Exploring the Significance of Physical Activity and Quality of Life Among Hemiplegic Elderly: A Novel Approach Using Mixed-Methods Grounded Theory

doi:10.21203/rs.3.rs-5302190/v1

Download PDF

Research Article

Exploring the Significance of Physical Activity and Quality of Life Among Hemiplegic Elderly: A Novel Approach Using Mixed-Methods Grounded Theory

https://doi.org/10.21203/rs.3.rs-5302190/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background

Elderly stroke survivors commonly live a sedentary life with some degree of physical disability despite their independent functional ability in performing activities of daily living (ADL) and ambulation. The perception and meanings given to physical activity (PA) play a significant role in promoting active aging for better Quality of life (QoL). This study aims to explore the QoL-related meanings of PA given by hemiplegic older adults living in Thailand's rural community to construct an explorative theoretical model.

Methods

A mixed-methods grounded theory (MM-GT) embedded research design. In-depth interviews collected the qualitative data from twenty samples of community-dwelling elderlies who were hemiplegic stroke survivors for more than one year. Quantifying the PA level of respondents was embedded using Global Physical Activity Questionnaires (GPAQ), whereas WHOQOL-BREF and Stroke Impact Scale (SIS) were used for quantifying QoL.

Results

The constructive theoretical model displayed three hierarchical meaningful PA categories. Firstly, initial PA refers to activities that positively drive to being more independent in performing ADL and negatively drive to avoid burdening the family. Secondly, identity PA meant what they do regarding the accountabilities to prior family roles, which were commonly viewed negatively instead of living a sedentary, empty life. Thirdly, optimizing PA was denoted as what they do to maintain and balance their existence in the community’s social and physical context. The more meaningful PA was, the more possibility to turn into action and contribute to QoL of elderly hemiplegic stroke survivors. The MM-GT embedded design helped to disclose the multidimensional QoL-related meanings of the PA behavior of older people, while the cognitive theories enhanced learning property and explanatory power. On the other hand, the theory of everything helped to ensure the inclusion of individual and societal perspectives and subjective and objective evidence.

Conclusions

These findings have significant implications for geriatrics, rehabilitation, and public health, providing insights into the role of PA in the QoL of elderly stroke survivors and suggesting potential strategies for promoting active aging and improving QoL in this population.

elderly

disability

stroke

physical activity

quality of life

mixed methods grounded-theory

Globally, stroke remains a leading cause of elderly disabilities(1). It commonly causes physical and mobility impairments, which eventually may turn older people into being partially or totally dependent on other for daily living(2). Declining ability to perform activities of daily living (ADL) and impaired neuromuscular control often lead to sedentary behaviors(3, 4), which have long-term effects on progressive regression of physical, mental, and social functioning(5) and heighten the risk of death(6). Rehabilitation programs are confined to intermediate and long-term care, which is vital for functional recovery and acquiring quality of life (QoL)(7). Stroke rehabilitation practices for older people mainly focus on mitigating neuromuscular impairments and mobility re-training for doing ADL and household ambulation. However, hemiplegic elderly usually have low levels of functional outcomes and partially depend on family caregivers(3) with low to moderate levels of QoL after stroke(8, 9). Moreover, degenerative aging superimposed by a lack of motivation will create poor adherence to rehabilitation programs. Ultimately, the social participation outcomes will be delayed, and this is associated with a lower energy level in performing any physical activities (PAs) and social withdrawal(10, 11). Psychological support and assistance from family are needed, which commonly burdens spouses who are also elderly. As a result, the elderly couple’s QoL diminishes(3). A less intensive community-based rehabilitation program focusing on both specific PAs to support daily living and general social and cultural PAs to enhance social participation becomes a strategic choice of elderly care aiming at promoting active aging and QoL(12). It was argued that the meanings of PA, which are relevant to their socio-cultural context, would drive older people to perform even if it might be difficult initially. Thailand disability statistics showed that 2,092,595 persons registered as disabled, of which 1,153,947 were elderly. Among the disabled elderly, 648,821 persons had physical and mobility disabilities, accounting for 56.23%(13).

QoL is a multidimensional medical and psychosocial construction involving individualistic and collectivistic perspectives and subjective and objective dimensions(14). In other words, the psychological and socio-cultural environments influence the rehabilitation process and outcomes. To promote active aging after a stroke, long-term rehabilitation care should be holistic and community-based approaches(15). It was reported that 80% of elderly stroke survivors commonly had a sedentary lifestyle, especially in the afternoon and evening of the day, despite resuming independent physical functional ability(16). This affected their QoL, especially within the first two years after stroke(17), whereas adaptive PA behaviors could help to reduce anxiety, enhance cognitive performance, and improve QoL in older people after stroke(18, 19).

The purposeful PA will have the motivational energy to move the elderly’s active life with good quality(20, 21). Family bonds and support, elderly social roles, and relationships are considered critical influential factors(20). Currently, QoL development among hemiplegic elderly has been quite challenging; it requires a multidisciplinary approach and integrative theoretical model covering both individualistic and collectivistic perspectives and objective and subjective dimensions. It was wondering how the meanings were given to the PA by the elderly and which kind of theoretical model could be used to identify their meaningful PA and explain the effects of meaningful PAs on motivating active community living and improving the QoL of older people.

This study aimed to develop an integrative theoretical model to explain how the meanings were assigned by the hemiplegic elderly to their PAs and to investigate the levels of PAs and QoL of hemiplegic elderly who engaged in the integrative model development process.

Mixed methods-grounded theory (MM-GT) with exploratory embedded design(21) was used for this study. A grounded theory approach was utilized to develop an integrative theoretical model to explain how the subjective meanings were assigned to PA and contributed to the QoL among hemiplegic elderly. It allowed the researchers to examine the perceptions of PAs, which are qualitatively stated by disabled elderly. The embedded approach was used because qualitative data on PA perceptions was considered a critical basis, while quantified PA and QoL data would be integrated into the analytical process and construction of the theoretical model(22). Both qualitative and quantitative data were simultaneously and iteratively collected and analyzed. This research was approved by the Mahidol University - Central Institutional Review Board, MU-CIRB No. 2021/196.0610, to study human respondents.

Two-step respondent recruitment was conducted. Firstly, systematic random sampling was done to identify potential respondents from a patient database of the purposively selected most northern provincial hospital in Thailand, representing 18 different geographical district areas. The primary criteria included being 60 years old or over, having a diagnosis of stroke (ICD10 code I60-I69), and being registered as physically disabled elderly. Secondly, case-by-case purposive theoretical sampling(23, 24) of 20 respondents was conducted according to 4 steps of the grounded analysis approach (Fig. 1). To ensure the richness of interviewed data, recruited respondents of each step were balanced among resonance, reflexive, and generative types of opinion (Fig. 2). The research information was provided, and written informed consent was done before assessment with secondary inclusion criteria, being the first episode of stroke with hemiplegia or hemiparesis for at least one year, Mini-Mental State Examination Thai version (MMSE) score was without cognitive impairment(25), having the ability to communicate with Thai language, having Brunnstrom motor recovery stage > 4(26), having unremarkable another impairments that limited performing physical activity, having stable health conditions, intact walking, and balancing functions, willing to participate in the study with the agreement of caregiver and/or family's member, accomplishing the 2019 Par-Q + Physical Activity Readiness Assessment, and residing in the study area throughout the data collection period. The exclusion criteria included significant behavioral problems (defined as Thai Brief Psychiatric Rating Scale; BPRS > 36/126), recurrent stroke or complications influencing mobility, pain exacerbated by PA, and benign paroxysmal positional vertigo (BPPV). If there were any physical and mental health problems during the study, the respondents were informed that they could withdraw at any time should they did not wish to continue. Finally, twenty poststroke hemiplegic elderly respondents were recruited (Fig. 2).

Demographic characteristics were interviewed at first engagement. Serial in-depth interviews using semi-structured questions and observation were conducted in respondents’ places while note-taking, audio-recording, and transcribing were done(27). Another serial quantitative data collection was embedded at respondents’ homes on initial engagement, 4th weeks, 8th weeks, and 12th weeks with the Thai version of the Global Physical Activity Questionnaire (GPAQ), Stroke Impact Scale (SIS 3.0 Thai version), and World Health Organization Quality of Life-Brief-Thai (WHOQOL-BREF-THAI). The data collection and analysis continued until theoretical saturation was achieved, and the final integrative theoretical model emerged. Parallelly, quantified PA and QoL data were incorporated at baseline, 4th, 8th, and 12th weeks (Fig. 1).

According to the grounded theory approach, qualitative data collection and analysis were sequentially evolved step by step (28); respondents were 4 times sequentially recruited according to four steps of grounded analysis: develop, test, adjust, and confirm the working hypothesis for its saturation. Firstly, developing the working hypothesis of an integrative theoretical model by using an open coding of respondents’ meanings given to PA. The open coding was the criteria for the next step of theoretical samples to synthesize a working hypothesis. Secondly, a working hypothesis was iteratively tested with data from the second cohort of respondents and the selection of axial coding. Thirdly, the working hypothesis was adjusted with new data collected from the third cohort of respondents. Core categories were constructed, and relevant core categories were selected. Finally, the fourth cohort of respondents was interviewed to confirm the saturation of the working hypothesis, and the proposed final integrative theoretical model for explaining and identifying meaningful PA of respondents emerged (Fig. 2). Descriptive and inferential statistics were used to analyze quantitative data and embedded into a grounded approach.

Twenty respondents, with an average age of 68.9 ± 4.8 years old and predominantly male respondents, were recruited for this study (Table 1). The PA, SIS, and QoL scores were shown as means ± SD at baseline engagement, week 4, week 8, and week 12 for the follow-up sessions (Table 2). It revealed the baseline of a moderate level of GPAQ and the good levels of all domains of QoL. For SIS, hand function showed the lowest mean score (49.5 + 39.8); communication showed the highest mean score (94.6 ± 12.2), followed by memory (84.8 + 4.2), emotion (82.9 + 3.0), ADL (78.9 + 3.7), and mobility (75.6 + 16.0). As a result, the mean participation score was lower than the recovery score.

Step I: Development of working hypothesis. Coding and analysis began after interviewing the first six respondents (code A). The initial codes revealed PAs regarding their meanings based on living style, experience, and personal belief, which were barriers or facilitators of maintaining family relationships and socioeconomic survival. They reflected positive and negative perceptions of their currently practicing PAs concerning their QoL. These contributed to constructing the working hypothesis, as shown in Fig. 3.

The meanings of PAs were evolving since attending rehabilitation programs until returning to their daily life at home in the community. In the beginning, PA meant ‘stroke rehabilitation’, which was an intervention expected to cure their disability from stroke. Eventually, it meant activity training to improve their physical functioning and ability to perform ADL to avoid dependence on others. Later on, it meant the activities were accountable to their meaningful roles in the family and community, which required advanced mobility abilities such as walking, bicycling, modified motorcycling, engaging in traditional events, and participating as volunteers. Some other meanings came from their experience of a proud and successful life, expected future life goals, and religious beliefs.

Step II: Testing the working hypothesis. The second-round interview (code B) was done to test the working hypothesis. The initial codes were confirmed, and the meaning of the joyfulness of PA was added. Then, they were categorized into axial codes to which social participation was added meaning. It was ascertained that meaningful PAs related to social involvement commonly required a higher level of physical ability. Being in a physically dependent state, particularly when performing ADL, created negative feelings regarding family relationships. To live a dignified life, some PAs meant a little pocket money earned by themselves, whereas some meant the value of a friend’s relationship.

Finally, six categories of the meanings of PA were determined; the positive ones included independently doing ADL, working according to roles and contributions, and social participation to maintain personal existence and some particular value, while the negative ones were around being a burden, losing an accountable role, and unbalancing reciprocity relationships. They were regrouped into three core categories: initial, identity, and optimizing PAs (Fig. 4). The ‘initial PA’ included independently doing ADL and avoiding being a burden. The respondents tried practicing ADL and household ambulation to live independently. Thus, it would not burden the family members. Doing the initial PAs themselves helps mitigate the respondents’ embarrassment. The ‘identity PA’ refers to accountability in family roles such as household income generator, motherhood, and housekeeper. The ‘optimizing PA’ focused on participating and contributing to the society they were living in, which reassured their meaningful existence, value, and dignity in the community.

Step III: Adjusting working hypothesis. To further explore the meanings of PA and adjust the working hypothesis, the core categories and categories were sorted into four quadrants of the theory of everything (TOE)(14) (Table 3). The first quadrant (Q1) showed the personal meanings underpinned by the intention to do PA to improve his/her QoL, whereas the second one (Q2) showed an individual’s explicit behaviors in doing PAs. The third quadrant (Q3) revealed the collective or social values affecting the personal meanings of doing PAs, such as the value of family roles, relationships, social transactions, and contribution, while the fourth one (Q4) reflected the explicit services and supporting system, including rehabilitation and long-term care, public transportation, accessible environment, and legislations that assured and protected elderly’s rights. Using the TOE framework, the third cohort of six respondents was recruited and interviewed to better enlighten the core categories' relationship. The theoretical saturation of the working hypothesis was considered reached after the completion of step III. To enhance active aging by increasing the level of PA, the cognitive theories that supported the explanation of given meanings of the disabled elderly were also matched; direct incentive or motivation can serve for initial PA, whereas self-determination theory can be used for identity PA, and SLCT was appropriate for optimizing PA.

Step IV: Confirmation for saturation of working hypothesis. The fourth cohort of two respondents was additionally interviewed to re-confirm core categories and their relationships. It reassured that social welfare, such as public transportation and disability pension, was essential. Furthermore, an accessible environment was confirmed as enabling for doing all kinds of PA.

“I want to resume car driving since our community has no public transport, but my son did not allow it. I have to hire someone with a car to take me to the hospital, the market, and my friends’ houses.” (Code C217)

Thus, an integrative theoretical model of the meaningful PA of the hemiplegic elderly emerged (Fig. 5). There were three hierarchical meaningful of PA, with specific goals and underpinned cognitive theories. The initial PA aims for functional recovery, the identity PA aims to retain visibility and value recognition, and the optimizing PA expects to achieve fulfillment, enjoyment, and life satisfaction. The driving forces can come from internal motivation and external incentives, while the continuing social and cognitive learning platform needs a facilitator.

Dynamic Correlation of GPAQ, QOL-BREF, and SIS scores

Serial quantitative data collection and analysis were conducted in parallel. The additional insights were embedded within the grounded data collection and analysis process. Explicitly, it revealed the score improvement of all domains of SIS, especially in strength, ADL, mobility, hand function, participation, and the level of PA. Whereas the QoL was not much changed as compared with baseline data (Table 2), there was a significant correlation between GPAQ and the relationship domain of QoL (r = .547, p < 0.05) as shown in week 4 (Table 4). The significant correlations between GPAQ and some domains of SIS: communication in weeks 8 and 12, mobility in week 8, hand function in weeks 4, 8, and 12, and recovery in week 8 were also demonstrated (Table 5). The gradual improvement during the interviewing and grounded analysis process was observed only in the hand function and mobility domains.

The MM-GT embedded design helped to disclose the multidimensional QoL-related meanings of the PA behavior of disabled elderly people, while the cognitive theories enhanced learning property and explanatory power. On the other hand, the TOE helped to integrate individual and societal perspectives and subjective and objective evidence. Using the grounded theory approach, the emergent saturated theoretical model pointed out three hierarchical levels of meaningful PA: initial PA, identity PA, and optimizing PA, which were influenced by cognitive, affective, and biological factors from both individualistic and collectivistic aspects. Since the first hemiplegic stroke attack, loss or decrease of physical functioning ability causes the elderly to be dependent on others for their daily routine. Rehabilitation programs can help to restore functional ability, which requires a longer period than younger stroke survivors but should be within the first year after a stroke attack. Initial PAs are relevant to the expected functional outcomes of a stroke rehabilitation program aiming at independence in performing ADL and household ambulation. It positively underpins restoring the elderly’s freedom and autonomy in daily routine. At the same time, it negatively means trying to avoid burdening family members, which eventually affects their relationship. This is a very intentional and individualistic viewpoint of all older people(29). However, regardless of the accessible and enabling household environment and good relational support from family members, it might be difficult to achieve. Relationship between disabled elderly and family members, particularly spouses, is a very critical factor. Once everyday life is independently manageable, higher levels of activities are expected. Identity PAs refer to personal and family values attached to the family roles of the disabled elderly, which include family leadership, income generator, looking after a grandchild, and housekeeping. If the elderly can do their relevant identity PAs, it would demonstrate the elderly’s role of accountability(30, 31). On the other hand, identity PAs may differ from the elderly’s previous practices, in which welfare subsidies or social support services might be needed. To prevent turning to a sedentary life and/or social withdrawal, this kind of PA should be achieved within a few years after a stroke attack.

Lastly, life satisfaction, fulfillment, and enjoyment are common desires of everyone(32), including the disabled elderly. Life does not mean only meaningful productivity, which could be done through identity PAs, but also the meaningful existence with equal opportunities to participate with equitable support from each other in a wider community or society. So, the top-most meaningful PA is determined as optimizing PAs, which are the results of balancing personal and social values, expectations, and supports to maintain a meaningful existence with life satisfaction.

Referring to Bandura’s triadic reciprocity concept of SCLT, even though initial PA was an individual intention, it required external motivation from family and rehabilitation staff within an accessible and supportive environment. To extend to identity PA, even though there was a need for the family, it demanded internal self-determination for action since it was related to personally recognized identity. Finally, as “QoL was a self-perception of a joyful, fulfilling, and satisfactory life”(33), it needed self-learning to balance internal and external values and expectations. To turn into action, the optimizing PA could be achieved through a balanced reciprocal transaction between disabled elderly and others. In this regard, reciprocal transactions are an important domain of QoL.

As observed, the incremental respondents’ mean scores of GPAQ from a baseline throughout the first eight weeks (Table 2) reflected the elderly’s self-learning during the grounded qualitative data collection and analysis. However, a statistically significant correlation was shown only with the improvement of the relationship score of QoL at week 4 (Table 4). Thus, the relationship is significant and has motivational effects on doing PA among older people(34). On the other hand, a gradual improvement of mean scores of hand function, communication, mobility, and recovery had statistically significant correlations with increasing GPAQ. It demonstrated the mutual effects of doing PAs and functional practices. The weekly interviews and self-activity records provided them with insights into their PA behaviors, related feelings, and underpinning thoughts of themselves and the surrounding context. This pointed out the usability of this emergent theoretical model of meaningful PA to facilitate disabled elderly to improve their PA levels to avoid a sedentary life and social withdrawal. The previous study found that the elderly preferred outdoor exercise with family or friends for relaxation or enjoyment and did it as part of their daily activities(35). However, consistent motivational drives from a supportive community system are needed to maintain the PA level as active aging(36). Exercise is a formal and common kind of PA(37), and regular therapeutic exercise is usually recommended(38) with a supervisor and in a safe manner(39) (40). However, without the meaning attached to exercise related to elderly life, it lacks a motivational effect.

While exploring the meanings of PA given by hemiplegic-stroke elderly using mixed-methods grounded theory exploratory embedded design, the integrative theoretical model emerged. The model comprises three core categories of meaningful PA: initial, identity, and optimizing PA, which have a hierarchical relationship. The initial PA was described as what positively drives one to be more independent in performing ADL and negatively drives one to avoid being a burden to the family. In contrast, identity PA refers to what they do regarding the accountabilities to prior family roles, which were commonly viewed negatively as opposed to living a sedentary life. Optimizing PA was defined as what they do to balance existence in the community’s social and physical context. The study pointed out that the higher the level of PA, the better the functional ability in daily living, while increasing meaningful PA levels can improve older people’s QoL, particularly in the relationship domain. The more meaningful PA was, the more possibility to turn into action and contribute to QoL of elderly hemiplegic stroke survivors. It suggested that this model should be a helpful measure to facilitate transforming the PA behavior of disabled elderly. The MM-GT embedded design was suggested for studying multidimensional and multiple perspectives issues, while other theoretical perspectives can be added. Lastly, the grounded theoretical model from this study was male-dominant, so it might have limitations for exploring or facilitating to determine female meaningful PA. It was also developed within the semi-urban context, where respondents were in agricultural settings, so it was unsuitable for urban contexts, particularly in business or industrial settings.

Declarations

Ethics approval and consent to participate

This study was conducted in accordance with the Declaration of Helsinki, which was approved by the Mahidol University - Central Institutional Review Board, MU-CIRB No. 2021/196.0610.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Author information

This study is a part of fulfillment for the Degree of Doctor of Philosophy (Quality of Life Development for Persons with Disabilities), Ratchasuda Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, completed by Ms.Kanokthip Sawangjaithum.

Funding

The Faculty of Graduate Studies and the Graduate Studies of Mahidol University Alumni Association partially funded this research project for field data collection.

Author Contribution

The substantial contributions of the authors include formulating research conception and questions by K.S., W.R., I.S.; design of research by K.S., W.R., R.S.; data analysis by K.S., W.R.; interpretation of data by K.S., W.R.; writing the main manuscript by K.S., W.R.; review and editing, K.S., W.R., I.S., R.S. All authors have approved the submitted version of the manuscript.

Acknowledgement

Thanks to the Faculty of Graduate Studies and Graduate Studies of Mahidol University Alumni Association for partially funding supporting in this study. Accordingly, I would like to thank the physical therapist who helped coordinate the contact during the study and all district community hospital personnel responsible for the elderly with disability from stroke for permitting me to collect the data. I am also grateful to all elderly with disabilities and their caregivers who participated in qualitative and quantitative data.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. All data generated or analysed during this study are included in this published article.

Global regional. national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021;20(10):795–820.
Khan F, Abusharha S, Alfuraidy A, Nimatallah K, Almalki R, Basaffar R et al. Prediction of Factors Affecting Mobility in Patients with Stroke and Finding the Mediation Effect of Balance on Mobility: A Cross-Sectional Study. Int J Environ Res Public Health. 2022;19(24).
Kunyodying T, Pothiban L, Khampolsiri T. Dependency of the Elderly with Stroke, Caregiver Burden, Social Support, and Quality of Life among Older Caregivers. Nurs J. 2015;42:11.
Gao J, Gao Q, Huo L, Yang J. Impaired Activity of Daily Living Status of the Older Adults and Its Influencing Factors: A Cross-Sectional Study. Int J Environ Res Public Health. 2022;19(23).
Ostir GV, Carlson JE, Black SA, Rudkin L, Goodwin JS, Markides KS. Disability in older adults. 1: Prevalence, causes, and consequences. Behav Med. 1999;24(4):147–56.
Yang Y, Du Z, Liu Y, Lao J, Sun X, Tang F. Disability and the risk of subsequent mortality in elderly: a 12-year longitudinal population-based study. BMC Geriatr. 2021;21(1):662.
Khumjun K, Wannapira P, Pinsakul P, Somjit S. Development of Intermediate Rehabilitation setting from hospital to community after stroke. BUDDHACHINARAJ Med J. 2018;35(3):9.
Nanthamongkolchai S, Tojeen A, Munsawaengsub C, Yodmai K, Suksatan W. Quality of Life of Older Adults with Physical and Mobility Disabilities during the COVID-19 Pandemic: A Cross-Sectional Study in Thailand. Sustainability. 2022;14(14):8525.
Yingkijsathavorn A, Harnphadungkit K. Quality of Life in Stroke Patients at Outpatient Rehabilitation Clinic, Siriraj Hospital. ASEAN J Rehabil Med. 2020;30(3):6.
Harrison J, Thetford C, Reeves MJ, Brown C, Joshi M, Watkins C. Returning to Leisure Activity Post-Stroke: Barriers and Facilitators to Engagement. Int J Environ Res Public Health. 2022;19(21).
Elayoubi J, Haley WE, Nelson ME, Hueluer G. How Social Connection and Engagement Relate to Functional Limitations and Depressive Symptoms Outcomes After Stroke. Stroke. 2023;54(7):1830–8.
Pipatsrisawat S. outcomes of rehabilitation in intermediate phase of stroke patients. Chiangrai Med J. 2020;12(3):10.
Person with disabilities statistic report. Department of Empowerment of persons with Disabilities; 2021.
Wilber K. A Theory of everthing. Boston: Shambhala publications, Inc.; 2000.
Promwatcharanom M, Ruengwongroj P. Activity daily living, mobility and social functioning of people with physical and mobility disability in Chiangrai reginal hospital. CHIANGRAI Med J. 2019;12(2):14.
Tieges Z, Mead G, Allerhand M, Duncan F, van Wijck F, Fitzsimons C, et al. Sedentary Behavior in the First Year After Stroke: A Longitudinal Cohort Study With Objective Measures. Arch Phys Med Rehabil. 2015;96(1):15–23.
Andrew NE, Kilkenny MF, Lannin NA, Cadilhac DA. Is health-related quality of life between 90 and 180 days following stroke associated with long-term unmet needs? Qual Life Res. 2016;25(8):2053–62.
Stuart M, Benvenuti F, Macko R, Taviani A, Segenni L, Mayer F, et al. Community-Based Adaptive Physical Activity Program for Chronic Stroke: Feasibility, Safety, and Efficacy of the Empoli Model. Neurorehabilit Neural Repair. 2009;23(7):726–34.
Aidar FJ, de Oliveira RJ, Silva AJ, de Matos DG, Carneiro AL, Garrido N, et al. The influence of the level of physical activity and human development in the quality of life in survivors of stroke. Health Qual Life Outcomes. 2011;9:89.
Wang R, Langhammer B. Predictors of quality of life for chronic stroke survivors in relation to cultural differences: a literature review. Scand J Caring Sci. 2018;32(2):502–14.
Howell Smith MC, Babchuk WA, Stevens J, Garrett AL, Wang SC, Guetterman TC. Modeling the Use of Mixed Methods–Grounded Theory: Developing Scales for a New Measurement Model. J Mixed Methods Res. 2020;14(2):184–206.
Creswell JW, Clark VLP. Designing and conducting mixed methods research. 2nd ed. Thousand Oaks, California: SAGE Publications, Inc; 2010.
Guetterman T. Descriptions of Sampling Practices Within Five Approaches to Qualitative Research in Education and the Health Sciences. Forum Qualitative Sozialforschung/Forum: Qualitative Social Research. 2015;16.
Creswell JW. Educational research: Planing, Conduction, and Evaluatuin Quantitative and Qualitative Reasearch: Upper Saddle. River, NJ: Pearson Education; 2002.
Khuha O, Wanichwarote J, Boonmeephiphit B, Thammawat N. Health technology assessment program Correlation of MMSE-Thai 2002 and Thai Mini-Mental State Examination (TMSE) Screening Test for Thai Elderly. Medicine IoG, DMS, MOPH, Thailand, editors. CG tool Co.Ltd.; 2551. p. 100.
Brunnstrom S. Movement Therapy in Hemiplegia: a Neurophysiological Approach. ed, editor. New York: Harper&Row; 1970.
Chun Tie Y, Birks M, Francis K. Grounded theory research: A design framework for novice researchers. SAGE Open Med. 2019;7:2050312118822927.
Rader S, Subhan Z, Lanier C, Brooksbank R, Yankah S, Spears K. CyberRx: Emerging social media marketing strategy for pharmaceuticals. Int J Pharm Healthc Mark. 2014;8.
Petretto DR, Pili R. Ageing and Disability According to the Perspective of Clinical Psychology of Disability. Geriatrics. 2022;7(3):55.
Ayoob SM. Senior Citizens and Their Roles in Family and Household. J Politics Law. 2020;13(2):12.
Islam A. Position of the Rural Elderly in Familial Decision Making: A Sociological Study. Int J Aging Res. 2020;3(65):14.
Wong FMF. Life Satisfaction and Quality of Life Enjoyment among Retired People Aged 65 or Older. Open J Social Sci. 2019;7(5):9.
Brown I, Brown RI. Quality of life and disability. London and Philadelphia: Jessica Kingsley; 2006.
Stehr P, Luetke Lanfer H, Rossmann C. Beliefs and motivation regarding physical activity among older adults in Germany: results of a qualitative study. Int J Qual Stud Health Well-being. 2021;16(1):1932025.
Noukpo SI, Triccas LT, Bonnechère B, Adoukonou T, Feys P, Kossi O. Physical Activity Level, Barriers, and Facilitators for Exercise Engagement for Chronic Community-Dwelling Stroke Survivors in Low-Income Settings: A Cross-Sectional Study in Benin. Int J Environ Res Public Health. 2023;20(3):1784.
Muchiri WA, Olutende OM, Kweyu IW, Vurigwa E. Meaning of Physical Activities for the Elderly: A Review. Am J Sports Sci Med. 2018;6(3):4.
Simpson LA, Eng JJ, Tawashy AE. Exercise perceptions among people with stroke: Barriers and facilitators to participation. Int J therapy rehabilitation. 2011;18(9):11.
Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie K, et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack. Stroke. 2006;37(2):577–617.
Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, et al. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2021;52(7):e364–467.
Ali A, Tabassum D, Baig SS, Moyle B, Redgrave J, Nichols S, et al. Effect of Exercise Interventions on Health-Related Quality of Life After Stroke and Transient Ischemic Attack. Stroke. 2021;52:11.

Tables 1 to 5 are available in the Supplementary Files section.

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Exploring the Significance of Physical Activity and Quality of Life Among Hemiplegic Elderly: A Novel Approach Using Mixed-Methods Grounded Theory

Status:

Version 1

Abstract

Background

Methods

Results

Conclusions

Figures

Background

Methods

Results

Dynamic Correlation of GPAQ, QOL-BREF, and SIS scores

Discussion

Conclusion

Declarations

Declarations

Competing interests

Author information

Funding

Author Contribution

Acknowledgement

Availability of data and materials

References

Tables

Additional Declarations

Supplementary Files

Status:

Version 1