Perceptions and experiences of health professionals when supporting adults with stroke to engage in physical activity
A. Pepar A , N. Mahendran A B * , E. Preston A and R. Keegan AA
B
Abstract
Understanding health professional perceptions and experiences when supporting post-stroke physical activity may assist with development of strategies targeting low physical activity observed in this group. The aims of this study were to explore health professionals’ perceptions and experiences of post-stroke physical activity, the barriers they experience and potential facilitators when supporting people with stroke to be active.
Ten focus groups were conducted with 57 health professionals (physiotherapists, occupational therapists, nurses, exercise physiologists, psychologists and sports scientists) and allied health students. Data were analysed via inductive thematic analysis.
Health professionals were reluctant to recommend moderate intensity physical activity. Barriers included: (1) post-stroke barriers being varied and individual; (2) resources being under pressure and (3) physical activity goals falling through the cracks. Suggested facilitators included: (1) clearly defined roles, processes and environments which encourage activity; (2) funding for more staff; (3) improving health professional skills and confidence and (4) using internal motivation and social supports after stroke.
Post-stroke physical activity is a complex goal. Varied and individual barriers require tailored solutions. Health professionals report insufficient time, resources and skills to address these individual barriers as well as limited pathways to access physical activity support. Resource-efficient interventions and care models that allow routine strategies targeting post-stroke physical activity are required.
Keywords: barriers, facilitators, health personnel, perspective, physical activity, qualitative research, secondary prevention, stroke.
References
Alsop T, Woodforde J, Rosbergen I, et al. (2023) Perspectives of health professionals on physical activity and sedentary behaviour in hospitalised adults: a systematic review and thematic synthesis. Clinical Rehabilitation 37(10), 1386-1405.
| Crossref | Google Scholar | PubMed |
Bernhardt J, Dewey HM, Thrift AG, et al. (2004) Inactive and alone: physical activity within the first 14 days of acute stroke unit care. Stroke 35, 1005-1009.
| Crossref | Google Scholar | PubMed |
Bradley EH, Curry LA, Devers KJ (2007) Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Services Research 42(4), 1758-1772.
| Crossref | Google Scholar | PubMed |
Braun V, Clarke V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3(2), 77-101.
| Crossref | Google Scholar |
Caspersen CJ, Powell KE, Christenson GM (1985) Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Reports 100(2), 126-131.
| Google Scholar | PubMed |
Connell LA, McMahon NE, Tyson SF, et al. (2016) Mechanisms of action of an implementation intervention in stroke rehabilitation: a qualitative interview study. BMC Health Services Research 16(1), 534.
| Crossref | Google Scholar | PubMed |
Crisford P, Winzenberg T, Venn A, et al. (2018) Factors associated with physical activity promotion by allied and other non-medical health professionals: a systematic review. Patient Education and Counselling 101(10), 1775-1785.
| Crossref | Google Scholar | PubMed |
Dudley E, Mahendran N, Howes T, et al. (2022) Perspectives of Stroke and Cardiac Clinicians on Cardiac Rehabilitation Post-TIA or Mild Stroke. Journal of Cardiopulmonary Rehabilitation and Prevention 42(5), 377-379.
| Crossref | Google Scholar | PubMed |
English C, Janssen H, Crowfoot G, et al. (2018) Breaking up sitting time after stroke (BUST-stroke). International Journal of Stroke 13(9), 921-931.
| Crossref | Google Scholar | PubMed |
Espernberger KR, Fini NA, Peiris CL (2021) Personal and social factors that influence physical activity levels in community-dwelling stroke survivors: a systematic review of qualitative literature. Clinical Rehabilitation 35(7), 1044-1055.
| Crossref | Google Scholar | PubMed |
Ezeugwu VE, Garga N, Manns PJ (2017) Reducing sedentary behaviour after stroke: perspectives of ambulatory individuals with stroke. Disability and Rehabilitation 39(25), 2551-2558.
| Crossref | Google Scholar | PubMed |
Fini NA, Holland AE, Keating J, et al. (2017) How Physically Active Are People Following Stroke? Systematic Review and Quantitative Synthesis. Physical Therapy 97(7), 707-717.
| Crossref | Google Scholar | PubMed |
Guba EG (1981) Criteria for Assessing the Trustworthiness of Naturalistic Inquiries. Educational Technology Research and Development 29(75), 75-91.
| Crossref | Google Scholar |
Guest G, Bunce A, Johnson L (2006) How Many Interviews Are Enough? Field Methods 18(1), 59-82.
| Crossref | Google Scholar |
Haussmann A, Gabrian M, Ungar N, et al. (2018) What hinders healthcare professionals in promoting physical activity towards cancer patients? The influencing role of healthcare professionals’ concerns, perceived patient characteristics and perceived structural factors. European Journal of Cancer Care 27(4), 12853.
| Crossref | Google Scholar | PubMed |
Hébert ET, Caughy MO, Shuval K (2012) Primary care providers’ perceptions of physical activity counselling in a clinical setting: a systematic review. British Journal of Sports Medicine 46(9), 625-631.
| Crossref | Google Scholar | PubMed |
Howes T, Mahendran N, Freene N (2020) Cardiac Rehabilitation: Are People With Stroke or Transient Ischaemic Attack Being Included? A Cross-Sectional Survey. Heart Lung and Circulation 29(3), 483-490.
| Crossref | Google Scholar | PubMed |
Johnson L, Kramer S, Catanzariti G, et al. (2020) Safety of Performing a Graded Exercise Test Early after Stroke and Transient Ischemic Attack. Physical Medicine and Rehabilitation 12(5), 445-453.
| Crossref | Google Scholar | PubMed |
Kleindorfer DO, Towfighi A, Chaturvedi S, et al. (2021) Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke 52(7), e364-e467.
| Crossref | Google Scholar | PubMed |
Leemrijse CJ, de Bakker DH, Ooms L, et al. (2015) Collaboration of general practitioners and exercise providers in promotion of physical activity a written survey among general practitioners. BMC Family Practice 16, 96.
| Crossref | Google Scholar | PubMed |
Luker J, Lynch E, Bernhardsson S, et al. (2015) Stroke Survivors’ Experiences of Physical Rehabilitation: A Systematic Review of Qualitative Studies. Archives of Physical Medicine and Rehabilitation 96(9), 1698-708.
| Crossref | Google Scholar | PubMed |
Lynch EA, Jones TM, Simpson DB, et al. (2018) Activity monitors for increasing physical activity in adult stroke survivors. The Cochrane Database for Systematic Reviews 27(7), CD012543.
| Crossref | Google Scholar |
Lynch EA, Mackintosh S, Luker J, et al. (2019) Access to rehabilitation for patients with stroke in Australia. The Medical Journal of Australia 210(1), 21-26.
| Crossref | Google Scholar | PubMed |
MacKay-Lyons M, Billinger SA, Eng JJ, et al. (2020) Aerobic Exercise Recommendations to Optimize Best Practices in Care After Stroke: AEROBICS 2019 Update. Physical Therapy 100, 149-156.
| Crossref | Google Scholar | PubMed |
Mahendran N, Kuys SS, Brauer SG (2016a) Recovery of ambulation activity across the first six months post-stroke. Gait and Posture 49, 271-276.
| Crossref | Google Scholar | PubMed |
Mahendran N, Kuys SS, Downie E, Ng P, Brauer SG (2016b) Are accelerometers and GPS devices valid, reliable and feasible tools for measurement of community ambulation after stroke? Brain Impairment 17(2), 151-161.
| Crossref | Google Scholar | PubMed |
Mahendran N, Kuys SS, Brauer SG (2020) Which impairments, activity limitations and personal factors at hospital discharge predict walking activity across the first 6 months poststroke? Disability and Rehabilitation 42(6), 763-769.
| Crossref | Google Scholar | PubMed |
Moore SA, Hrisos N, Flynn D, et al. (2018) How should long-term free-living physical activity be targeted after stroke? A systematic review and narrative synthesis. The International Journal of Behavioural Nutrition and Physical Activity 15(1), 100.
| Crossref | Google Scholar | PubMed |
Morris JH, Macgillivray S, McFarlane S (2014) Interventions to promote long-term participation in physical activity after stroke: a systematic review of the literature. Archives of Physical Medicine Rehabilitation 95(5), 956-967.
| Crossref | Google Scholar | PubMed |
Morris JH, Oliver T, Kroll T, et al. (2015) From physical and functional to continuity with pre-stroke self and participation in valued activities: a qualitative exploration of stroke survivors’, carers’ and physiotherapists’ perceptions of physical activity after stroke. Disability and Rehabilitation 37(1), 64-77.
| Crossref | Google Scholar | PubMed |
Nicholson S, Sniehotta FF, van Wijck F, et al. (2013) A systematic review of perceived barriers and motivators to physical activity after stroke. International Journal of Stroke 8(5), 357-64.
| Crossref | Google Scholar | PubMed |
Parry SM, Knight LD, Connolly B, et al. (2017) Factors influencing physical activity and rehabilitation in survivors of critical illness: a systematic review of quantitative and qualitative studies. Intensive Care Medicine 43(4), 531-542.
| Crossref | Google Scholar | PubMed |
Rosbergen IC, Grimley RS, Hayward KS, et al. (2017) Embedding an enriched environment in an acute stroke unit increases activity in people with stroke: a controlled before-after pilot study. Clinical Rehabilitation 31(11), 1516-1528.
| Crossref | Google Scholar | PubMed |
Saunders DH, Sanderson M, Hayes S, et al. (2020) Physical fitness training for stroke patients. The Cochrane Database for Systematic Reviews 243(3), CD003316.
| Crossref | Google Scholar | PubMed |
Stroke Foundation (2022) ‘Clinical Guidelines for Stroke Management.’ (Melbourne, Vic, Australia) Available at https://informme.org.au/guidelines/living-clinical-guidelines-for-stroke-management
Tong A, Sainsbury P, Craig J (2007) Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care 19(6), 349-357.
| Crossref | Google Scholar | PubMed |
Turan TN, Nizham A, Lynn MJ, et al. (2017) Relationship between risk factor control and vascular events in the SAMMPRIS trial. Neurology 88, 379-385.
| Crossref | Google Scholar | PubMed |
Weed M (2009) Research quality considerations for grounded theory research in sport & exercise psychology. Psychology of Sports and Exercise 10(5), 502-510.
| Crossref | Google Scholar |
Woodhead G, Sivaramakrishnan D, Baker G (2023) Promoting physical activity to patients: a scoping review of the perceptions of doctors in the United Kingdom. Systematic Reviews 12, 104.
| Crossref | Google Scholar | PubMed |