In this thesis, the possible benefits and challenges regarding taking part in a comprehensive individualized physiotherapy intervention, called I-CoreDIST and usual care physiotherapy following an acute stroke, along with patient perceptions of participation along the rehabilitation continuum are addressed. This is a mixed method study consisting of a randomised controlled trial (RCT) and an in-depth interview study.
Sixty participants with acute strokes were recruited for the RCT and randomised into receiving I-CoreDIST or usual care physiotherapy for 12 weeks in equal doses. Assessments of postural control, levels of physical activity, balance gait and health related quality of life were undertaken at baseline and at 12 weeks post inclusion. Between- and within-group effects were calculated. From the full sample, 19 participants were purposely selected for interviews. The interviews were transcribed and analysed using systematic text condensation. The findings from the quantitative and qualitative analysis were integrated through extracting the main findings and identifying common themes, divergences, and inconsistencies. In doing so we aimed to highlight aspects related to the overall aim of the study that either study could not have alone. The analysis was informed by the International Classification of Functioning, Disability and Health framework and enactive theory.
There were no differences between groups in term of effect of I-CoreDIST or usual care physiotherapy except for significant gains in health-related quality of life in the usual care group. The integrated findings show improvements in postural control, balance and gait that align with experiences of becoming able, indicating that partaking in 12 weeks of intensive physiotherapy was beneficial regardless of group allocation. Variations in organisational structures and cultures shape opportunities for active patient participation in post-stroke rehabilitation. Meaning and motivation is connected to experiencing bodily changes and tailored treatment. Sustained inactivity despite functional improvements is a challenge in long-term care.
Paper I: Sivertsen, M., Arntzen, E.C., Alstadhaug, K.B. & Normann, B. (2022). Effect of innovative vs. usual care physical therapy in subacute rehabilitation after stroke. A multicenter randomized controlled trial. Frontiers in Rehabilitation Sciences, 3, 987601. Also available in Munin at https://hdl.handle.net/10037/26917.
Paper II: Sivertsen, M., De Jaegher, H., Alstadhaug, K.B., Arntzen, E.C. & Normann, B. (2022). The precarity of patient participation - a qualitative interview study of experiences from the acute stroke and rehabilitation journey. Physiotherapy Theory and Practice, advance online publication. Also available in Munin at https://hdl.handle.net/10037/27853.
Paper III: Sivertsen, M., De Jaegher, H., Arntzen, E.C., Alstadhaug, K.B. & Normann, B. (2022). Embodiment, tailoring, and trust are important for co-construction of meaning in physiotherapy after stroke: A qualitative study. Physiotherapy Research International, 27(3), e1948. Also available in Munin at https://hdl.handle.net/10037/27677.