Enablers and barriers of adherence to home exercise programmes after stroke: caregiver perceptions

Abstract

Background/Aims: In stroke rehabilitation, the goal is to discharge patients at their optimal functional level, however, this level of independence is not always reached at discharge due to decreased length of stay and a high demand for beds. Thus, patients rely upon caregivers to assist them not only with activities of daily living but also with home exercise programmes. The purpose of this study was to establish caregivers' perceived enablers and barriers of adherence to home exercise programmes in stroke survivors. Methods: A qualitative study design was used with in-depth interviews of the caregivers of stroke survivors who were dependent in functional activities. Findings: The average age of the caregivers was 47.8 years (±13.96) years and all of them were the stroke survivors' family members. The most common enablers of adherence to home exercise programmes were self–motivation, external motivation from friends and family, having a daily routine, spirituality, caregivers' attitude and desires, and caregiver knowledge. The most common barriers of adherence to home exercise programmes were general health issues, caregiver having other responsibilities, lack of family and social support, caregiver burden and stress, low self-efficacy and mood, and fear of falling. Conclusions: Adherence to home exercise programmes is multifactorial and does not only relate to the stroke survivor alone. Caregivers have a lot of responsibilities and experience emotional strain and burden. This has an influence on stroke survivors' adherence to home exercise programmes as they rely upon caregivers for assistance.

Perseverance with technology-facilitated home-based upper limb practice after stroke: a systematic mixed studies review

“…Dose and content of UL HEP are variable, ranging from a structured one-size-fits-all program, to an individualised program specific to the needs and goals of the stroke survivor [ 6 ]. Adherence to HEP after stroke has been attributed to family support, confidence in therapist knowledge and experience, and goal oriented practice with an accountability strategy [ 7 – 9 ]. Non-adherence with HEP after stroke has been attributed to fatigue, depression and diminished motivation, musculoskeletal issues, and lack of time due to competing commitments [ 8 , 9 ].…”

“…Adherence to HEP after stroke has been attributed to family support, confidence in therapist knowledge and experience, and goal oriented practice with an accountability strategy [ 7 – 9 ]. Non-adherence with HEP after stroke has been attributed to fatigue, depression and diminished motivation, musculoskeletal issues, and lack of time due to competing commitments [ 8 , 9 ]. Additionally, some stroke survivors have found that traditional HEP are not enjoyable, too difficult or insufficiently challenging, and thus of minimal functional benefit [ 8 – 10 ].…”

“…Non-adherence with HEP after stroke has been attributed to fatigue, depression and diminished motivation, musculoskeletal issues, and lack of time due to competing commitments [8,9]. Additionally, some stroke survivors have found that traditional HEP are not enjoyable, too difficult or insufficiently challenging, and thus of minimal functional benefit [8][9][10]. Evidently, practicing intensely in the home over a long period of time is challenging for stroke survivors.…”

Current stroke rehabilitation services and physiotherapy research in South Africa

“…Caregivers have a lot of responsibilities and they experience emotional strain and burden. This may influence stroke survivors’ adherence to home exercise programmes and recovery of function as some of them rely upon caregivers for assistance (Scorrano, Ntsiea & Maleka 2018). Thus, caregivers and stroke survivors need more support post-discharge.…”

Users’ experience of community-based power assisted exercise: a transition from NHS to third sector services

“…However, fitness professionals report that they have limited confidence in supporting the specific needs of PwS (Condon & Guidon, 2018 ) and inaccessible equipment has been identified as a barrier to the uptake of exercise amongst the stroke population (Nicholson et al, 2014 ). Exercise programmes can be effectively delivered in the home environment (Galvin et al, 2014 ) but barriers to exercising at home include fear of falling, caregiver addressing other priorities, unsuitable environment and limited confidence with correct exercise technique (Galvin et al, 2014 ; Scorrano et al, 2018 ).…”