The unfolding illness trajectory of stroke.
PURPOSE: To describe the characteristics of the illness trajectory of stroke during the first year. METHOD: A qualitative, prospective case study design; repeated in-depth semi-structured interviews with nine mild to moderately affected stroke patients during the course of the first year. A total of 63 interviews were conducted. The interview data were transcribed verbatim and analysed as a text, using a hermeneutic approach. RESULTS: A stroke is not necessarily experienced as an abrupt psychosocial crisis by the stroke patient. The adjustment process seems to be gradually evolving and prolonged over most of the first year following the cerebro-vascular accident (CVA). The illness trajectory may be divided into four phases, each with characteristic tasks and focal points. The adjustment process involves hard physical and psychosocial work on the part of patient. A necessary pre-requisite for adjustment is a realistic conception of the illness and its implications. This takes time and experience to achieve. CONCLUSIONS: The adjustment process following stroke is gradual and prolonged. In order to move away from the predominant functional rehabilitation approach towards a more comprehensive and better targeted service, increased understanding of the complexities of the adjustment process is necessary.