Abstract
Stroke is a major cause of disability worldwide and different types of impairments can affect the individual’s ability to manage everyday activities such as travel that is essential for participation in society. The purpose of this study was to investigate the feasibility of a new self-management intervention (BUS TRIPS) focusing on travelling by bus, and potential contributions to an improved ability to travel by bus for people with cognitive impairments after stroke. This is a pilot study of five individuals, utilizing a multiple case study design with a mixed methods approach. Assessments (Stroke Impact Scale, General Self-Efficacy Scale and Life Satisfaction Scale-11, Item 1) were performed before, two weeks after, and three months after the program. The data collection also comprised reflection notes from the group leaders (an occupational therapist and a physiotherapist), a semi-structured group interview and an individual phone survey. The feasibility of the intervention was presented in four sub-categories: (1) appreciated group format despite too short sessions; (2) the importance of skilled leaders and motivated participants; (3) session material adequate but needs minor revision to fit the target group; and (4) homework is valuable but reflective group discussions must be supported. The narratives of each case showed that all participants made some progress related to travelling by bus, but the overall positive results could not be verified by all of the quantitative assessments. We conclude that the BUS TRIPS intervention is feasible and can potentially contribute to an improved ability to travel by bus for the target group. Future studies is called for, and should focus on recruitment challenges, to clarify assessments that would be suitable to use in larger scale clinical trials and during subsequent implementation in clinical practice.
Highlights
Stroke is a major cause of disability worldwide, causing different types of impairments that can affect the individual’s ability to manage everyday activities and reintegration in the community [1,2].Barriers in the outdoor environment are related to avoidance of leaving home [3] and outdoor mobility, including ability to travel, is essential for participation in society [4,5]
We developed a new program: BUS TRIPS (BUS Travel for Improved Participation in Stroke survivors) based on previous knowledge gained from self-management strategies (SMs) interventions targeting people with cognitive impairments (CIs) in Multiple Sclerosis [23,24] and rehabilitation interventions for people with acquired brain injury [25]
When developing BUS TRIPS, we presented a draft of the program to people with stroke, their family members, rehabilitation professionals, and researchers and used their comments to refine the program prior to the study
Summary
Barriers in the outdoor environment are related to avoidance of leaving home [3] and outdoor mobility, including ability to travel, is essential for participation in society [4,5]. Because many people with stroke cease to drive a car [6], they often have to rely on family and friends or use public transport to move around in society. Many people with stroke want and need to travel with public transport, only a minority have the ability [7,8], mainly caused by an inaccessible travel chain (e.g., planning the trip, walking to the bus-stop, buying tickets, and getting on and off the bus) [9,10]. Public Health 2017, 14, 1353; doi:10.3390/ijerph14111353 www.mdpi.com/journal/ijerph
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