From physical and functional to identity enhancing and life-fulfilling: Physiotherapists', stroke survivors', and carers' perspectives of physical activity after stroke

Introduction:

There is good evidence that participation in physical activity (PA) after stroke is beneficial for health, functioning and wellbeing. Many survivors experience disability that prevents them from being active without support. This study explored ways in which physiotherapists and carers support survivors to be physically active.

Method:

Sample and data collection: Semi-structured interviews with community dwelling stroke survivors (n=38), two focus groups each with carers (n=12) and rehabilitation physiotherapists (n=12). Expected outcomes of PA and roles played by carers and physiotherapists to support PA participation were explored.

Data Analysis: Framework analysis was used to structure analysis to identify themes and concepts and facilitate interpretation.

Results:

Survivors and carers prioritised as PA outcomes prevention of future health problems, restoration of pre-stroke identity and return to participation in valued activities. Carers used motivating, monitoring and problem-solving strategies to support survivors’ PA and facilitate participation in shared life activities. Adopting a deficit reduction model, physiotherapists saw physical restoration and function as primary goals of PA.  They viewed survivors as motivated or not, often adopting directive strategies to support survivors’ PA participation.  They discussed carers’ roles mainly with reference to risk assessment and safety.

Conclusion:

Roles adopted by physiotherapists and carers to support survivors’ PA can be competing rather than complementary, which may hinder survivors’ engagement in PA. Physiotherapists should adopt person-centred, psychosocially relevant approaches, to support survivors’ identity continuity and recognise and encourage the pragmatic and facilitatory role played by carers.