Abstract
Purpose: Upper limb disability following stroke may have multiple effects on the individual. Existing assessment instruments tend to focus on impairment and function and may miss other changes that are personally important. This study aimed to identify personally significant impacts of upper limb disability following stroke. Methods: Accounts by stroke survivors, in the form of web-based diaries (blogs) and stories, were sought using a blog search engine and in stroke-related web-sites. Thematic analysis using the World Health Organisation’s International Classification of Functioning Disability and Health (ICF) was used to identify personal impacts of upper limb disability following stroke. Results: Ninety-nine sources from at least four countries were analysed. Many impacts were classifiable using the ICF, but a number of additional themes emerged, including emotional, cognitive and behavioural changes. Blogs and other web-based accounts were easily accessible and rich sources of data, although using them raised several methodological issues, including potential sample bias. Conclusions: A range of impacts was identified, some of which (such as use of information technology and alienation from the upper limb) are not addressed in current assessment instruments. They should be considered in post-stroke assessments. Blogs may help in the development of more comprehensive assessments.Implications for RehabilitationA comprehensive assessment of the upper limb following stroke should include the impact of upper limb problems on social participation, as well as associated emotional, cognitive and behavioural changes.Using personalised assessment instruments alongside standardised measures may help ensure that these broader domains are considered in discussions between clinicians and patients.Rehabilitation researchers should investigate whether and how these domains could be addressed and operationalised in standard upper limb assessment instruments.
Highlights
The effects of stroke on the upper limb are a common and significant source of long-term disability [1]
We found a range of phenomena associated with upper limb disability that are not included in the ICF, they may be important factors in the health state of the individual
Other studies have found that recovery from stroke may involve the reformation of self-concept [30,31], and our study suggests that upper limb-related cognitions could be important in this process
Summary
The effects of stroke on the upper limb are a common and significant source of long-term disability [1] Problems such as paresis, loss of sensation, pain and spasticity in the hand, arm and shoulder can have manifold consequences in the daily lives of those affected [2]. A range of assessment tools is available to gauge the effects of stroke on the individual, and numerous instruments have been developed to assess the upper limb [5,6,7]. Some, such as the Stroke Impact Scale [8] and the Motor Activity Log [9], are both stroke- and upper limb-specific
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