Understanding development of contractures in people with stroke: formulation of a logic-model to inform care and prevention.

Abstract

Purpose: Contracture is stiffness and reduction in how much a joint and muscle can move and may impact on self-care and functional ability. We outline the development of the first comprehensive Logic-Model of the problem for contracture development, to inform prevention and treatment.

Method: The initial Logic-Model was developed based on the literature by the research team. The draft Logic-Model of the problem was presented to people with stroke and carers from our Public, Patient Involvement (PPI) group and clinicians. This process resulted in a comprehensive model to describe factors associated with contracture development.

Results: Following construction of the initial logic-model, items were identified by the PPI group and clinicians as elements that might particularly influence contracture development, and categorised as follows: Personal Determinants: Person with stroke: perceived advantage and disadvantage (of knowledge of health condition), apathy, low self-efficacy, limited skills and knowledge Family carers and supporters: negative attitude and self-efficacy, lack of skills and knowledge,; Professionals and paid carers: low awareness of services and knowledge. For Environmental Factors: lack of support for management was identified as a priority.

Conclusion: The resulting Logic-Model of the problem will enable development of evidence-based pathways to prevent and treat contracture.