T. Levy1, M. Killington2, K. Laver3, N. Lannin4, M. Crotty3, L. Christie5
1Flinders Medical Centre, Flinders University, Flinders Health and Medical Research Institute, Bedford Park, Australia, 2Flinders University, College of Nursing and Health Sciences, Bedford Park, Australia, 3Flinders University, Flinders Health and Medical Research Institute, Bedford Park, Australia, 4Monash University, Department of Neuroscience, Central Clinical School, Melbourne, Australia, 5St Vincent’s Health Network, Allied Health Research Unit, Sydney, Australia
Background: Up to 80% of stroke survivors will experience arm impairment immediately post stroke and less than half will be able to use their affected arm at 6 months. Intensive upper limb exercise programs are recommended within stroke guidelines to optimise recovery, however there has been limited research exploring the experiences of stroke survivors participating in intensive upper limb programs. An understanding of barriers and enablers to adherence to intensive upper limb programs will enable health practitioners to design exercise programs that maximise adherence and effectiveness.
Purpose: To identify barriers and enablers influencing adherence to an intensive upper limb exercise program in people with stroke.
Methods: Qualitative design using semi-structured interviews. Twenty stroke survivors (mean time 8 years post stroke) who had participated in an intensive upper limb rehabilitation program as part of a randomised controlled trial (the InTENSE trial) were interviewed individually to explore their perspectives of participation, including perceived barriers and enablers to upper limb program adherence.
Interviews were audio-recorded, transcribed and imported into Nvivo for analysis. Using deductive coding, themes were mapped to the Capabilities, Opportunities, Motivation- Behaviour (COM-B) behaviour change model to identify barriers and enablers to program adherence and engagement.
Interviews were audio-recorded, transcribed and imported into Nvivo for analysis. Using deductive coding, themes were mapped to the Capabilities, Opportunities, Motivation- Behaviour (COM-B) behaviour change model to identify barriers and enablers to program adherence and engagement.
Results: Enablers influencing adherence included routine practice times (Motivation – automatic), accountability to staff (Motivation – reflective), social support (Opportunity – social) and face to face contact with staff (Opportunity – physical). Barriers to adherence included exercises being too difficult, reliance on others to help, fatigue (Capability – physical) and difficulty ‘fitting it in’ (Motivation – reflective).
Conclusion(s): Findings will inform recommendations for the delivery of intensive upper limb exercise programs to improve adherence, and ultimately assist rehabilitation services to deliver programs that enable self-directed practice by stroke survivors.
Implications: This comprehensive analysis of the perceptions of why this group of adults after stroke undertook a large amount of independent practice provides unique insights into how physiotherapists and occupational therapists could support intensive motor training. Developing exercise programs that target these relevant barriers and enablers will maximise the amount of upper limb rehabilitation practice undertaken, and our findings should be considered when designing research trials and therapy protocols.
Funding, acknowledgements: Nil funding to declare
Keywords: Adherence, Stroke, Intensity
Topic: Neurology: stroke
Did this work require ethics approval? Yes
Institution: Southern Adelaide Local Health Network
Committee: Southern Adelaide Clinical Human Research Committee
Ethics number: 259.15
All authors, affiliations and abstracts have been published as submitted.
