Il ruolo dei fattori di contesto nella riabilitazione post ictus: meta-sintesi e meta-summary

Purpose: The aim of this study is to outline the contextual factors influencing the rehabilitation after stroke and to develop a taxonomy capable of classifying the results obtained. Contextual factors have already been extensively investigated in the musculoskeletal field, whereas in the neurological field there is no defined taxonomy yet, that can help practitioners in favouring placebo effects during their clinical practice. Materials and methods: A systematic review has been conducted within four databases: Pubmed, CINAHL, Web of Science and Cochrane Library. The search strings were defined using the SPIDER method, including only articles in Italian or English for which the abstract was available, with no restriction on the year of publication. The population included subjects with stroke who had been exposed to contextual factors. The systematic review was performed following the PRISMA protocol: the article selection was triple-blind and performed using the Rayyan software, first by reading the title and abstract, then analysing the full text. The included articles were qualitatively assessed using the Critical Appraisal Skills Programme (CASP) tool. For the meta-synthesis and meta-summary process, Sandelowski and Barroso's guidelines were applied: the themes that emerged were grouped and sorted using the ‘thinking aloud’ strategy, then their frequency and inter-study intensity were analysed. Results: Twenty qualitative studies of high quality were included. Six main categories of contextual factors emerged from the analysis of the studies: treatment characteristics, patient characteristics, physiotherapist characteristics, characteristics of the therapeutic relationship, social relationships, setting characteristics. Among the sub-categories, those with a higher frequency effect are: motivation and emotional aspects (48%), importance of achieving goals (43%) and family involvement in rehabilitation (43%). Conclusions: This meta-summary has defined a taxonomy of contextual factors in neurology to be considered in clinical practice. Physiotherapists involved in rehabilitation of persons with stroke must involve the patient in the intervention planning. During treatment, goal setting and specific feedback given to the patient play a central role. In contrast to the musculoskeletal field, it is crucial to involve the caregiver in the rehabilitation process, as a great source of motivation and an intermediary for rehabilitation at home. Group rehabilitation are also important as a source of support and help between patients with the same pathology. Further research in this field should consider other neurological pathologies and also analyse the point of view of the caregiver, a key figure in the neurological context.

Introduzione: L’ictus (o stroke) è una patologia invalidante che colpisce sempre più persone in tutto il mondo; la riabilitazione è un processo fondamentale per garantire la miglior funzionalità e qualità della vita alle persone colpite da questa problematica. La riabilitazione è influenzata da numerosi fattori di contesto, che possono incidere positivamente o meno sull’efficacia della riabilitazione stessa. L’obiettivo di questa tesi è definire quali sono i fattori di contesto che entrano in gioco nella riabilitazione post ictus, evidenziare quali sono le percezioni dei pazienti nella riabilitazione e definire l’utilità possono avere questi fattori contestuali nella pratica clinica. Materiali e metodi: è stata eseguita una ricerca in diverse banche dati, aggiornando stringhe di ricerca già precedentemente utilizzate per studi simili. Gli articoli sono stati inclusi secondo precisi criteri di inclusione ed esclusione e valutati in doppio cieco tramite la piattaforma Rayyan, prima tramite la lettura di titolo e abstract, mentre in un secondo momento sono stati analizzati i full text.