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Marriage after the transition to stroke: a systematic review

Published online by Cambridge University Press:  19 June 2017

SHARON ANDERSON  and
NORAH KEATING
SHARON ANDERSON*
Affiliation:
Department of Human Ecology, University of Alberta, Edmonton, Canada.
NORAH KEATING
Affiliation:
College of Human Sciences & Health Sciences, Swansea University, UK.
*
Address for correspondence: Sharon Anderson, Department of Human Ecology, University of Alberta, 302 Human Ecology Building, Edmonton, AB Canada T6 G 2N1 E-mail: sdanders@ualberta.ca
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Abstract

In health and chronic illness, satisfying marriages promote wellbeing and life satisfaction, yet stroke research has focused on either the stroke survivor as the patient or the spouse as a care-giver. Using Pope, Mays and Popay's framework for synthesising qualitative and quantitative methods, we conducted a systematic review and synthesis of 39 peer-reviewed studies to determine what happens to marital relationships after one partner has suffered a stroke. All the articles examined the impact of stroke. Three overarching themes characterise the evolution of marriage after stroke: chaos in the marriage, work to re-establish the marriage and evolution of the marriages. While both the stroke condition itself and the survivors’ need for care undermined the emotional qualities of the relationship for some couples, about two-thirds were able to retain or regain the relationship closeness. As in other chronic illnesses, the relationship closeness and a couple's ability to collaborate contributed to the survivor's recovery and to the satisfaction with life of the stroke survivor and the spouse. Our results underscore the need to consider the quality of, and the qualities of, the relationship between stroke survivors and their spouses. Future research could include a greater focus on qualitative or mixed-methods approaches to explore the interactions between stroke survivors and spouses that impact the wellbeing of both partners.

Keywords

marriagestrokereviewinterpersonal relations
Type
Article
Information
Ageing & Society , Volume 38 , Issue 11 , November 2018 , pp. 2241 - 2279
Copyright
Copyright © Cambridge University Press 2017 

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References

*†Achten, D., Visser-Meily, J. M. A., Post, M. W. M. and Schepers, V. P. M. 2012. Life satisfaction of couples 3 years after stroke. Disability and Rehabilitation, 34, 17, 1468–72.Google Scholar
Aizer, A. A., Chen, M. H., McCarthy, E. P., Mendu, M. L., Koo, S., Wilhite, T. J., Graham, P. L., Choueiri, T. K., Hoffman, K. E., Martin, N. E., Hu, J. C. and Nguyen, P. L. 2013. Marital status and survival in patients with cancer. Journal of Clinical Oncology, 31, 31, 3869–76.Google Scholar
*Backstrom, B., Asplund, K. and Sundin, K. 2010. The meaning of middle-aged female spouses’ lived experience of the relationship with a partner who has suffered a stroke, during the first year postdischarge. Nursing Inquiry, 17, 3, 257–68.Google Scholar
Badr, H. and Krebs, P. 2013. A systematic review and meta-analysis of psychosocial interventions for couples coping with cancer. Psycho-Oncology, 22, 8, 1688–704.Google Scholar
Bakas, T., Clark, P. C., Kelly-Hayes, M., King, R. B., Lutz, B. J. and Miller, E. L. 2014. Evidence for stroke family caregiver and dyad interventions: a statement for healthcare professionals from the American Heart Association and American Stroke Association. Stroke, 45, 9, 2836–52.Google Scholar
*Banks, P. and Pearson, C. 2004. Parallel lives: younger stroke survivors and their partners coping with crisis. Sexual and Relationship Therapy, 19, 4, 413–29.Google Scholar
Beard, R. L., Sakhtah, S., Imse, V. and Galvin, J. E. 2012. Negotiating the joint career: couples adapting to Alzheimer's and aging in place. Journal of Aging Research, 2012, 797023, 1–12.Google Scholar
Berg, C. A. and Upchurch, R. 2007. A developmental–contextual model of couples coping with chronic illness across the adult life span. Psychological Bulletin, 133, 6, 920–54.Google Scholar
Bookwala, J. 2012. Marriage and other partnered relationships in middle and late adulthood. In Blieszner, R. H. B. V. (ed.), Handbook of Families and Aging. Praeger, Santa Barbara, California, 91–123.Google Scholar
*Brann, M., Himes, K. L., Dillow, M. R. and Weber, K. 2010. Dialectical tensions in stroke survivor relationships. Health Communication, 25, 4, 323–32.Google Scholar
*Buschenfeld, K., Morris, R. and Lockwood, S. 2009. The experience of partners of young stroke survivors. Disability and Rehabilitation, 31, 20, 1643–51.Google Scholar
Cameron, J. I., Czerwonka, A., Naglie, G., Gignac, M. A. M., Green, T., Warner, G., Bayley, M., Cheung, A., Phillips, S., Silver, F. and Huijbregts, M. 2013. Identifying family caregivers at risk during the acute stroke phase. Cerebrovascular Diseases, 35, 200.Google Scholar
Cameron, J. I., Naglie, G., Gignac, M. A. M., Bayley, M., Warner, G., Green, T., Czerwonka, A., Huijbregts, M., Silver, F. L., Phillips, S. J. and Cheung, A. M. 2014. Randomized clinical trial of the Timing it Right stroke family support program: research protocol. BMC Health Services Research, 14, 18.Google Scholar
*†Carlsson, G. E., Forsberg-Warleby, G., Moller, A. and Blomstrand, C. 2007. Comparison of life satisfaction within couples one year after a partner's stroke. Journal of Rehabilitation Medicine, 39, 3, 219–24.Google Scholar
Clark-Polner, E. and Clark, M. S. 2014. Understanding and accounting for relational context is critical for social neuroscience. Frontiers in Human Neuroscience, 8, 127.Google Scholar
*Coombs, U. E. 2007. Spousal caregiving for stroke survivors. Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses, 39, 2, 112–9.Google Scholar
Dalteg, T., Benzein, E., Fridlund, B. and Malm, D. 2011. Cardiac disease and its consequences on the partner relationship: a systematic review. European Journal of Cardiovascular Nursing, 10, 3, 140–9.Google Scholar
*DeLaune, M. and Brown, S. C. 2001. Spousal responses to role changes following a stroke. MEDSURG Nursing, 10, 2, 79–88.Google Scholar
Demiray, B. and Bluck, S. 2014. Time since birth and time left to live: opposing forces in constructing psychological wellbeing. Ageing & Society, 34, 7, 1193–218.Google Scholar
Dixon-Woods, M., Sutton, A., Shaw, R., Miller, T., Smith, J., Young, B., Bonas, S., Booth, A. and Jones, D. 2007. Appraising qualitative research for inclusion in systematic reviews: a quantitative and qualitative comparison of three methods. Journal of Health Services Research and Policy, 12, 1, 42–7.Google Scholar
*Enterlante, T. M. and Kern, J. M. 1995. Wives’ reported role changes following a husband's stroke: a pilot study. Rehabilitation Nursing: The Official Journal of the Association of Rehabilitation Nurses, 20, 3, 155–60.Google Scholar
*Erikson, A., Park, M. and Tham, K. 2010. Belonging: a qualitative, longitudinal study of what matters for persons after stroke during one year of rehabilitation. Journal of Rehabilitation Medicine, 42, 9, 831–8.Google Scholar
Feigin, V. L., Forouszanfarm, M. H., Krishnamurthi, R., Mensha, G. A., Connors, M., Bennet, D. A., Moran, A. E., Sacco, R. L., Anderson, L., Truelsen, T., O'Donnell, M., Venketasubramanian, N., Barker-Collo, S., Lawes, C. M. M., Wang, W., Shinohara, T., Witt, E., Ezzati, M., Naghavi, M. and Murray, C. 2014. Global and regional burden of stroke during 1990–2010: findings from the global burden of disease study 2010. The Lancet, 383, 9913, 245–55.Google Scholar
*†Forsberg-Warleby, G., Moller, A. and Blomstrand, C. 2004. Life satisfaction in spouses of patients with stroke during the first year after stroke. Journal of Rehabilitation Medicine, 36, 1, 4–11.Google Scholar
Gaugler, J. E. 2010. The longitudinal ramifications of stroke caregiving: a systematic review. Rehabilitation Psychology, 55, 2, 108–25.Google Scholar
*Giaquinto, S., Buzzelli, S., Di Francesco, L. and Nolfe, G. 2003. Evaluation of sexual changes after stroke. Journal of Clinical Psychiatry, 64, 3, 302–7.Google Scholar
Go, A. S., Mozaffarian, D., Roger, V. L., Benjamin, E. J., Berry, J. D., Blaha, M. J., Dai, S. F., Ford, E. S., Fox, C. S., Franco, S., Fullerton, H. J., Gillespie, C., Hailpern, S. M., Heit, J. A., Howard, V. J., Huffman, M. D., Judd, S. E., Kissela, B. M., Kittner, S. J., Lackland, D. T., Lichtman, J. H., Lisabeth, L. D., Mackey, R. H., Magid, D. J., Marcus, G. M., Marelli, A., Matchar, D. B., McGuire, D. K., Mohler, E. R., Moy, C. S., Mussolino, M. E., Neumar, R. W., Nichol, G., Pandey, D. K., Paynter, N. P., Reeves, M. J., Sorlie, P. D., Stein, J., Towfighi, A., Turan, T. N., Virani, S. S., Wong, N. D., Woo, D., Turner, M. B., American Heart Association Statistics Committee and Stroke Statistics Subcommittee. 2014. Heart disease and stroke statistics – 2014 update: a report from the American Heart Association. Circulation, 129, 3, E28–292.Google Scholar
*†Godwin, K. M., Ostwald, S. K., Cron, S. G. and Wasserman, J. 2013 a. Long-term health-related quality of life of stroke survivors and their spousal caregivers. Journal of Neuroscience Nursing, 45, 3, 147–54.Google Scholar
*†Godwin, K. M., Swank, P. R., Vaeth, P. and Ostwald, S. K. 2013 b. The longitudinal and dyadic effects of mutuality on perceived stress for stroke survivors and their spousal caregivers. Aging & Mental Health, 17, 4, 423–31.Google Scholar
Goldman, D. P., Cutler, D., Rowe, J. W., Michaud, P. C., Sullivan, J., Peneva, D. and Olshansky, S. J. 2013. Substantial health and economic returns from delayed aging may warrant a new focus for medical research. Health Affairs, 32, 10, 1698–705.Google Scholar
Goodin, D. S. and Reder, A. T. 2012. Evidence-based medicine: promise and pitfalls. Multiple Sclerosis Journal, 18, 7, 947–8.Google Scholar
*†Green, T. L. and King, K. M. 2009. Experiences of male patients and wife-caregivers in the first year post-discharge following minor stroke: a descriptive qualitative study. International Journal of Nursing Studies, 46, 9, 1194–200.Google Scholar
*†Green, T. L. and King, K. M. 2010. Functional and psychosocial outcomes 1 year after mild stroke. Journal of Stroke & Cerebrovascular Diseases, 19, 1, 10–16.Google Scholar
*†Green, T. L. and King, K. M. 2011. Relationships between biophysical and psychosocial outcomes following minor stroke. Canadian Journal of Neuroscience Nursing, 33, 2, 15–23.Google Scholar
Greenhalgh, T. and Peacock, R. 2005. Effectiveness and efficiency of search methods in systematic reviews of complex evidence: audit of primary sources. British Medical Journal, 331, 7524, 1064–65.Google Scholar
Hackett, M. L., Glozier, N., Jan, S. and Lindley, R. 2012. Returning to paid employment after stroke: the Psychosocial Outcomes in Stroke (POISE) cohort study. PLOS ONE, 7, 7.Google Scholar
Hackett, M. L. and Pickles, K. 2014. Part I: frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies. International Journal of Stroke, 9, 8, 1017–25.Google Scholar
Haley, W. E., Roth, D. L., Hovater, M. and Clay, O. J. 2015. Long-term impact of stroke on family caregiver well-being: a population-based case-control study. Neurology, 84, 13, 1323–29.Google Scholar
Hall, R. K. F., Khan, F., Levi, J., Zhou, L., Lumsden, J., Martin, C., Morrison, K., Moore, P., Kelloway, L., Kapral, M. K., O'Callaghan, C., Bayley, M. and Linkewich, B. 2015. Ontario and LHIN 2014/15 Stroke Report Cards and Progress Reports: Active Knowledge Exchange to Drive System Integration and Stroke Best Practices. Institute for Clinical Evaluative Sciences, Toronto. Available online at http://ontariostrokenetwork.ca/wp-content/uploads/2014/06/OSN_Stroke_Report_Card_2016.pdf?x88896 [Accessed 12 June 2016].Google Scholar
Holt-Lunstad, J., Smith, T. B. and Layton, J. B. 2010. Social relationships and mortality risk: a meta-analytic review. PLOS Medicine, 7, 7.Google Scholar
Huang, L., Cronin, K. A., Johnson, K. A., Mariotto, A. B. and Feuer, E. J. 2008. Improved survival time: what can survival cure models tell us about population-based survival improvements in late-stage colorectal, ovarian, and testicular cancer? Cancer, 112, 10, 2289–300.Google Scholar
Jacobs, S., Xie, C., Reilly, S., Hughes, J. and Challis, D. 2009. Modernising social care services for older people: scoping the United Kingdom evidence base. Ageing & Society, 29, 4, 497–538.Google Scholar
Karraker, A. and Latham, K. 2015. In sickness and in health? Physical illness as a risk factor for marital dissolution in later life. Journal of Health and Social Behavior, 56, 3, 420–35.Google Scholar
King, K. B. and Reis, H. T. 2012. Marriage and long-term survival after coronary artery bypass grafting. Health Psychology, 31, 1, 55–62.Google Scholar
Kinsella, K., Beard, J. and Suzman, R. 2013. Can populations age better, not just live longer? Generations, 37, 1, 19–26.Google Scholar
*†Kitzmuller, G., Asplund, K. and Haggstrom, T. 2012. The long-term experience of family life after stroke. Journal of Neuroscience Nursing, 44, 1, E1–13.Google Scholar
*†Kitzmuller, G. and Ervik, B. 2015. Female spouses’ perceptions of the sexual relationship with stroke-affected partners. Sexuality and Disability 33, 4 , 499–512.Google Scholar
*†Kitzmüller, G., Häggström, T., Asplund, K. and Gilje, F. 2012. The existential meaning of couples’ long-term experience of living with stroke. Illness, Crisis and Loss, 20, 4, 339–62.Google Scholar
*Korpelainen, J. T., Nieminen, P. and Myllyla, V. V. 1999. Sexual functioning among stroke patients and their spouses. Stroke: A Journal of Cerebral Circulation, 30, 4, 715–9.Google Scholar
Kravdal, H. and Syse, A. 2011. Changes over time on the effect of marital status on cancer survival. BMC Public Health, 11, 804.Google Scholar
Krueger, H., Koot, J., Hall, R. E., O'Callaghan, C., Bayley, M. and Corbett, D. 2015. Prevalence of individuals experiencing the effects of stroke in Canada: trends and projections. Stroke: A Journal of Cerebral Circulation, 46, 8, 2226–31.Google Scholar
*Lapkiewicz, E., Grochmal-Bach, B., Pufal, A. and Tlokinski, W. 2008. Aphasia and changes in the quality of marital relations. Acta Neuropsychologica, 6, 3, 237–46.Google Scholar
*Lemieux, L., Cohen-Schneider, R. and Holzapfel, S. 2002. Aphasia and sexuality. Sexuality and Disability, 19, 4, 253–65.Google Scholar
Lutz, B. J. and Young, M. E. 2010. Rethinking intervention strategies in stroke family caregiving. Rehabilitation Nursing, 35, 4, 152–60.Google Scholar
Mancini, A. D. and Bonanno, G. A. 2006. Marital closeness, functional disability, and adjustment in late life. Psychology and Aging, 21, 3, 600–10.Google Scholar
Martin, S. C. 2016. Relational issues within couples coping with Parkinson's disease: implications and ideas for family-focused care. Journal of Family Nursing, 22, 2, 224–51.Google Scholar
Mayo, N. E., Wood-Dauphinee, S., Carlton, R., Durcan, L. and Carlton, J. 2002. Activity, participation, and quality of life 6 months poststroke. Archives of Physical Medicine and Rehabilitation, 83, 8, 1035–42.Google Scholar
*†McCarthy, M. J. and Bauer, E. 2015. In sickness and in health: couples coping with stroke across the life span. Health & Social Work, 40, 3, E92–100.Google Scholar
McCarthy, M. J., Lyons, K. S. and Powers, L. E. 2011. Expanding poststroke depression research: movement toward a dyadic perspective. Topics in Stroke Rehabilitation, 18, 5, 450–60.Google Scholar
*†McCarthy, M. J., Lyons, K. S. and Powers, L. E. 2012. Relational factors associated with depressive symptoms among stroke survivor–spouse dyads. Journal of Family Social Work, 15, 4, 303–20.Google Scholar
McGovern, J. 2011. Couple meaning-making and dementia: challenges to the deficit model. Journal of Gerontological Social Work, 54, 7, 678–90.Google Scholar
*†McPherson, C. J., Wilson, K. G., Chyurlia, L. and Leclerc, C. 2010. The balance of give and take in caregiver–partner relationships: an examination of self-perceived burden, relationship equity, and quality of life from the perspective of care recipients following stroke. Rehabilitation Psychology, 55, 2, 194–203.Google Scholar
*†McPherson, C. J., Wilson, K. G., Chyurlia, L. and Leclerc, C. 2011. The caregiving relationship and quality of life among partners of stroke survivors: a cross-sectional study. Health and Quality of Life Outcomes, 9, 29.Google Scholar
Mortimer, D. and Segal, L. 2008. Is the value of a life or life-year saved context specific? Further evidence from a discrete choice experiment. Cost Effectiveness and Resource Allocation, 6, 8.Google Scholar
Murray, S. L. and Holmes, J. G. 2011. Interdependent Minds: The Dynamics of Close Relationships. The Guilford Press, New York.Google Scholar
Ostwald, S. K. 2008. Predictors of life satisfaction among stroke survivors and spousal caregivers: a narrative review. Aging Health, 4, 3, 241–52.Google Scholar
*†Ostwald, S. K., Bernal, M. P., Cron, S. G. and Godwin, K. M. 2009. Stress experienced by stroke survivors and spousal caregivers during the first year after discharge from inpatient rehabilitation. Topics in Stroke Rehabilitation, 16, 2, 93–104.Google Scholar
*†Ostwald, S. K., Godwin, K. M. and Cron, S. G. 2009. Predictors of life satisfaction in stroke survivors and spousal caregivers after inpatient rehabilitation … with commentary by Bays CL. Rehabilitation Nursing, 34, 4, 160–74.Google Scholar
Palmer, S. and Glass, T. A. 2003. Family function and stroke recovery: a review. Rehabilitation Psychology, 48, 4, 255–65.Google Scholar
Pearson, A., White, H., Bath-Hextall, F., Salmond, S., Apostolo, J. and Kirkpatrick, P. 2015. A mixed-methods approach to systematic reviews. International Journal of Evidence-based Healthcare, 13, 3, 121–31.Google Scholar
Pietromonaco, P. R., Uchino, B. and Schetter, C. D. 2013. Close relationship processes and health: implications of attachment theory for health and disease. Health Psychology, 32, 5, 499–13.Google Scholar
Pluye, P. 2013. Critical appraisal tools for assessing the methodological quality of qualitative, quantitative and mixed methods studies included in systematic mixed studies reviews. Journal of Evaluation in Clinical Practice, 19, 4, 722.Google Scholar
Pluye, P. and Hong, Q. N. 2014. Combining the power of stories and the power of numbers: mixed methods research and mixed studies reviews. Annual Review of Public Health, 35, 29–45.Google Scholar
Pope, C., Mays, N. and Popay, J. 2007. Synthesizing Qualitative and Quantitative Evidence: A Guide to Methods. McGraw-Hill, Maidenhead, UK.Google Scholar
Quinn, K., Murray, C. and Malone, C. 2014 a. Spousal experiences of coping with and adapting to caregiving for a partner who has a stroke: a meta-synthesis of qualitative research. Disability and Rehabilitation, 36, 3, 185–98.Google Scholar
*†Quinn, K., Murray, C. D. and Malone, C. 2014 b. The experience of couples when one partner has a stroke at a young age: an interpretative phenomenological analysis. Disability and Rehabilitation, 36, 20, 1670–8.Google Scholar
*†Radcliffe, E., Lowton, K. and Morgan, M. 2013. Co-construction of chronic illness narratives by older stroke survivors and their spouses. Sociology of Health and Illness, 35, 7, 993–1007.Google Scholar
*†Robinson-Smith, G. and Mahoney, C. 1995. Coping and marital equilibrium after stroke. Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses, 27, 2, 83–9.Google Scholar
Robles, T. F., Slatcher, R. B., Trombello, J. M. and McGinn, M. M. 2014. Marital quality and health: a meta-analytic review. Psychological Bulletin, 140, 1, 140–87.Google Scholar
Rohrbaugh, M. J., Shoham, V., Cleary, A. A., Berman, J. S. and Ewy, G. A. 2009. Health consequences of partner distress in couples coping with heart failure. Heart and Lung: Journal of Acute and Critical Care, 38, 4, 298–305.Google Scholar
Salter, K., Hellings, C., Foley, N. and Teasell, R. 2008. The experience of living with stroke: a qualitative meta-synthesis. Journal of Rehabilitation Medicine, 40, 8, 595–602.Google Scholar
Salter, K., Zettler, L., Foley, N. and Teasell, R. 2010. Impact of caring for individuals with stroke on perceived physical health of informal caregivers. Disability and Rehabilitation, 32, 4, 273–81.Google Scholar
Satink, T., Cup, E. H., Ilott, I., Prins, J., De Swart, B. J. and Nijhuis-Van Der Sanden, M. W. 2013. Patients’ views on the impact of stroke on their roles and self: a thematic synthesis of qualitative studies. Archives of Physical Medicine and Rehabilitation, 94, 6, 1171–83.Google Scholar
*Schmitz, M. A. and Finkelstein, M. 2010. Grand rounds. Perspectives on poststroke sexual issues and rehabilitation needs. Topics in Stroke Rehabilitation, 17, 3, 204–13.Google Scholar
Spittlehouse, C., Acton, M. and Enock, K. 2000. Introducing critical appraisal skills training in UK social services: another link between health and social care? Journal of Interprofessional Care, 14, 4, 397–404.Google Scholar
Tanji, H., Anderson, K. E., Gruber-Baldini, A. L., Fishman, P. S., Reich, S. G., Weiner, W. J. and Shulman, L. M. 2008. Mutuality of the marital relationship in Parkinson's disease. Movement Disorders, 23, 13, 1843–9.Google Scholar
Teasell, R., Hussein, N., McClure, A. and Meyer, M. 2014. Stroke: more than a ‘brain attack’. International Journal of Stroke, 9, 2, 188–90.Google Scholar
*Tellier, M., Rochette, A. and Lefebvre, H. 2011. Impact of mild stroke on the quality of life of spouses. International Journal of Rehabilitation Research, 34, 3, 209–14.Google Scholar
*Thompson, H. S. and Ryan, A. 2009. The impact of stroke consequences on spousal relationships from the perspective of the person with stroke. Journal of Clinical Nursing, 18, 12, 1803–11.Google Scholar
Traa, M. J., De Vries, J., Bodenmann, G. and Den Oudsten, B. L. 2015. Dyadic coping and relationship functioning in couples coping with cancer: a systematic review. British Journal of Health Psychology, 20, 1, 85–114.Google Scholar
*Trygged, S., Hedlund, E. and Kåreholt, I. 2011. Education and poststroke separation among couples with mutual children. Journal of Divorce and Remarriage, 52, 6, 401–14.Google Scholar
*Van Nes, F., Runge, V. and Jonsson, H. 2009. One body, three hands and two minds: a case study of the intertwined occupations of an older couple after a stroke. Journal of Occupational Science, 16, 3, 194–202.Google Scholar
*†Visser-Meily, A., Post, M., van de Port, I., Maas, C., Forstberg-Warleby, G. and Lindeman, E. 2009. Psychosocial functioning of spouses of patients with stroke from initial inpatient rehabilitation to 3 years poststroke: course and relations with coping strategies. Stroke: A Journal of Cerebral Circulation, 40, 4, 1399–404.Google Scholar
*Yilmaz, S. D., Gumus, H. and Yilmaz, H. 2015. Sexual life of poststroke women with mild or no disability: a qualitative study. Journal of Sex & Marital Therapy, 41, 2, 145–54.Google Scholar