WEWALK: WALKING WITH A BUDDY AFTER STROKE. A PILOT STUDY OF A PERSON-CENTRED DYADIC BEHAVIOUR CHANGE INTERVENTION USING QUALITATIVE EVALUATION

J. Morris¹, L. Irvine¹, S. Dombrowski², T. Tooman¹, B. McCormack³, F. Van Wijck⁴, M. Lawrence⁴

¹University of Dundee, School of Health Sciences, Dundee, United Kingdom, ²University of New Brunswick, Kinesiology, Frederiction, Canada, ³University of Sydney, School of Nursing and Midwifery, Sydney, Australia, ⁴Glasgow Caledonian University, School of Health Sciences, Glasgow, United Kingdom

Background: Stroke survivors spend >80% of waking hours sedentary, even when they have physical capacity to be physically active. Qualitative studies show walking is valued as physical activity (PA) by stroke survivors, however finding effective ways to promote and maintain post-stroke walking have not been extensively explored. Developing novel and effective ways to promote PA in stroke survivors in their communities is a priority. Social support can influence the uptake and maintenance of PA. Dyadic interventions involve two people working together to support behaviour change of one or both dyad members. With stroke survivors, their families and rehabilitation professionals, we co-designed a novel, theoretically based, person-centred 12-week dyadic behaviour change intervention called WeWalk where stroke survivors work with a walking buddy to achieve outdoor walking as a regular form of PA.

Purpose: This pilot study aimed to: examine the feasibility of recruiting dyads; explore participants’ experiences using WeWalk, including their perceptions of acceptability; and identify potential refinements before progressing to a clinical trial.

Methods: Design: A single-arm observational pilot study with qualitative evaluation. Participants: Community-dwelling ambulatory stroke survivors. Intervention: WeWalk involved facilitated face-to-face and telephone sessions over 12 weeks, supported by intervention handbooks. Dyads agreed personally relevant walking goals and plans, monitored progress and developed strategies for increasing and maintaining walking. They completed diaries to record goals, plans and progress. Evaluation: Descriptive data on recruitment and retention were collected and diaries were reviewed. Interview data examining acceptability were collected through semi-structured interviews and analysed using thematic analysis, guided by a theoretical framework of acceptability.

Results: We recruited 21 dyads comprising 15 male and six female community-dwelling stroke survivors and their walking buddies, who were either family members (n=17) or volunteers (n=4). Median(range) values for stroke survivor age was 62.5 (43, 82); for months post-stroke was 12 (1,84) and for Rivermead Mobility Index Score was 12 (4,15). Ten dyads fully completed WeWalk before UK government-imposed COVID-19 lockdown. Despite lockdown, 18 dyads completed exit interviews. We identified three themes: acceptability evolves with experience; mutuality; and person-centred adaptability. As dyads recognised how WeWalk components supported walking, perceptions of acceptability grew. Effort receded as goals and enjoyment of walking together were realised. The dyadic structure provided accountability, and participants’ confidence developed as they experienced physical and psychological benefits of walking. Diaries illustrated that most dyads engaged with WeWalk and reported benefits including enhanced confidence, stamina, wellbeing and social interaction. WeWalk worked best when dyads exhibited relational connectivity and mutuality in setting and achieving goals. Adapting intervention components to their individual circumstances and values supported dyads in participation and achieving meaningful goals.

Conclusions: Notwithstanding Covid-19 lockdown, recruiting dyads was feasible and most dyads engaged with WeWalk. Participants viewed the dyadic structure and intervention components as acceptable for promoting outdoor walking and valued the personally-tailored nature of WeWalk.

Implications: WeWalk is a novel intervention that aligns with physiotherapy aims for PA promotion during and after rehabilitation. Future research will test effectiveness in increasing PA and explore optimal delivery and training strategies for practitioners and walking buddies.

Funding acknowledgements: Chief Scientist Office, Scottish Government. Grant number HIPS-17-03

Keywords:
Stroke
Physical Activity Promotion
Walking

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

Did this work require ethics approval? Yes

Institution: North of Scotland Research Ethics Service

Committee: Ethics Committee 2

Ethics number: 19/NS/0077