Philosophiae Doctor - PhD / Background: Stroke is acknowledged globally and among Nigerian rehabilitation researchers as a public health problem that leave half of its survivors with significant neurological deficits. The attendant sequelae of stroke affects the functional ability, limits activity performance and participation of stroke survivors within the community. The inability to re-establish pre-existing roles after stroke further poses additional challenges on the society, friends and families of the stroke survivor with regards to cost and burden of care. Although stroke disrupt the career pathway of working age survivors briefly, recurrently or permanently; a systematic pathway that facilitates job placement and retention at work for stroke survivors could reduce the devastation and burden caused by unemployment following stroke. As this vocational rehabilitation pathway and programme is currently unavailable for stroke survivors, this study aimed to design a RTW intervention programme that could facilitate the work re-entry for stroke survivors in the state of Osun, Nigeria. Method: The study utilized a multi-phase mixed method research design that was guided by the Intervention Mapping (IM) framework to achieve its objectives. This consisted of three iterative phases that informed one another with the findings culminating into the developed return to work programme for stroke survivors in Osun State. Phase one used a convergent mixed method parallel approach to obtain baseline information on the RTW process, the impairments, activity limitation, and the participation restrictions experienced by stroke survivors in Osun state, Nigeria in two distinct stages that involved a cross-sectional survey and qualitative interviews. The cross sectional survey administered questionnaires that included the Work Rehabilitation Questionnaire, the International Classification of Functioning, Disability and Health (ICF) Brief Core Sets for vocational rehabilitation (VR) and the Work Impact Questionnaire (WIQ) using the face to face method. Descriptive statistics such as measure of central tendencies and frequencies as well as inferential statistics such as logistic regression analysis were performed on the questionnaire data. The qualitative study involved concept mapping using in-depth interviews with stroke survivors who have and those that have not RTW. The transcripts from the in-depth interviews were analysed using the thematic content method. Phase two entailed a scoping review of literature that reported on interventions aimed at facilitating RTW of stroke survivors. The last phase of the study involved a Delphi study with experts in the field of stroke and vocational rehabilitation. The Delphi survey was conducted over three rounds with the final draft of the RTW programme emerging at the third round. Results: Two hundred and ten stroke survivors with mean age 52.90±7.92 responded to the quantitative stage of the phase thereby yielding a response rate of 76.36%. Sixty three point eight percent of the respondents had returned to work with half of them in full time employment (32.9%) while 36.2% had not returned to work. The majority of the respondents identified that travel to and from work (43.8%) and access at work (43.3%) had an impact ranging from ‘quite a bit’ to ‘extreme’ on their ability to work on the WIQ. The results from the quantitative stage further showed that more than ten percent of the respondents experienced complete problem in four components of activity and participation domains of the ICF brief core sets for VR and these include remunerative employment (21.4%), acquiring new skills (17.1%), non-remunerative employment (16.7%), as well as acquiring, keeping and terminating jobs (14.3%). Similarly, energy and drive functions (41.9%) and higher level cognitive function (36.2%) were indicated as culminating in moderate to severe problems in more than a third of the respondents while the “performance of complex interpersonal relationship” and “exercise tolerance function” resulted in no or little difficulty for the respondents. The findings from the logistic regression analysis showed that the combination of side of body affected by stroke (left), type of vocational rehabilitation programme, symptoms of stroke, environment, body function impairments as well as activity and participation problems were the factors that predict RTW after stroke. The logistic regression model significantly explained 55.0% to 75.4% of the variance in RTW after stroke and correctly classified 89.0% of all the cases/respondents. Results from the qualitative stage of the first phase suggests the lived experience of returning to work after stroke to have entailed three themes that was represented by a concept map. The first theme revealed that “it was difficult to live with stroke” for the survivor. The second theme revealed that the stroke survivors’ environment could either worsen or lessen the difficulty experience while the third theme highlighted the various issues that directly impacted on the resumption of worker role of the participants. The scoping review phase (phase two) identified that RTW interventions for stroke survivors falls into three core components which includes 1) intervention components that interface with the stroke survivor; 2) intervention components that interfaced with the workplace and; 3) components that describe strategies of implementation. These core components are interventions that could guarantee an effective RTW for strokes survivors when included in a RTW programme. In the third phase which was the concluding phase of the study, 13 experts in the field of stroke and vocational rehabilitation unanimously agreed at the third round of Delphi that the content of RTW programme for stroke survivors should include an assessment phase, work intervention training phase, work test placement phase and clients full participation in worker role phase that will span a 12 week duration. The developed RTW programme, conceptualized as Stroke Return to Work Intervention Programme (SReTWIP) was designed to be individually tailored to meet the need of the stroke survivor and implemented by an interdisciplinary team that will include the OT and PT as key members. Equally, the stroke survivor is expected to be involved in the decision making process throughout the duration of the SReTWIP. And finally, the programme is to be coordinated by a case manager who will be a member of the interdisciplinary team. Conclusion: It can be concluded that 63.9% of stroke survivors in Osun State, Nigeria return to work. Problems pertaining to lack of energy and drive functioning; higher level cognitive functioning; acquiring new skills; handling stress and psychosocial demands; travel to and from work and access were the common body impairments and problems with activities and participation restrictions that the stroke survivors encountered. Similarly, the study concludes that a multi-faceted programme, the SReTWIP, comprising of four interconnected phases of interventions that targets multiple factors such as personal and environment factors influencing work resumption is likely to be more effective in facilitating quick RTW after stroke.

In-hospital onset strokes represent 4% to 20% of all reported strokes in the United States. The variability of treatment protocols and workflows as well as the complex etiology and multiple comorbidities of the in-hospital stroke subpopulation often result in unfavorable outcomes and higher mortality rates compared to those who experience strokes outside of the hospital setting. The purpose of this project was to conduct a systematic review to identify and summarize effective strategies and practices for prompt recognition and treatment of in-hospital strokes. The results of the literature review with leading-edge guidelines for stroke care were corelated to formulate recommendations at an organizational level for improving care delivery and workflow. Peer-reviewed publications and literature not controlled by publishers were analyzed. An appraisal of 24 articles was conducted, using the guide for classification of level of evidence by Fineout-Overholt, Melnyk, Stillwell, and Williamson. The results of this systematic review revealed that the most effective strategies and practices for prompt recognition and treatment of in-hospital strokes included: staff education, creating a dedicated responder team, analysis and improvement of internal processes to shorten the time from discovery to diagnosis, and offering appropriate evidence-based treatments according to acute stroke guidelines. Creating organizational protocols and quality metrics to promote timely and evidence-based care for in-hospital strokes may result in a positive social change by eliminating the existing care disparities between community and in-hospital strokes and improving the health outcomes of this subpopulation of strokes.

Sze Kai-hoi, Frank. / "February 2002." / Thesis (M.D.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (p. 280-301). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

Fragestellung Die Prognose eines akuten Hirninfarktes bei Verschluss einer proximalen Hirnarterie ist trotz der intravenösen Thrombolyse mit rtPA ungünstig. Kann die kombinierte pharmaco-mechanische Rekanalisation von proximalen Gefäßverschlüssen bei akutem Hirninfarkt zu einer Verbesserung des klinischen Ergebnisses führen? Methoden Wir analysierten retrospektiv 66 konsekutiv aufgenommene Patienten (36m, 30w; mittleres Alter 61 Jahre (23-86 Jahre), die von 2010 bis 2012 kombiniert pharmako-mechanisch intra-arteriell behandelt wurden. 32 Patienten wiesen einen kombinierten ACI-/M1-Verschluss, 23 einen M1-Verschluss und 11 eine Basilaristhrombose auf. Mittlerer NIHSS lag bei 23. 57 Patienten erhielten eine kombinierte pharmaco-mechanische Therapie, 3 Patienten wurden lediglich pharmakologisch und 6 Patienten rein mechanisch rekanalisiert. Rekanalisierung bei 35 Patienten mit einem Stent-Retriever (32 Patienten mit pREset, 3 Patienten mit SOLITAIRE) erfolgt. Bei 46 Patienten wurde rtPA und bei 32 Patienten Tirofiban als Bridging Verfahren eingesetzt. Eine Stentanlage erfolgte in 28,78% der Fälle. Ergebnisse Die erzielten Rekanalisationsraten lagen bei 89,4% bei einer mittleren Dauer der Intervention von 96 Minuten (53,03% unter 90 Min.). Ein günstiges klinisches Ergebnis nach mRS (mRS 0-2) wurde bei 48% der Patienten erreicht. Die Rate an symptomatischen intrazerebralen Blutungen lag bei 4,55%. Die Mortalität war 19,7%. Die multivariate Regressionsanalyse ergab als modifizierbare Prediktoren für ein günstiges Outcome die Dauer bis zur Rekanalisation und die Gabe von rtPA. Schlussfolgerungen Die kombinierte endovaskuläre pharmako-mechanische Therapie kann die Mortalität und Morbidität von Schlaganfallpatienten mit Verschlüssen einer proximalen Hirnarterie reduzieren. / Background The prognosis of ischemic stroke due to occlusion of proximal intracranial arteries is poor, even with intravenous rt-PA thrombolysis. Can a combined pharmaco-mechanical thrombolysis lead to a better Outcome in this patients? Materials and methods We analysed 66 consecutive patients (36m, 30f; mean age 61, range 23 - 86 years), treated with a combined pharmaco-mechanical intra-arterial thrombolysis from 2010 to 2012. 32 patients presented with ICA and MCA tandem occlusions, 23 with occlusion of the main trunk of the MCA, and 11 of the BA. The mean NIH-Stroke-Scale (NIHSS) at admission was 23. 57 patients underwent combined pharmaco-mechanical thrombolisys, 3 patients were only pharmacological and 6 patients only mechanical recanalised. In 35 patients were Stent-Retriever-Systems utilized (32 patients pREset, 3 patients SOLITAIRE). A bridging therapie with rtPA was in 46 patients used and with tirofiban in 32 patients. Stenting were performed as well in 28,78%. Results The Rekanalizationrate was 89,4%. The mean duration of the intervention was 96 minutes (53,03% under 90 minutes). After rehabilitation had 48% of our patient a favorable outcome measured with the mRS (mRS 0-2).The procent of sICH in our patients was 4,55. The Mortality was 19.7%. The modifiable Predictors for a favorable Outcome detected with a multivariate logistic regression analysis were the time to recanalisation and the bridging therapy with rtPA. Conclusion The combined intra-arterial pharmaco-mechanical thrombolysis may reduce mortality and morbidity after occlusions of the proximal intracranial arteries in acute stroke patients.

Bakgrund Varje år drabbas 17 miljoner människor av stroke, varav cirka 5 miljoner blir handikappade livet ut och behöver vård från bland annat anhöriga. Att vara anhörig till en strokedrabbad innebär ofta en stressig situation med både fysiska och psykiska konsekvenser. Syfte Syftet med litteraturstudien var att beskriva erfarenheter av att vara anhörig till en närstående som drabbats av stroke som bor och vårdas hemma. Metod En litteraturstudie gjord med åtta kvalitativa studier. Sökningar har genomförts i Cinahl och Scopus. Studierna har blivit granskade, analyserade och har ställts samman till ett resultat. Resultat Resultatet presenterades i fem kategorier och 13 underkategorier och visar många beskrivningar av känslor och krav som tyngde anhöriga och påverkade deras hälsa både fysiskt och psykiskt. Förändrade relationer, mötet med vården och anpassningen till en ny vardag var något som anhöriga kämpade med. Konklusion Litteraturstudien visar att anhöriga kan ha stora behov av stöd och information för att kunna klara av vårdarrollen. Genom att arbeta utifrån familjefokuserad omvårdnad kan anhörigas behov och styrkor lyftas fram. Ytterligare forskning på anhöriga till närstående som drabbats av stroke utifrån ett genusperspektiv skulle vara intressant, bland annat eftersom den största delen anhörigvårdare är kvinnor. / Background Each year 17 million people suffer stroke worldwide, of these nearly 5 million are permanently disabled and in need of care from relatives among others. Being a relative of a stroke victim often means a stressful situation with both physical and psychological consequences. Aim The purpose of this study was to describe the experiences of being a relative of a stroke victim living and cared for at home. Method A literature study with eight qualitative studies. Searches have been made inCinahl and Scopus. The studies have been reviewed, analyzed and compiled. Result The results were presented in five main categories and 13 subcategories. The relatives described many emotions and demands, which affected their health both physically and mentally. They struggled with changed relationships, the health care and adjustment to a new living. Conclusion This study shows that to be able to handle the caring role relatives may have a big need for support and information. The relatives’ needs and strengths can be highlighted by working from the basis of family-focused care. More research on relatives of a stroke victim from a gender perspective would be interesting, for instance since most caregivers are women.

<p>Stroke är en av de tre sjukdomar som årligen skördar flest antal vuxna liv – endast hjärtsjukdomar och cancer dödar fler. Bara i Sverige drabbas cirka 20 000 personer per år. Av dessa 20 000 Personer, räddas förstås många till livet. Sjukdomen är dock sällan komplikationsfri utan leder oftast till en rad konsekvenser, vilka i sin tur kan vara bestående såväl som temporära. Att insjukna i en stroke är en omvittnat obehaglig upplevelse – inte bara för de drabbade själva utan även för deras närmast anhöriga. De fysiska skador som ofta blir följd av en stroke, är oftast lätta att upptäcka. Något annat som inte är lika uppenbart, är den upplevelse av försämrad livskvalitet, som många patienter upplever till följd av att ha drabbats av en stroke.</p><p>Syftet med denna studie har varit att beskriva hur patienter som har drabbats av stroke upplever sin livskvalitet utifrån tre perspektiv; fysiskt, psykiskt, samt socialt.  Underlaget till denna studie kommer från olika databaserna Medline, PubMed och Academic Search Elite. Genom att använda relevanta sökord på engelska så påträffades de artiklar som sedan använts i studien. Totalt har 17 artiklar granskats för att besvara studiens frågeställning. Artiklarnas relevans för studien varierade. Tillsammans bidrog dock alla 17 separata artiklar till förståelsen av problemställningen.</p><p>Resultatet av undersökningen visade att personer med stroke upplever förändringar i sin livskvalitet när det gäller den psykiska, fysiska samt det sociala perspektivet. De försämringar som äger rum i samtliga perspektiv kan avvärjas med hjälp av bättre kommunikation mellan patient och vårdpersonal samt mellan anhöriga och vårdpersonal. En försämring av det ena perspektivet, innebär alltså även att de andra två perspektiven löper en överhängande risk att försämras.</p><p> </p><p> </p><p>Nyckelord: stroke, livskvalitet, omvårdnad</p><p> </p> / <p>Stroke is one of the third most common diseases among adults today. Only in Sweden there’s approximately 20 000 persons that get diagnosed with stroke. Those who survive stroke have to live with the consequences, permanent as well as temporary. To suffer from stroke is an unpleasant experience, not only for those who suffer stroke, but also for their family and relatives. Apart from the psychical damages that arise from stroke, the patients also experience variation in their quality of life.</p><p><strong>  </strong>The aim of this study is to describe how stroke patients experience their own quality of life from a physical, mental and social point of view. The basic data which is the foundation for this study were found in the databases Medline, PubMed and Academic Search Elite. The searches were made with simple keywords to find the relevant articles. In total, 17 articles were reviewed in order to answer the question of the study. Although the relevance of the articles were varying, they all had in common that they contributed to an understanding for this study.</p><p>The result of this study shows that people who suffer from stroke experiences have changes in their quality of life when it comes to the mental, physical and the social sphere. The decreases in their quality of life, no matter which sphere, can improve with better communication between patient and caregivers and to relatives and caregivers. Nevertheless, the different spheres are linked each other, and a decrease in quality of life in one sphere, often affects another.</p><p> </p><p> </p><p> </p><p>Keywords: Stroke, quality of life, nursing</p>

<p>The aim of this study was to describe the experience of quality of life among people who had suffered a stroke. The articles were found through searches in Cinahl and a total of 17 articles were included.</p><p>The result shows three perspectives which effects the stroke survivor´s lives. These three are physical, psychological and social. The result of this study shows that stroke limits a person’s life in many ways, and has a negative influence on quality of life. Feelings like anxiety are common, and also a fear of having another stroke. Another issue is social isolation, often caused by the physical changes. The physical changes can be dysphagia and paralysis.</p><p>Support and information is extremely important after a stroke. People who have suffered a stroke often feel fear to go out among other people and often feel like they are a burden to their family and friends. All these things change the person’s quality of life in different ways.</p><p><strong><p>Keywords: Stroke, Quality of life and experience</p></strong></p> / <p><p>Sammanfattning</p><p>Syftet med denna studie var att beskriva upplevelsen av livskvalitet hos människor som drabbats av stroke. Detta gjordes genom sökningar i databasen Cinahl och resulterade i att 17 artiklar inkluderades.</p><p>Resultatet av denna studie visar att en stroke medför många begränsningar för den som drabbas och detta kan påverka deras livskvalitet på ett negativt sätt. Känslor som oro och ångest är vanliga, samt en rädsla att drabbas av en ny stroke. Sociala svårigheter och isolering är ytterligare begränsningar. Den fysiska påfrestningen är otroligt påtaglig vilket ytterligare bidrar till den sociala isoleringen. Dessa fysiska påfrestningar kan till exempel vara dysfagi och förlamning. Stöd och information är oerhört viktigt i efterförloppet av en stroke. Människor som drabbas känner en rädsla för att gå ut bland andra och drar sig lätt undan. De har även en känsla av att alltid vara en börda för sina närstående, vilket leder till att de isolerar sig. Dessa delar sammantaget resulterar i försämrad livskvalitet för de flesta som drabbas, även om det finns undantag.Nyckelord: Stroke, livskvalitet och upplevelse</p></p>

Stroke är en av de tre sjukdomar som årligen skördar flest antal vuxna liv – endast hjärtsjukdomar och cancer dödar fler. Bara i Sverige drabbas cirka 20 000 personer per år. Av dessa 20 000 Personer, räddas förstås många till livet. Sjukdomen är dock sällan komplikationsfri utan leder oftast till en rad konsekvenser, vilka i sin tur kan vara bestående såväl som temporära. Att insjukna i en stroke är en omvittnat obehaglig upplevelse – inte bara för de drabbade själva utan även för deras närmast anhöriga. De fysiska skador som ofta blir följd av en stroke, är oftast lätta att upptäcka. Något annat som inte är lika uppenbart, är den upplevelse av försämrad livskvalitet, som många patienter upplever till följd av att ha drabbats av en stroke. Syftet med denna studie har varit att beskriva hur patienter som har drabbats av stroke upplever sin livskvalitet utifrån tre perspektiv; fysiskt, psykiskt, samt socialt.  Underlaget till denna studie kommer från olika databaserna Medline, PubMed och Academic Search Elite. Genom att använda relevanta sökord på engelska så påträffades de artiklar som sedan använts i studien. Totalt har 17 artiklar granskats för att besvara studiens frågeställning. Artiklarnas relevans för studien varierade. Tillsammans bidrog dock alla 17 separata artiklar till förståelsen av problemställningen. Resultatet av undersökningen visade att personer med stroke upplever förändringar i sin livskvalitet när det gäller den psykiska, fysiska samt det sociala perspektivet. De försämringar som äger rum i samtliga perspektiv kan avvärjas med hjälp av bättre kommunikation mellan patient och vårdpersonal samt mellan anhöriga och vårdpersonal. En försämring av det ena perspektivet, innebär alltså även att de andra två perspektiven löper en överhängande risk att försämras.     Nyckelord: stroke, livskvalitet, omvårdnad / Stroke is one of the third most common diseases among adults today. Only in Sweden there’s approximately 20 000 persons that get diagnosed with stroke. Those who survive stroke have to live with the consequences, permanent as well as temporary. To suffer from stroke is an unpleasant experience, not only for those who suffer stroke, but also for their family and relatives. Apart from the psychical damages that arise from stroke, the patients also experience variation in their quality of life.   The aim of this study is to describe how stroke patients experience their own quality of life from a physical, mental and social point of view. The basic data which is the foundation for this study were found in the databases Medline, PubMed and Academic Search Elite. The searches were made with simple keywords to find the relevant articles. In total, 17 articles were reviewed in order to answer the question of the study. Although the relevance of the articles were varying, they all had in common that they contributed to an understanding for this study. The result of this study shows that people who suffer from stroke experiences have changes in their quality of life when it comes to the mental, physical and the social sphere. The decreases in their quality of life, no matter which sphere, can improve with better communication between patient and caregivers and to relatives and caregivers. Nevertheless, the different spheres are linked each other, and a decrease in quality of life in one sphere, often affects another.       Keywords: Stroke, quality of life, nursing

The aim of this study was to describe the experience of quality of life among people who had suffered a stroke. The articles were found through searches in Cinahl and a total of 17 articles were included. The result shows three perspectives which effects the stroke survivor´s lives. These three are physical, psychological and social. The result of this study shows that stroke limits a person’s life in many ways, and has a negative influence on quality of life. Feelings like anxiety are common, and also a fear of having another stroke. Another issue is social isolation, often caused by the physical changes. The physical changes can be dysphagia and paralysis. Support and information is extremely important after a stroke. People who have suffered a stroke often feel fear to go out among other people and often feel like they are a burden to their family and friends. All these things change the person’s quality of life in different ways. Keywords: Stroke, Quality of life and experience / Sammanfattning Syftet med denna studie var att beskriva upplevelsen av livskvalitet hos människor som drabbats av stroke. Detta gjordes genom sökningar i databasen Cinahl och resulterade i att 17 artiklar inkluderades. Resultatet av denna studie visar att en stroke medför många begränsningar för den som drabbas och detta kan påverka deras livskvalitet på ett negativt sätt. Känslor som oro och ångest är vanliga, samt en rädsla att drabbas av en ny stroke. Sociala svårigheter och isolering är ytterligare begränsningar. Den fysiska påfrestningen är otroligt påtaglig vilket ytterligare bidrar till den sociala isoleringen. Dessa fysiska påfrestningar kan till exempel vara dysfagi och förlamning. Stöd och information är oerhört viktigt i efterförloppet av en stroke. Människor som drabbas känner en rädsla för att gå ut bland andra och drar sig lätt undan. De har även en känsla av att alltid vara en börda för sina närstående, vilket leder till att de isolerar sig. Dessa delar sammantaget resulterar i försämrad livskvalitet för de flesta som drabbas, även om det finns undantag.Nyckelord: Stroke, livskvalitet och upplevelse

Bakgrund: Patienter som har haft stroke kan uppleva många hinder för välbefinnande. Sjukdomen i sig kan innebära trötthet, depression och olika funktionshinder. Omgivningen kan öka illabefinnandet om den präglas av fördomar, brister i vården och problem i relationer till anhöriga. Coping innebär att hitta bemästringsstrategier som reducerar stress och illabefinnande. Syftet: Att genom självbiografier beskriva hinder och förutsättningar för coping ur ett livsvärldsperspektiv hos människor som haft en stroke. Metod: En kvalitativ innehållsanalys av självbiografier så som den beskrivs av Granheim &amp; Lundman (2012). Resultat: Fynden sorterades in under två domäner, hinder för coping och förutsättningar för coping. Det som visade sig hindra coping hos den strokedrabbade var ” Brist på följsamhet och bemötande hos personalen”, ”Att kämpa mot sjukdom som omgivning”, ”Att känna skam över sina oförmågor” samt ”Ofrivillig ensamhet och isolation”. Förutsättningar för coping är ”Förmåga till anpassning”, ” Förmåga att hantera känslor och identitet” samt ”God rehabilitering”. Vid behov har kategorierna förtydligats med hjälp av underkategorier. Slutsats: Resultatet visade på att vården kring den strokedrabbade kan bli mer gynnsam om större fokus läggs på patientens livsvärld och utifrån denna förstå vad som är hinder respektive förutsättningar för dennes coping. / Background: Patients who suffered stroke can experience different obstacles for wellbeeing. The illness itself implicates symptoms such as tiredness, depression and various functional limitations. Surroundings can increase the feeling of discomfort when based on prejudices, insufficient care and problems in relations to significant others. Coping concerns finding ways to control different situations in order to reduce stress and discomfort. Aim: To through selfbiographies describe what prevents and promotes coping seen from a lifeworldperspective from individuals who suffered from stroke. Method: Qualitative content analysis of selfbiographies as described in Granheim and Lundman (2012).Result: The findings were sorted in two domains, labeled what prevents and promotes coping. Categories that prevents coping are “Lac of compliance and caring from personnel”, “To struggle against illness and surrounding”, “To feel shame about ones incapacities” and “Unwanted loneliness and isolation”. Categories that promotes coping are “Capacity to adaption”, “Capacity to handle feelings and identity” and “Proper rehabilitation”. These are further described in subcategories. Conclusion: The result indicates that healthcare concerning the patient can be more favorable if the lifeworld of the patient is given more focus and out of that perspective understand what promotes and prevents coping of this individual.