these outcomes dem-onstrate the efficacy of care initiatives, strokesurvivors report dissatisfaction with their reinte-gration into community.
Community reintegra-tion refers to re-establishing or developing newroles and relationships.
The transition to the com-munity remains a challenge and many stroke sur-vivors experience depression, social isolation andpoor quality of life.
Clearly there is a need toreview stroke management strategies to more ade-quately address the process of community reinte-gration after stroke.Improving community reintegration requiresgreater collaboration between health care pro-viders and stroke survivors. Patient priorities forrecovery differ from those of health care providersand focus on the social context of recovery, includ-ing ‘normality’, re-establishing former identity andresuming roles.
In contrast, health care pro-viders focus primarily on the execution of discretephysical tasks.
While critical in the early stagesof recovery, this focus on physical function doesnot meet all of the patient’s needs once they tran-sition to the community. Returning to work andmaintaining occupational, family, social and rec-reational roles remain unaddressed issues formany patients.
After return home, social inter-actions are further complicated by an uncouplingof self-identity, personal expectations and physicalability.
As survivors recover from stroke, theyneed to reconcile changes in their bodies with theirexpectations for role engagement.
Both physicalcapacity and self-identity change rapidly over timeduring stroke recovery, making it difficult tomatch a stroke survivor’s expectations for roleengagement with their physical status.
In orderto enhance rehabilitation it is necessary to focuson social engagement and identify changing needsduring the process of community reintegrationfrom the patients’ perspective.Little longitudinal work has documented ongo-ing recovery from the patient’s perspective oncethey return to the community. As a result, under-standing how the needs of stroke survivors changeover time during the process of community reinte-gration is limited. A longitudinal, patient-centredinvestigation is warranted to identify the goals,challenges and needs of patients as they re-estab-lish themselves in their communities. The purposeof this study was to examine this process of community reintegration after stroke from thepatient’s perspective.
The theoretical perspective of the authors is con-sistent with one of the tenets of symbolic interac-tionism (SI), which states that meaning is derivedfrom interaction with others. Participants wereconsidered actors who continually adjusted theirbehaviour based on their interpretation of interac-tions with others.
Participants are believed tohave the means to control their actions, althoughthey may not always use this ability.
Symbolicinteractionism is a complex and broad sociologicaltheory; however, in this study the authors focusedon meaning derived from interaction.Grounded theory was selected as an inductiveapproach to provide insight into the patients’ per-spectives and to generate theory that is groundedin the data collected from the field.
Groundedtheory methodology, as described by Corbin andStrauss,
was originally designed to study pro-cesses. It was used here to provide insight intothe patients’ perspectives and to facilitate under-standing of the experiences of stroke survivorsover the first year post stroke rehabilitation.
Community reintegration is a complex process andcannot be readily measured by quantitative means.Understanding a patient’s experience of stroke isessential to develop effective and appropriatestrategies to facilitate recovery and promote com-munity reintegration.
A literature review wasconducted to enhance sensitivity to relevantissues and research, and to guide development of the research question. Grounded theory guided byCorbin and Strauss methodology also involvessystematic data collection and analysis, includingtheoretical sampling, saturation and constantcomparison.
Participants were recruited from two inpatientrehabilitation facilities between 2007 and 2008.Participants were sampled from an ongoing ran-domized control trial investigating the effect of physical therapy intervention on physical capacity1046