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

Abstract

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. 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. 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: <b>Personal Determinants: Person with stroke:</b> perceived advantage and disadvantage (of knowledge of health condition), apathy, low self-efficacy, limited skills and knowledge <b>Family carers and supporters:</b> negative attitude and self-efficacy, lack of skills and knowledge,; <b>Professionals and paid carers:</b> low awareness of services and knowledge. For <b>Environmental Factors:</b> lack of support for management was identified as a priority. The resulting Logic-Model of the problem will enable development of evidence-based pathways to prevent and treat contracture.