Stroke survivors’ perspectives of factors influencing adherence to an intensive upper limb exercise program.

Levy, T.1 , Laver, K.1 , Killington, M.1 , Crotty, M.1 , Lannin, N.2 , Christie, L.3

1SALHN, SA Health and Flinders University, South Australia, 2Department of Neuroscience, Monash University, Victoria, 3Allied Health Research Unit, St Vincent Health Network, New South Wales

 

Background: Up to 80% of stroke survivors will experience upper limb impairments immediately post stroke and less than half will be able to use their arm at 6 months. Guidelines recommend the use of intensive upper limb exercise programs to optimise recovery, however there has been limited research exploring experiences of stroke survivors participating in intensive programs.

Aim: To identify factors influencing adherence to an intensive upper limb exercise program in people with stroke.

Methods: Qualitative design. Semi structured interviews were conducted with 20 stroke survivors (mean time since stroke = 8.3 years) who had participated in an intensive upper limb rehabilitation program as part of a randomised controlled trial (the InTENSE trial). We explored perspectives of participation, including perceived barriers and enablers to adherence with the program.

Interviews were audio-recorded, transcribed and imported into Nvivo for analysis. Using deductive coding, two authors mapped themes to the Capabilities, Opportunities, Motivation- Behaviour (COM-B) behaviour change model to identify barriers and enablers to exercise 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: Findings will inform recommendations for the delivery of intensive upper limb exercise programs to improve adherence, and ultimately assist services to provide rehabilitation in a manner that enables self-directed practice by stroke survivors.


Tamina Levy

Tamina works as an Advanced Practitioner, Neurological Rehabilitation at Division of Rehabilitation, Aged & Palliative Services (Southern Adelaide LHN) and has over 30 years’ experience in neurological physiotherapy. She completed a Graduate Diploma in Neurology in 1998 and is currently a PhD candidate at Flinders University where she is exploring ‘Exercise Adherence in People with Stroke’. In her clinical leadership role, Tamina has significant experience in implementing and evaluating evidence-based programs and in developing best practice amongst junior practitioners in this field. She has a strong background in stroke rehabilitation and in the management of spasticity after neurological deficit. Tamina has presented research findings from her PhD at numerous conferences and has published papers in two highly ranked journals.

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