Understanding and defining people’s body image experiences after a stroke

Abstract

When someone has a stroke, it can cause bodily changes which may lead to an altered body image experience. What this experience is like, and how it impacts wellbeing and
recovery, is not fully understood. We need to understand this to identify whether support for body image experience is required post-stroke. This thesis involves three studies which aimed to build the evidence base and allow deeper insight into poststroke body image experiences. If these experiences impacted wellbeing and recovery, the aim would also be to recommend how body image could be assessed and supported post-stroke.

A systematic review, which identified 61 relevant papers, enabled a summary of existing evidence. Findings showed that people experience a changed body image post-stroke, which impacted their everyday lives. Methods for assessing body image within these studies were not specifically validated for stroke. Semi-structured interviews with 22 people with stroke confirmed this changed experience, its impacts, and enhanced our understanding by providing additional nuanced detail. From this, a stroke-specific definition of body image to support patient, family, carer and clinician understanding was developed. Feedback from clinicians, participants, and public advisors described this as being clear, relevant and comprehensive.

An expert panel of clinicians reviewed my interpretation of the findings and found them to be clinically relevant. They recommended practical, and psychological, methods
whereby body image experience could be supported. They also considered how poststroke body image and any benefits of support could be assessed.

Recommendations for clinical practice and future research have been made. The stroke-specific summary and definition of body image will facilitate a more consistent understanding around, and identification of, people who might be struggling with their post-stroke body image experience. Initial recommendations for post-stroke body image support and methods of assessing any benefits of this support provide direction for future research.