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Vol. 24. Issue 1.
Pages 61-68 (01 January 2020)
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Vol. 24. Issue 1.
Pages 61-68 (01 January 2020)
Original Research
DOI: 10.1016/j.bjpt.2018.11.008
How does context influence arm use after stroke? A qualitative content analysis among rural community-dwelling stroke survivors
Vasanthan Rajagopalana,
Corresponding author

Corresponding author at: Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India.
, Manikandan Natarajana,c, Johnson Alexb,1, John M. Solomona,c
a Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, India
b Department of Behavior Sciences, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
c Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Acdemy of Higher Education, Manipal, India

  • Personal and environmental context influence affected arm use of stroke survivors.

  • Rural stroke survivors have limited awareness and knowledge of active functional task practice.

  • For recovery of the affected upper extremity, many stroke survivors rely on passive recovery methods.

  • Self-engagement in active functional task practice is facilitated by an enriched home environment and perception of ongoing recovery.

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Tables (4)
Table 1. Participant categorisation framework.
Table 2. Qualitative interview guide.
Table 3. Demographic characters of participants.
Table 4. Participant physical ability and activity profiles.
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To explore the personal and environmental contextual factors that influence use of affected arm for function among stroke survivors.


We conducted a qualitative phenomenological study using an interpretivist paradigm among 23 stroke survivors in their late sub-acute and chronic stages and their relatives living in the rural regions of India using maximum variation sampling. Semi-structured interviews were conducted to identify personal and environmental contextual factors relevant to arm use. Their current level of arm use, motor and functional ability were evaluated using Motor Activity Log, AbilHand and Lawton Instrumental Activities of Daily Living scales and the scores were categorized in order to describe and compare the participant's characteristics before analyzing each interview. Differences among the contextual factors of participants with high and low levels of functional arm use and exercise using paretic limb were analyzed using qualitative content analysis.


Study participants followed active exercises or passive interventions to improve their arm. Their immediate social environment influenced these decisions. Lack of awareness on how to self-engage or scale down their physical environment to match their abilities demoted active functional task performance. Ability to perceive small gains in arm function helped them sustain their efforts.


Context influences arm use. Addressing contextual determinants influencing arm use such as facilitating understanding about the need for active functional task engagement; identifying and addressing factors moderating motivation to sustain functional task practice and enriching objects to match their movement abilities can increase arm use and promote upper limb recovery.

Stroke recovery
Qualitative research
Psychology and behaviour
Prognostic factor


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Brazilian Journal of Physical Therapy

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