Early supported discharge following mild stroke: a qualitative study of patients' and their partners' experiences of rehabilitation at home

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Strokes are characterised by a sudden and unexpected onset. Often, a stroke is followed by physical and cognitive impairments that impact the patient's everyday life, future hopes and social network in varying degrees. In several qualitative reviews of patients' experiences with strokes, a stroke is described as a sudden and overwhelming catastrophe that profoundly disrupts and irrevocably changes life‐as‐known 1. As such, a stroke is described as a ‘biographical disruption’ 4 in which the taken‐for‐granted assumptions and behaviours of everyday life are shattered; it demands rethinking and repair of one's identity and biography 5.
Interestingly, the majority of stroke patients suffer mild‐to‐moderate strokes. The increased use of thrombolysis, along with anticoagulants and antihypertensive drugs, has led to fewer massive strokes and stroke‐related deaths 6 and more mild‐to‐moderate strokes in which people suffer fewer and milder residual impairments 7. These patients may experience less disruption and fewer irrevocable changes in their everyday lives as well, but in the current literature, distinctions between degrees of disruption and continuity are rarely made 8.
Such knowledge is particularly relevant because of the increasing focus in modern health care on early discharge to increase effectiveness and reduce costs. In the case of stroke, there is increasing emphasis on the value of early supported discharge (ESD) 10. ESD allows patients to return home as soon as possible and continue rehabilitation in familiar surroundings and at their own pace. Studies indicate that ESD services can increase the quality of rehabilitation for mild‐to‐moderate stroke patients by providing a ‘seamless service’, that spans the first weeks at home, which is a time that patients and partners often find difficult 12. It has been argued that the patient's home is the best place to relearn and reorganise the skills and practices necessary to function in that environment 13. Critics of ESD have suggested that economic concerns rather than the patient's needs may influence speed of discharge, leading to premature discharges, unmet rehabilitation needs and poorer patient outcomes 16. However, how ESD is experienced by patients and their partners and how it may hinder or support rehabilitation remains poorly investigated 17.
For stroke patients who share their life and home with a partner, stroke is not an individual matter but a mutual concern. The partner's everyday life and hopes for the future are tied inextricably to the patient and are potentially disrupted correspondingly. This is particularly relevant with respect to ESD, because the patient returns home only a few days after a stroke. The first month at home has been identified as the time when stroke patients' partners may experience difficulties related to the practical aspects of care and their new (and often unexpected) role as caregiver 18. Although there are studies of patients' and partners' individual experiences of life after stroke, there has been less focus on the shared experiences and concerns of patients and their partners as they adjust to life after a stroke. Some studies have suggested that patients and partners ‘co‐manage’ the patient's health and rehabilitation 19. Thus, the co‐construction of experiences is crucial for understanding patients' experiences of stroke, early discharge and rehabilitation at home.
The aim of this study was to investigate how mild stroke patients and their partners experience and manage everyday life in a context of ESD. The results may add to a more nuanced understanding of biographical disruption as an analytical concept in qualitative research on strokes.

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