Finding Occupational Coherence After a Stroke: A Grounded Theory

The purpose of this study was to understand how individuals find occupational coherence after a stroke. Occupational coherence is defined as the continuity between life before and after having a stroke. This study used a constructivist grounded theory approach. Inclusion criteria was (1) had a stroke within the past 2-6 years from the time of the interview, (2) were aged 60 to 80 years old, (3) received physical, occupational, and/or speech therapy rehabilitation services for at least two weeks following their stroke, (4) must self-identify as having a sense of occupational coherence. Semi-structured interviews were done via phone or Zoom call with 6 participants. Data analysis and memo writing was conducted immediately following interviews. Line-by-line coding was done to understand the participant’s experience. Memo writing was done following each interview and after initial rounds of coding. Interviews continued until saturation was reached. After coding was completed, categories were made based on commonalities found amongst the participants. This process led to the creation of a theory on how individuals reach occupational coherence. Four categories were made showing the phases of recovery participants experienced: the phase of life before the stroke occurred; the stroke itself; a period of recovery; and reaching occupational coherence. This is depicted in a conceptual model of a cliff that turns into a journey to the top of a mountain. The phase of recovery contains ‘rocks,’ or obstacles that participants faced, varying in size depending on how the obstacles impacted them. The participants reached occupational coherence by carrying these ‘rocks,’ despite the challenge of it. Findings suggest that all individuals who have had a stroke have the potential to reach occupational coherence, but the ‘rocks’ they face may be part of the reason why they cannot get there. Further study of occupational coherence is important to understand how OTs can support recovery.

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