Understanding the facilitators and barriers of stroke survivors’ adherence to recovery-oriented self-practice: a thematic synthesis

Abstract

Purpose: Stroke survivors receive considerable rehabilitation efforts as inpatients, but one-on-one therapy decreases after discharge. The gap between the amount of required therapy and the lack of its availability in this phase of care may be partly overcome by self-practice. However, patient's adherence to prescribed programs is often low. While single studies have examined factors affecting adherence in this specific case, they have not been reviewed and synthesised previously. Methods: A thematic synthesis of qualitative studies explored factors affecting stroke survivors' adherence to prescribed, recovery-oriented self-practice. Five databases were systematically searched for references: Medline, Psycinfo, CINAHL, Embase, and ASSIA. Quality assessment was undertaken using the CASP tool. Results: From 1308 references, 68 potential papers were read in full, and 12 were included in the review. An overarching theme was identified as: "Tailoring and personalization rather than standardization." It was informed by the following three analytical themes: "The meaning of 'self' in self-practice," "Identifying self-practice as a team effort," and "Self-practice that is grounded in one's reality." Conclusion: To have a positive effect on adherence to self-practice, clinicians are advised to spend time learning about each individual's life circumstances, so they can tailor proposed exercise programs to patients' personal situations, preferences, and needs. ä IMPLICATIONS FOR REHABILITATIONThe topic of patient's adherence to self-practice of prescribed exercise is a common concern, often voiced by frustrated rehabilitation health professionals. Bridging the gap between the patient's needs for post-discharge intensive therapy and the inability of healthcare systems to provide it could be filled partly by self-practice. Adherence to self-practice has become even more essential since the COVID 19 pandemic and the decrease in face-to-face delivery of rehabilitation due to social distancing requirements. Adherence to exercise is a broad topic. Reasons for poor adherence differ between patient populations and the exercises they are prescribed. This study focuses on post-discharge stroke survivors' adherence to recovery targeted exercise that could be described as repetitive and less physically demanding movements and functions. Reviewed studies were qualitative and usually included a relatively small number of participants within a specific context. Using thematic synthesis, we combined these small pieces of the puzzle into a larger picture, to produce recommendations that could be drawn on by clinicians to improve self-practice adherence.

Exercise preference in stroke survivors: a concept analysis

“…The studies mentioning concepts similar to exercise preference in stroke survivors have been found in the fields of nursing, medicine, psychology, physiology, and occupational therapy. Most of these are exploratory qualitative studies regarding experience ( 10 ), dilemma ( 26 ), expectation ( 27 ), facilitators, and barriers ( 11 , 13 , 26 ) in the rehabilitation process. Moreover, several quantitative studies have investigated the association between and among exercise preferences, potential barriers, and psychosocial factors such as self-efficacy and depression ( 14 , 15 , 21 ).…”

“…This is mainly reflected in the choice of exercise programs such as social situation, location, type of exercise, intensity, frequency, and duration ( 28 ). Choosing or refusing a certain mode of exercise depends on what they like or what they do not like when exercising ( 13 ). Individuals with stroke are more interested in a certain exercise mode and more likely to make corresponding choices and exhibit better adherence ( 13 , 29 ).…”

“…Choosing or refusing a certain mode of exercise depends on what they like or what they do not like when exercising ( 13 ). Individuals with stroke are more interested in a certain exercise mode and more likely to make corresponding choices and exhibit better adherence ( 13 , 29 ). Of course, there are also pros and cons to weigh in this process ( 30 ).…”

“…Exercise rehabilitation is a long-term, dynamic, multifactorial, and complex process, and stroke survivors present different exercise preferences over time ( 10 ). Patients want themselves, rather than the techniques, to be kept as the center of attention in the rehabilitation process, such as the exercise mode they are interested in, accessible, positive, and meaningful as they perceived it, confidence, external supervision and support, and so on ( 11 – 13 ). Exercise regimes need to be designed that keeping in mind exercise preferences that promote the affective response of stroke survivors so that they become engaged and motivated to be physically active ( 14 , 15 ).…”

“…The concept of exercise preference in stroke survivors is more focused on the personal preferences in the recommended rehabilitation regimen. Exercise preference in stroke survivors has been presented only as a fragmented information in several studies ( 13 – 15 ). But exercise preference of stroke survivors has not been extensively covered, including the heterogeneity of personal values and inclination for long-term rehabilitation ( 11 , 13 , 21 ).…”