Jessie Janssen1, Tara D Klassen2, Louise A Connell3, Janice J Eng4. 1. J. Janssen, PhD, Allied Health Research Unit, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom; and Institute of Therapeutic Sciences, IMC University of Applied Sciences Krems, Krems an der Donau, Austria. Address all correspondence to Dr Janssen at: Jessie.janssen@fh-krems.ac.at. 2. T.D. Klassen, PhD, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; and Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver, British Columbia, Canada. 3. L.A. Connell, PhD, Allied Health Research Unit, Faculty of Health and Wellbeing, University of Central Lancashire. 4. J.J. Eng, PhD, Department of Physical Therapy, University of British Columbia and Rehabilitation Research Program, GF Strong Rehab Centre.
Abstract
BACKGROUND: Despite increasing evidence regarding the benefit of 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 semistructured interviews with people with stroke who were part of a randomized clinical trial, the Determining Optimal post-Stroke Exercise study, which delivered a higher intensity intervention. An interview guide was developed and data analyzed using implementation frameworks. Factors emerging from interviews with people with stroke were compared and contrasted with 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 regarding 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.
BACKGROUND: Despite increasing evidence regarding the benefit of 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 semistructured interviews with people with stroke who were part of a randomized clinical trial, the Determining Optimal post-Stroke Exercise study, which delivered a higher intensity intervention. An interview guide was developed and data analyzed using implementation frameworks. Factors emerging from interviews with people with stroke were compared and contrasted with 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 regarding 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.
Authors: Tara D Klassen; Sean P Dukelow; Mark T Bayley; Oscar Benavente; Michael D Hill; Andrei Krassioukov; Teresa Liu-Ambrose; Sepideh Pooyania; Marc J Poulin; Jennifer Yao; Janice J Eng Journal: Int J Stroke Date: 2018-07-16 Impact factor: 5.266
Authors: Carolee J Winstein; Joel Stein; Ross Arena; Barbara Bates; Leora R Cherney; Steven C Cramer; Frank Deruyter; Janice J Eng; Beth Fisher; Richard L Harvey; Catherine E Lang; Marilyn MacKay-Lyons; Kenneth J Ottenbacher; Sue Pugh; Mathew J Reeves; Lorie G Richards; William Stiers; Richard D Zorowitz Journal: Stroke Date: 2016-05-04 Impact factor: 7.914
Authors: Debbie Hebert; M Patrice Lindsay; Amanda McIntyre; Adam Kirton; Peter G Rumney; Stephen Bagg; Mark Bayley; Dar Dowlatshahi; Sean Dukelow; Maridee Garnhum; Ev Glasser; Mary-Lou Halabi; Ester Kang; Marilyn MacKay-Lyons; Rosemary Martino; Annie Rochette; Sarah Rowe; Nancy Salbach; Brenda Semenko; Bridget Stack; Luchie Swinton; Valentine Weber; Matthew Mayer; Sue Verrilli; Gabrielle DeVeber; John Andersen; Karen Barlow; Caitlin Cassidy; Marie-Emmanuelle Dilenge; Darcy Fehlings; Ryan Hung; Jerome Iruthayarajah; Laura Lenz; Annette Majnemer; Jacqueline Purtzki; Mubeen Rafay; Lyn K Sonnenberg; Ashleigh Townley; Shannon Janzen; Norine Foley; Robert Teasell Journal: Int J Stroke Date: 2016-04-14 Impact factor: 5.266
Authors: Sarah Nicholson; Falko F Sniehotta; Frederike van Wijck; Carolyn A Greig; Marie Johnston; Marion E T McMurdo; Martin Dennis; Gillian E Mead Journal: Int J Stroke Date: 2012-09-13 Impact factor: 5.266