PhD defence: “It’s not just somebody that’s had a stroke… it’s a person that had a life before”
A figurational study of physical activity for older adult stroke survivors
Georgia Emily Clay
PhD thesis
Stroke is amongst the most prevalent long-term health conditions globally, and older adults (OAs) are at greater risk of stroke occurrence. Stroke can have a life-altering impact for individual stroke survivors (SSs) and those around them. Physical activity (PA) can prevent recurrent strokes and improve rehabilitation outcomes, yet in the UK opportunities are limited. Within community stroke rehabilitation (SR), policy/guidance recommends rehabilitative support from professional multidisciplinary teams, friends, and family. Recommendations for PA specifically tailored to OA SSs are sparse, despite the unique challenges OAs face in maintaining an active lifestyle. In this thesis, figurational sociology was selected to help investigate how the intended actions of individual people can, over time, unintentionally influence the PA support offered to, and received by OAs in community SR.
Findings from an initial scoping review indicated that OAs’ PA needs are under-acknowledged in guidance. Few long-term stroke-specific PA programmes were identified, and scant sources were later-life specific. Conceptualisations of PA-based information were largely underpinned by biomedical perspectives focusing on improved function and independence, rather than PA needs and experiences. Importantly, the review recognised the salience of professionals' PA knowledge and referral practice, and input from family/friends, in facilitating provision and support.
Two qualitative studies, analysed using a figurational sociological framework, involved 12 semi-structured interviews with professionals supporting PA post-stroke. A figurational mapping activity helped identify bonds of association between professionals, services, guidance, SSs, and their families. Eight interviews were then conducted with OA SSs and two of their partners, applying a biographical mapping tool to explore changes to relationships, and embodied PA experiences post-stroke. Data were analysed via reflexive thematic analysis.
Five overarching themes were abductively developed from the professionals’ data, representing how professionals enter their roles, and the hierarchies that exist within the SR figuration. The consequences of collaborative and contested relationships within and between professionals, family members, and external elements such as SR policy/guidance, were apparent.
Professionals’ conceptualisations of PA emphasised how social structures surrounding SR underpin OA SSs’ experiences of PA through the body after stroke. The emphasis on self-management of PA after stroke highlighted how professionals remain interdependent with SSs when providing them with support. Three overarching themes were identified from the SS interviews, presenting key interdependencies present within the SR journey and how these influence PA provision and experience. Participants’ embodied experiences of navigating PA post-stroke influenced PA engagement, as did perceptions of habitus pre- and post-stroke.
The thesis findings highlight how interdependent individuals involved in the SR journey strongly influence both PA provision and experiences via intended actions, which can also lead to unintended consequences. Unequal balances of power exist within SR figurations, which shape professional practice and SSs’ experience surrounding PA. The use of figurational sociology offers novel theoretical insights about how relationships within community SR influence PA provision and experiences of support, and how habitus influences OA SSs’ long-term commitment to re-engage with PA immediately post-stroke and beyond. Such findings may help practitioners to implement support more appropriate for OA SSs PA needs.
2024, 362 pages.
Download Abstract; Abstrakt (Danish); Contents.
Time
31 October 2024, 14:30
Place
Ross Lucas Medical Sciences Building (LMS), University of Lincoln, UK
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Meeting ID: 397 792 641 015
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Assessment committee
Associate Professor Laila Ottesen (Chair), Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.
Professor Dominic Malcolm, Loughborough University, UK.
Professor Ros Kane, University of Lincoln, UK.
Supervisors
Associate Professor Adam Evans, Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.
Associate Professor Hannah Henderson, University of Lincoln, UK.
Emerita Professor Jacquelyn Allen-Collinson, University of Lincoln, UK.