PHYSICAL ACTIVITY INTERVENTIONS AND STROKE. WHAT DO WE KNOW ABOUT TERMINOLOGY, MODE, MEASUREMENT AND THE APPLICATION ACROSS THE STROKE PATHWAY?

C. McFeeters¹, K. Pedlow², N. Kennedy³, H. Colquhoun⁴, S. McDonough⁵

¹Ulster University, Physiotherapy, Health Sciences, Belfast, United Kingdom, ²Ulster University, Physiotherapy, Ulster University, Belfast, United Kingdom, ³Ulster University, Psychology, Ulster University, Belfast, United Kingdom, ⁴University of Toronto, Department of Occupational Science and Occupational Therapy, Toronto, Canada, ⁵Royal College of Surgeons in Ireland, School of Physiotherapy, Dublin, Ireland

Background: Stroke physical activity interventions are not consistently implemented across the entire stroke pathway of care.Most published studies are being carried out as a subset of physical activity; for a specific purpose e.g., improving strength rather than a change in long term lifestyle. The lack of implementation and variation in both reporting of and the terminology used in this evidence warranted further investigation into the content of physical activity interventions.

Purpose: A scoping review of systematic reviews within the area of physical activity and stroke is timely to learn more about these interventions, the terminology and outcome measures used and the key emerging themes from all the reviews that need some consensus building.

Methods: A scoping review was conducted to identify and describe available systematic review evidence on physical activity in the adult stroke population. Retrieval was limited to systematic reviews; within those reviews there were no restrictions on primary study design. Included reviews had been determined to be within the field of physical activity and included adults 18 years or older with a diagnosis of stroke.

Results: There were 50 systematic reviews analysed. 33 of 36 reviews that reported ambulatory status were based on ambulant participants. Of the 50 reviews, only 11 reviews defined physical activity. The average participant was 64 years old, marginally male (ratio 58:42), approximately 22 months post stroke, without cognitive impairment and more likely to be classified as chronic in the stroke pathway of care.The content of interventions is largely based on subsets of physical activity (n=31) where a measurement of physical activity is not consistent. In addition, a description of theories underpinning the interventions was lacking. A wide range of modes of physical activity (n =27) was described within reviews. Physical activity outcome measures were reported in 22 reviews. Physiotherapists were most common actors with a combination range of professions also reported.. Frequency was the most reported dimension of physical activity (n = 42), time/ duration (n =37). The intensity was the least reported dimension of physical activity (n =15). There is a lack of reporting and clarity in defining physical activity (n=11) and intervention dimensions and domains across the stroke pathway (including varying levels of physical capacities) and population demographics.

Conclusions: Defining physical activity, specific to the stroke population, is uncommon and therefore an appropriate definition should be determined which aligns to the various physical capacity levels of the stroke population. Research into clinician knowledge and routine practice of physical activity promotion and its outcomes should be completed in the first instance as a starting point of implementation

Implications: Better reporting of physical activity interventions is required to allow implementation and a clear focus for future research, which should include physical activity outcome measures to measure the effects of different physical activity interventions across the stroke pathway. Determining which physical activity modes of interventions and establishing the physical activity parameters of each intervention would be useful in determining the optimal intervention for stroke survivors with different physical activity capacity levels and at each stage of the stroke pathway.

Funding acknowledgements: The author(s) report there is no funding associated with the work featured in this work

Keywords:
Stroke
Physical activity
Rehabilitation

Topics:
Neurology: stroke
Health promotion & wellbeing/healthy ageing/physical activity
Disability & rehabilitation

Did this work require ethics approval? No

Reason: Since the scoping review methodology was aimed at synthesising information from publicly available publications, this study did not require ethical approval.