Deans' stroke musings: Factors that Influence the Clinical Implementation of Aerobic Exercise in Stroke Rehabilitation: a Theory-Informed Qualitative Study

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Saturday, February 26, 2022

Factors that Influence the Clinical Implementation of Aerobic Exercise in Stroke Rehabilitation: a Theory-Informed Qualitative Study

So we still know NOTHING about aerobic exercise post stroke. Aren't you glad your stroke medical team knows absolutely nothing concrete about getting you recovered?

Factors that Influence the Clinical Implementation of Aerobic Exercise in Stroke Rehabilitation: a Theory-Informed Qualitative Study

Abstract

Objective

Best practice guidelines recommend that aerobic exercise (AEx) be implemented as early as possible poststroke, yet the prescription of AEx remains limited in stroke rehabilitation settings. This study used theoretical frameworks to obtain an in-depth understanding of barriers and enablers to AEx implementation in the stroke rehabilitation setting.

Methods

A qualitative, descriptive study was conducted. Participants were recruited from 4 stroke rehabilitation settings in Ontario, Canada, that have participated in an implementation study to provide structured AEx programming as part of standard care. Six clinician focus groups (with 19 physical therapists and 5 rehabilitation assistants) and one-to-one interviews with 7 managers and 1 physician were conducted to explore barriers and enablers to AEx implementation. The Theoretical Domains Framework (TDF) and Consolidated Framework for Implementation Research (CFIR) informed content analysis for clinician and manager perspectives, respectively.

Results

Barriers specific to resource constraints and health care system pressures, combined with patient goals, led to interventions to improve function being prioritized over AEx. Successful implementation was enabled through an interprofessional approach and team engagement in the planning and implementation process. Health care providers described concerns about patient safety, but confidence and capability for implementing AEx were enabled by education, skill development, use of exercise tests, and consultation with individuals with content expertise. Participants described the development of supportive processes that enabled AEx implementation within team workflows and shared resources.

Conclusion

Strategies to support implementation of AEx in stroke rehabilitation should incorporate knowledge and skills; the provision of clinical decision-making tools; access to expert consultation; the roles and social influence of the interprofessional team and formal and informal leaders; and supportive processes adapted to the local context.

Impact

Results from this study will inform the development of a clinical implementation toolkit to support clinical uptake of AEx in the stroke rehabilitation setting.