A survey of exercise professionals’ barriers and facilitators to working with stroke survivors
Corresponding Author
Marie Condon BSc Physio (UL), MISCP, MSc (RCSI)
School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
Correspondence
Ms Marie Condon, Physiotherapy Department, Cork University Hospital, Cork, Ireland.
Email: [email protected]
Search for more papers by this authorMarie Guidon Dip. Physio (UCD), MISCP, Dip. Stat (TCD), MSc (TCD), PhD (NUI, RCSI)
School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
Search for more papers by this authorCorresponding Author
Marie Condon BSc Physio (UL), MISCP, MSc (RCSI)
School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
Correspondence
Ms Marie Condon, Physiotherapy Department, Cork University Hospital, Cork, Ireland.
Email: [email protected]
Search for more papers by this authorMarie Guidon Dip. Physio (UCD), MISCP, Dip. Stat (TCD), MSc (TCD), PhD (NUI, RCSI)
School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
Search for more papers by this authorAbstract
Stroke survivors (SSs) are largely inactive despite the benefits of exercise. Exercise professionals (EPs), skilled in exercise prescription and motivation, may have a role in promoting exercise among SSs. However, the number of EPs working with SSs is estimated to be low. This study aimed to investigate EPs’ opinions on working with SSs by rating their agreement of barriers and facilitators to working with SSs. The study also investigated EPs skills, interest and experience working with SSs and the relationship between EPs’ barriers and facilitators with their training on stroke. A descriptive cross-sectional study was conducted using a researcher-designed online survey between October and December 2015. Purposive sampling was used to survey EPs on the Register of Exercise Professionals in Ireland (n = 277). The response rate was 31% (87/277). Only 22% (19/86) of EPs had experience working with SSs. The primary barriers rated by EPs included insufficient training on psychological problems post-stroke (84%; 61/73), unsuitable equipment for SSs (69%; 50/73) and the level of supervision SSs require (56%; 41/73). The primary facilitators rated included access to suitable equipment (97%; 69/71), practical (100%; 71/71) and theoretical training (93%; 66/71) on stroke. Respondents with no training on stroke were significantly more likely to agree that insufficient training on psychological problems post-stroke and lack of experience were barriers. Seventy-six per cent of EPs (58/76) were interested in one-to-one exercise sessions with SSs but only 53% (40/76) were interested in group sessions. Eighty-two per cent of EPs (62/76) rated their motivational skills as good or very good but 42% (32/76) indicated having only acceptable skills dealing with psychological problems. Results indicate that EPs are interested in working with SSs despite limited experience and practical barriers. Training opportunities on stroke need to be developed; taking into account EPs’ barriers, facilitators and skills along with access to suitable equipment.
REFERENCES
- Arbour-Nicitopoulos, K. P., & Ginis, K. A. (2011). Universal accessibility of “accessible” fitness and recreational facilities for persons with mobility disabilities. Adapted Physical Activity Quarterly, 28(1), 1–15.
- Best, C., van Wijck, F., Dennis, J., Smith, M., Donaghy, M., Fraser, H., Dinan-Young, S., & Mead, G. (2012). A survey of community exercise programmes for stroke survivors in Scotland. Health and Social Care in the Community, 20(4), 400–411.
- Brainin, M., Norrving, B., Sunnerhagen, K. S., Goldstein, L. B., Cramer, S. C., Donnan, G. A. … Zorowitz, R. (2011). Post stroke chronic disease management: Towards improved identification and interventions for post stroke spasticity-related complications. International Journal of Stroke, 6(1), 42–46.
- Central YMCA (2014). Tomorrows exercise professionals: What does the future hold?. London: Central YMCA Qualifications.
- Cramp, M. C., Greenwood, R. J., Gill, M., Lehmann, A., Rothwell, J. C., & Scott, O. M. (2010). Effectiveness of a community-based low intensity exercise programme for ambulatory stroke survivors. Disability and Rehabilitation, 32(3), 239–247.
- Davies, P., Taylor, F., Beswick, A., Wise, F., Moxham, T., Rees, K., & Ebrahim, S. (2010). Promoting patient uptake and adherence in cardiac rehabilitation. Cochrane Database of Systematic Reviews, 7, CD007131.
- Department of Health. (2016). HI: Healthy Ireland. Retrieved from http://www.healthyireland.ie/
- Elsworth, C., Dawes, H., Sackley, C., Soundy, A., Howells, K., Wade, D. … Izadi, H. (2009). A study of perceived facilitators to physical activity in neurological conditions. International Journal of Therapy and Rehabilitation, 16(1), 17.
10.12968/ijtr.2009.16.1.37936 Google Scholar
- Field, M. J., Gebruers, N., Shanmuga Sundaram, T., Nicholson, S., & Mead, G. (2013). Physical activity after stroke: A systematic review and meta-analysis. ISRN Stroke, 2013, 1–13.
10.1155/2013/464176 Google Scholar
- Fullerton, A., Macdonald, M., Brown, A., Ho, P. L., Martin, J., Tang, A. … Brooks, D. (2007). Survey of fitness facilities for individuals post-stroke in the Greater Toronto area. Applied Physiology, Nutrition, and Metabolism, 33(4), 713–719.
- Halbesleben, J. R., & Whitman, M. V. (2013). Evaluating survey quality in health services research: A decision framework for assessing nonresponse bias. Health Services Research, 48(3), 913–930.
- Hare, S. W., Price, J. H., Flynn, M. G., & King, K. A. (2000). Attitudes and perceptions of fitness professionals regarding obesity. Journal of Community Health, 25(1), 5–21.
- Harrington, R., Taylor, G., Hollinghurst, S., Reed, M., Kay, H., & Wood, V. A. (2010). A community-based exercise and education scheme for stroke survivors: A randomized controlled trial and economic evaluation. Clinical Rehabilitation, 24, 3–15.
- HeartMoves. (2015). HeartMoves. Retrieved from http://www.heartmoves.org.au/
- Hickey, A., Horgan, F., O'Neill, D., & McGee, H. (2012). Community-based post-stroke service provision and challenges: A national survey of managers and inter-disciplinary healthcare staff in Ireland. BMC Health Services Research, 12(1), 111.
- Hicks, C. M. (2009). Research Methods for Clinical Therapists: Applied project design and analysis ( 5th ed.). London: Elsevier Health Sciences.
- Hutzal, C. E., Wright, F. V., Stephens, S., Schneiderman-Walker, J., & Feldman, B. M. (2009). A qualitative study of fitness instructors’ experiences leading an exercise program for children with juvenile idiopathic arthritis. Physical and Occupational Therapy in Paediatrics, 29(4), 409–425.
- Irish Association of Cardiac Rehabilitation. (2016). Irish Association of Cardiac Rehabilitation. Retrieved from http://www.iacr.info/
- Kasser, S. L., & Rizzo, T. (2013). An exploratory study of fitness practitioner intentions toward exercise programming for individuals with multiple sclerosis. Disability and Health Journal, 6(3), 188–194.
- Kilbride, C., Norris, M., Theis, N., & Mohagheghi, A. A. (2013). Action for rehabilitation from neurological injury (ARNI): A pragmatic study of functional training for stroke survivors. Open Journal of Therapy and Rehabilitation, 1(2), 40–51.
10.4236/ojtr.2013.12008 Google Scholar
- Kokemuller, N. (2016). What is the purpose of a workplace policy? Retrieved from http://smallbusiness.chron.com/purpose-workplace-policy-41601.html
- Kozub, F. M., & Lienert, C. (2003). Attitudes toward teaching children with disabilities: Review of literature and research paradigm. Adapted Physical Activity Quarterly, 20(4), 323–346.
- Later Life Training. (2015). Exercise and fitness training after stroke instructor. Retrieved from http://www.laterlifetraining.co.uk/courses/exercise-for-stroke-instructor/
- Lowensteyn, I., Coupal, L., Zowall, H., & Grover, S. A. (2000). The cost-effectiveness of exercise training for the primary and secondary prevention of cardiovascular disease. Journal of Cardiopulmonary Rehabilitation and Prevention, 20(3), 147–155.
- Mead, G., & Bernhardt, J. (2011). Physical fitness training after stroke, time to implement what we know: More research is needed. International Journal of Stroke, 6(6), 506–508.
- Merali, S., Cameron, J. I., Barclay, R., & Salbach, N. M. (2015). Characterising community exercise programmes delivered by fitness instructors for people with neurological conditions: A scoping review. Health and Social Care in the Community, 24(6), e101–e116.
- Morris, J. H., & Williams, B. (2009). Optimising long-term participation in physical activities after stroke: Exploring new ways of working for physiotherapists. Physiotherapy, 95(3), 227–233.
- Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M. … Turner, M. B. (2015). Heart disease and stroke statistics—2015 update: A report from the American Heart Association. Circulation, 131, e29–e322.
- Mulligan, H., Fjellman-Wiklund, A., Hale, L., Thomas, D., & Häger-Ross, C. (2011). Promoting physical activity for people with neurological disability: Perspectives and experiences of physiotherapists. Physiotherapy Theory and Practice, 27(6), 399–410.
- Norris, M., Kilbride, C., Mohagheghi, A., & Victor, C. (2013). Exercise instructor-led functional training programme for community dwelling stroke survivors: A qualitative study. International Journal of Therapy and Rehabilitation, 20(12), 597.
10.12968/ijtr.2013.20.12.597 Google Scholar
- O'Donoghue, E., O'Sullivan, T., O'Donovan, T., Sheehy, J., Morrisroe, P., & O'Sullivan, L. (2014). Neuro-functional training programme: An innovative service-development where suitable individuals with a neurological condition can exercise optimally and safely in a non-clinical community gym setting. Irish Society of Chartered Physiotherapists Conference, Dublin, 7–8 November 2014.
- Oprescu, F., McKean, M., & Burkett, B. (2012). Exercise professionals: Could they be the forgotten public health resource in the war against obesity? Journal of Sports Medicine Doping Studies, 2(5), 122.
- Ovbiagele, B., Goldstein, L. B., Higashida, R. T., Howard, V. J., Johnston, S. C., Khavjou, O. A. … Trogdon, J. G. (2013). Forecasting the future of stroke in the United States: A policy statement from the American Heart Association and American Stroke Association. Stroke, 44(8), 2361–2375.
- Paul, S. L., Srikanth, V. K., & Thrift, A. G. (2007). The large and growing burden of stroke. Current Drug Targets, 8, 786–793.
- Reed, M., Harrington, R., Duggan, Á., & Wood, V. (2010). Meeting stroke survivors’ perceived needs: A qualitative study of a community based exercise and education scheme. Clinical Rehabilitation, 24, 16–25.
- Register for Exercise Professionals Ireland. (2015). REPs Ireland. Retrieved from http://www.repsireland.ie
- Rimmer, J. H., & Henley, K. Y. (2013). Building the crossroad between inpatient/outpatient rehabilitation and lifelong community-based fitness for people with neurologic disability. Journal of Neurologic Physical Therapy, 37(2), 72–77.
- Rimmer, J. H., Riley, B., Wang, E., & Rauworth, A. (2005). Accessibility of health clubs for people with mobility disabilities and visual impairments. American Journal of Public Health, 95(11), 2022.
- Rimmer, J. H., Riley, B., Wang, E., Rauworth, A., & Jurkowski, J. (2004). Physical activity participation among persons with disabilities: Barriers and facilitators. American Journal of Preventive Medicine, 26(5), 419–425.
- Rimmer, J. H., Schiller, W., & Chen, M. D. (2012). Effects of disability-associated low energy expenditure deconditioning syndrome. Exercise and Sport Sciences Reviews, 40(1), 22–29.
- Rimmer, J. H., Wang, E., & Smith, D. (2008). Barriers associated with exercise and community access for individuals with stroke. Journal of Rehabilitation Research and Development, 45(2), 315.
- Robinson, R. G., & Jorge, R. E. (2015). Post-stroke depression: A review. American Journal of Psychiatry, 173(3), 221–231.
- Salbach, N. M., Howe, J. A., Brunton, K., Salisbury, K., & Bodiam, L. (2014). Partnering to increase access to community exercise programs for people with stroke, acquired brain injury, and multiple sclerosis. Journal of Physical Activity and Health, 11(4), 838–845.
- Saunders, D. H., Greig, C. A., & Mead, G. E. (2014). Physical activity and exercise after stroke: Review of multiple meaningful benefits. Stroke, 45(12), 3742–3747.
- Simpson, L. A., Eng, J. J., & Tawashy, A. E. (2011). Exercise perceptions among people with stroke: Barriers and facilitators to participation. International Journal of Therapy and Rehabilitation, 18(9), 520.
- Sims, J., Galea, M., Taylor, N., Dodd, K., Jespersen, S., Joubert, L., & Joubert, J. (2009). Regenerate: Assessing the feasibility of a strength-training program to enhance the physical and mental health of chronic post stroke patients with depression. International Journal of Geriatric Psychiatry, 24(1), 76–83.
- Stuart, M., Benvenuti, F., Macko, R., Taviani, A., Segenni, L., Mayer, F. … Weinrich, M. (2009). Community-based adaptive physical activity program for chronic stroke: Feasibility, safety, and efficacy of the Empoli model. Neurorehabilitation and Neural Repair, 23(7), 726–734.
- Urimubenshi, G., & Rhoda, A. (2011). Environmental barriers experienced by stroke patients in Musanze district in Rwanda: A descriptive qualitative study. African Health Sciences, 11(3), 398–405.
- Van de Mortel, T. F. (2008). Faking it: Social desirability response bias in self-report research. Australian Journal of Advanced Nursing, 25(4), 40.
- Warburton, D. E., Charlesworth, S. A., Foulds, H. J., McKenzie, D. C., Shephard, R. J., & Bredin, S. S. (2013). Qualified exercise professionals’ best practice for work with clinical populations. Canadian Family Physician, 59(7), 759–761.
- Wiles, R., Demain, S., Robison, J., Kileff, J., Ellis-Hill, C., & McPherson, K. (2008). Exercise on prescription schemes for stroke patients post-discharge from physiotherapy. Disability and Rehabilitation, 30(26), 1966–197.
- Woods, C., McCaffrey, N., Furlong, B., Fitzsimons-D'Arcy, L., Murphy, M., Harrison, M. … Peppard, C. (2016). The national exercise referral framework. Dublin: Health Service Executive Health and Wellbeing Division.