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Janssen JC1, Klassen TD2, Connell LA1, Eng JJ2
1University of Central Lancashire, Allied Health Research Unit, Preston, United Kingdom, 2University of British Columbia, Department of Physical Therapy, Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver, Canada
Background: Currently patients only spend a few minutes of a therapy session in recommended aerobic heart zones, despite evidence of benefits of intense exercise rehabilitation in sub-acute stroke rehabilitation. The feasibility of implementing intensive physical therapy sessions is currently being assessed in the Determining Optimal post-Stroke Exercise (DOSE) trial. This trial consists of a graded exercise (stress) test, up to 2 hours/day, 5 days a week of intensive task specific physiotherapy based on aerobic and walking exercise for 4 weeks.
Purpose: To compare the perceptions of therapists and people with stroke in the DOSE trial on intensive exercise rehabilitation in the inpatient sub-acute stroke setting.
Methods: In this qualitative, cross-sectional study, people with stroke and their therapists were interviewed. The semi-structured interview guide was developed using implementation frameworks and interviews were transcribed verbatim. Two physiotherapist researchers analysed the transcripts using the Consolidated Framework of Implementation Research (CFIR), consisting of Individual, Intervention, Inner Setting, and Outer Setting factors. Factors emerging from people with stroke were compared and contrasted to factors from therapists.
Results: Fifteen therapists and ten people with stroke consented to be interviewed. The four main factors of the CFIR framework are listed below.
- Individuals: Patients believed their improvements in function were partly due to additional exercises and were happy to work hard. Therapists did see the benefits of the intervention, but were conflicted as there was limited room to enhance quality of movement. Therapists felt more confident in pushing people harder after the graded exercise test.
- Intervention: For the therapists, the intervention consisted of an evidence-based intervention including a graded exercise (stress) test, up to 2 hours/day intensive task-specific physiotherapy for 4 weeks, and monitoring devices, such as heart rate monitors and step counters. The patients saw the intervention more holistically and talked about the benefits of having supportive, motivated therapists assisting with their recovery for up to 2 hours a day.
- Inner setting: Patients had limited insight into the hospital setting and overall did not perceive any issues. Therapists on the other hand expressed concerns regarding staffing, resources and logistic issues.
- Outer setting: Therapists felt supported by the Canadian guidelines for stroke, which states that a graded exercises test should be undertaken in people with stroke, however questioned the likelihood of it being implemented. Patients' outer setting mainly consisted of their family and friends support.
Conclusion(s): Therapists' benefits of being involved in the DOSE trial consisted of improved confidence in pushing patients harder due to the graded exercise test, while people with stroke saw improvement in their function. Defining the intervention was more complicated as therapists perceived the intervention in technical terms, while patients viewed the intervention more holistically. Therapists were concerned about resources and staffing levels for further implementation.
Implications: If intensive physical therapy sessions are going to be implemented in daily inpatient rehabilitation stroke settings, factors such as resources (graded exercises test), staffing levels and perception of the intervention need to be taken into account.
Keywords: stroke, physical therapy, intensive therapy
Funding acknowledgements: Canada Research Chair Program, Canadian Institutes of Health Research, and Heart and Stroke Foundation Canadian Partnership for Stroke Recovery.
Purpose: To compare the perceptions of therapists and people with stroke in the DOSE trial on intensive exercise rehabilitation in the inpatient sub-acute stroke setting.
Methods: In this qualitative, cross-sectional study, people with stroke and their therapists were interviewed. The semi-structured interview guide was developed using implementation frameworks and interviews were transcribed verbatim. Two physiotherapist researchers analysed the transcripts using the Consolidated Framework of Implementation Research (CFIR), consisting of Individual, Intervention, Inner Setting, and Outer Setting factors. Factors emerging from people with stroke were compared and contrasted to factors from therapists.
Results: Fifteen therapists and ten people with stroke consented to be interviewed. The four main factors of the CFIR framework are listed below.
- Individuals: Patients believed their improvements in function were partly due to additional exercises and were happy to work hard. Therapists did see the benefits of the intervention, but were conflicted as there was limited room to enhance quality of movement. Therapists felt more confident in pushing people harder after the graded exercise test.
- Intervention: For the therapists, the intervention consisted of an evidence-based intervention including a graded exercise (stress) test, up to 2 hours/day intensive task-specific physiotherapy for 4 weeks, and monitoring devices, such as heart rate monitors and step counters. The patients saw the intervention more holistically and talked about the benefits of having supportive, motivated therapists assisting with their recovery for up to 2 hours a day.
- Inner setting: Patients had limited insight into the hospital setting and overall did not perceive any issues. Therapists on the other hand expressed concerns regarding staffing, resources and logistic issues.
- Outer setting: Therapists felt supported by the Canadian guidelines for stroke, which states that a graded exercises test should be undertaken in people with stroke, however questioned the likelihood of it being implemented. Patients' outer setting mainly consisted of their family and friends support.
Conclusion(s): Therapists' benefits of being involved in the DOSE trial consisted of improved confidence in pushing patients harder due to the graded exercise test, while people with stroke saw improvement in their function. Defining the intervention was more complicated as therapists perceived the intervention in technical terms, while patients viewed the intervention more holistically. Therapists were concerned about resources and staffing levels for further implementation.
Implications: If intensive physical therapy sessions are going to be implemented in daily inpatient rehabilitation stroke settings, factors such as resources (graded exercises test), staffing levels and perception of the intervention need to be taken into account.
Keywords: stroke, physical therapy, intensive therapy
Funding acknowledgements: Canada Research Chair Program, Canadian Institutes of Health Research, and Heart and Stroke Foundation Canadian Partnership for Stroke Recovery.
Topic: Neurology: stroke; Professional practice: other
Ethics approval required: Yes
Institution: University of British Columbia (UBC), University of Central Lancashire (UCLan)
Ethics committee: UBC Behavioral Research Ethics Board, UCLan STEMH Board
Ethics number: H16–0,2449, STEMH 560
All authors, affiliations and abstracts have been published as submitted.
