Development of strategies to support home-based exercise adherence after stroke: a Delphi consensus

Abstract

ObjectiveTo develop a set of strategies to enhance adherence to home-based exercises after stroke, and an overarching framework to classify these strategies.MethodWe conducted a four-round Delphi consensus (two online surveys, followed by a focus group then a consensus round). The Delphi panel consisted of 13 experts from physiotherapy, occupational therapy, clinical psychology, behaviour science and community medicine. The experts were from India, Australia and UK.ResultsIn round 1, a 10-item survey using open-ended questions was emailed to panel members and 75 strategies were generated. Of these, 25 strategies were included in round 2 for further consideration. A total of 64 strategies were finally included in the subsequent rounds. In round 3, the strategies were categorised into nine domains—(1) patient education on stroke and recovery, (2) method of exercise prescription, (3) feedback and supervision, (4) cognitive remediation, (5) involvement of family members, (6) involvement of society, (7) promoting self-efficacy, (8) motivational strategies and (9) reminder strategies. The consensus from 12 experts (93%) led to the development of the framework in round 4.ConclusionWe developed a framework of comprehensive strategies to assist clinicians in supporting exercise adherence among stroke survivors. It provides practical methods that can be deployed in both research and clinical practices. Future studies should explore stakeholders’ experiences and the cost-effectiveness of implementing these strategies.

Research hotspots and trends of the tele-rehabilitation for stroke survivors based on CiteSpace: A review

“…The remote supervision, professional rehabilitation guidance and task training interest provided by the remote rehabilitation project can all help to cultivate the self-efficacy of patients after stroke, improve patients’ self-health management willingness, and increase the enthusiasm of patients to participate in rehabilitation exercise. Owing to bad mood, fatigue, pain, lack of health-related knowledge, and lack of supervision and motivation factors, stroke survivors have poor functional exercise compliance, [ 51 ] and researchers have noticed this characteristic. Future studies should implement measures to improve rehabilitation participation and exercise enthusiasm in remote intervention programs.…”

The co‐design of an exercise‐based, lifestyle intervention for people with venous leg ulcers; a self‐care, expert‐supported strategy for a chronic condition

“…These constructs will be targeted through a graded, individualised programme with tapered support, which includes a lower number of exercises (a higher rate of compliance is associated with those prescribed fewer exercises) 47 that are functional, easy to grasp and can be undertaken independently. Self‐regulatory behaviour change techniques have also been shown to promote exercise adherence in clinical populations 48,49 . Goal setting, reviews, feedback, and a monitoring system will be part of the intervention.…”

Innovative Telerehabilitation Enhanced Care Programme (ITECP) in young and middle-aged patients with haemorrhagic stroke to improve exercise adherence: protocol of a multicentre randomised controlled trial

“…Maintain healthy behaviours to avoid giving up Incentive strategies will be developed using the telerehabilitation platform and WeChat groups, 29 which will include complimentary remote follow-up visits, exercise rehabilitation demonstration videos, telephone follow-up by the research team, and regular dissemination of knowledge on haemorrhagic stroke prevention and treatment. This telerehabilitation platform for young and middle-aged patients with haemorrhagic stroke, designed through a multi-qualitative study of patients, medical staff and technicians, includes five modules: User Information, Ding Ding Medication, Enjoy Pulse, Lighting Heart Lamp and Help Centre.…”