Journal of Rehabilitation Medicine 51-5 | Page 36

J Rehabil Med 2019; 51: 352–360 ORIGINAL REPORT DEVELOPING INTERVENTIONS TO ADDRESS SEXUALITY AFTER STROKE: FINDINGS FROM A FOUR-PANEL MODIFIED DELPHI STUDY Margaret MCGRATH, PhD 1 , Sandra LEVER, MN 3, Annie MCCLUSKEY, PhD 1,4 and Emma POWER, PhD 5,6 From the 1 Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney, 2 Graythwaite Rehabilitation Centre Ryde Hospital, 3 Susan Wakil School of Nursing and Midwifery (Sydney Nursing School), The University of Sydney, 4 The StrokeEd Collaboration, and 5 Graduate School of Health, University of Technology Sydney, 6 Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, Australia Background: Although stroke has a profound im- pact on sexuality there are limited evidence-based interventions to support rehabilitation professionals in this area. The aim of the current research was to prioritize content areas and approaches to sexual rehabilitation from the perspective of stroke survi- vors, their partners, stroke rehabilitation clinicians and researchers. Methods: A 2-step online Delphi method was used to prioritize the content of, and approaches to, sexual rehabilitation with stroke survivors, their partners, stroke rehabilitation clinicians and researchers. Results: Stroke survivors (n  = 30), their partners (n  = 18), clinicians and researchers in stroke reha- bilitation (n  = 45) completed at least 1 of 2 investi- gator-developed surveys. Participants prioritized 18 core content areas for inclusion in sexual rehabili- tation following stroke with a high degree of con- sensus. Another 27 content areas were considered moderately important. There was strong consen- sus that sexual rehabilitation should be offered in the subacute and chronic phases of stroke recovery. Participants would prefer health professionals to de- liver the intervention face-to-face. Conclusion: This study presents opinions from stro- ke survivors, partners of stroke survivors, clinicians and researchers. The information about content, ti- ming and mode of delivery will be used to develop and evaluate a comprehensive sexuality rehabilita- tion programme. Key words: Delphi-technique; sexuality; sexual behaviours; stroke; rehabilitation. Accepted Mar 12; Epub ahead of print Mar 21, 2019 J Rehabil Med 2019; 51: 352–360 Correspondence address: Margaret McGrath, Cumberland Campus C42, The University of Sydney, PO Box 170, Lidcombe, NSW 1825 Australia. E-mail: [email protected] S troke has a profound impact on the ways in which sexuality is experienced and expressed by stroke survivors and their partners. A recent thematic syn- thesis found that, while sexuality is largely silenced by stroke, it nonetheless remains important to stroke survivors and their partners (1). International clini- cal guidelines for stroke rehabilitation propose that sexuality should be included as a core component of LAY ABSTRACT Although stroke often impacts on sexuality there are very limited programmes to provide sexual rehabilita- tion for stroke survivors or their partners. We asked stroke survivors, partners of stroke survivors, reha- bilitation professionals and clinicians to identify what should be included in a sexual rehabilitation programme for stroke survivors, when this programme should be offered, what professionals should be involved in de- livering the programme, and how they should provide the programme. The participants completed 2 online surveys and prioritized 18 core topics to be included in sexual rehabilitation following stroke. There was strong consensus among participants that sexual rehabilitation should be offered in person once the stroke survivor was medically stabilized and throughout rehabilitation. These results will be used to design an intervention to address sexuality after stroke. comprehensive rehabilitation (2–4). However, research consistently shows that health professionals rarely address sexuality during stroke rehabilitation (5–7). For stroke survivors and their partners, failure to address sexuality may result in increased anxiety and depression and poorer quality of life outcomes (8–11). Sexual rehabilitation is effective for people under- going cancer rehabilitation (12, 13), cardiac rehabilita- tion (14) and those living with spinal cord injury (15). However, evidence to support sexual rehabilitation following stroke is less well developed. Only 2 stu- dies have reported interventions to address sexuality after stroke. In South Korea, Song and colleagues (16) developed a 32-page manual, which they used in conjunction with a pre-discharge, nurse-led informa- tion session addressing: (i) the impact of stroke on sexual function; (ii) fear of post-stroke sexual activity; (iii) strategies to reduce sexual dysfunction; and (iv) questions and concerns. A similar programme was delivered in Australia by Sansom and colleagues (17, 18) based on the intervention by Song and colleagues (16) and involving a 30-min consultation by a reha- bilitation physician. While these programmes offer a starting point for professionals interested in sexual rehabilitation, both programmes placed a strong em- phasis on sexual activity as the primary outcome of interest, rather than including broader dimensions of This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2548 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977