Abstract

Background
Despite increasing evidence on intensive task-specific practice and aerobic exercise in stroke rehabilitation, implementation remains difficult. The factors influencing implementation have been explored from therapists’ perspectives; however, despite an increased emphasis on patient involvement in research, patients’ perceptions have not yet been investigated.
Objective
The study aimed to investigate factors influencing implementation of higher intensity activity in people with stroke and to compare this with therapists’ perspectives.
Design
The design was a cross-sectional qualitative study.
Methods
The study used semi-structured interviews with people with stroke who were part of a randomized clinical trial, the Determining Optimal post-Stroke Exercise (DOSE) study, which delivered a higher intensity intervention. An interview guide was developed and data analyzed using implementation frameworks. Factors emerging from people with stroke were compared and contrasted to factors perceived by rehabilitation therapists.
Results
Ten people with stroke were interviewed before data saturation was reached. Participants had a positive attitude regarding working hard, and were satisfied with the graded exercise test, high intensity intervention, and the feedback monitoring devices. Therapists and patients had contrasting perceptions about their beliefs of intensive exercise and the content of the intervention, with therapists more focused on the methods and patients more focused on the personal interactions stemming from the therapeutic relationship.
Conclusions
People with stroke perceived no barriers regarding the implementation of higher intensity rehabilitation in practice and were positive towards working at more intense levels. Contrastingly, from the therapists’ perspective, therapists’ beliefs about quality of movement and issues around staffing and resources were perceived to be barriers. In addition, therapists and people with stroke perceived the contents of the intervention differently, highlighting the importance of involving patients and clinicians in the development and evaluation of rehabilitation interventions.
Stroke Rehabilitation, Exercise, Knowledge Translation, Professional Practice, Physical Therapy Specialty
Issue Section:
ORIGINAL RESEARCH
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