A qualitative theory guided analysis of stroke survivors' perceived barriers and facilitators to physical activity.

PURPOSE: After stroke, physical activity and physical fitness levels are low, impacting on health, activity and participation. It is unclear how best to support stroke survivors to increase physical activity. Little is known about the barriers and facilitators to physical activity after stroke. Thus, our aim was to explore stroke survivors' perceived barriers and facilitators to physical activity. METHODS: Semi-structured interviews with 13 ambulatory stroke survivors exploring perceived barriers and facilitators to physical activity post stroke were conducted in participants' homes, audio-recorded and transcribed verbatim. The Theoretical Domains Framework (TDF) informed content analysis of the interview transcripts. RESULTS: Data saturation was reached after interviews with 13 participants (median age of 76 years (inter-quartile range (IQR) = 69-83 years). The median time since stroke was 345 d (IQR = 316-366 d). The most commonly reported TDF domains were "beliefs about capabilities", "environmental context and resources" and "social influence". The most commonly reported perceived motivators were: social interaction, beliefs of benefits of exercise, high self-efficacy and the necessity of routine behaviours. The most commonly reported perceived barriers were: lack of professional support on discharge from hospital and follow-up, transport issues to structured classes/interventions, lack of control and negative affect. CONCLUSIONS: Stroke survivors perceive several different barriers and facilitators to physical activity. Stroke services need to address barriers to physical activity and to build on facilitators to promote physical activity after stroke. IMPLICATIONS FOR REHABILITATION: Physical activity post stroke can improve physical fitness and function, yet physical activity remains low among stroke survivors. Understanding stroke survivors' perceived barriers and facilitators to physical activity is essential to develop targeted interventions to increase physical activity. Beliefs about capabilities, environmental context and resources and social influences were the mostly commonly report influences on stroke survivors' perceived barriers and facilitators to physical activity.

The effects and experiences of goal setting in stroke rehabilitation - a systematic review.

OBJECTIVE: To systematically integrate and appraise the evidence for effects and experiences of goal setting in stroke rehabilitation. DESIGN: Systematic review of quantitative and qualitative studies. METHODS: Relevant databases were searched from start of database to 30 April 2011. Studies of any design employing goal setting, reporting stroke-specific data and evaluating its effects and/ or experiences were included. RESULTS: From a total of 53998 hits, 112 full texts were analysed and 17 studies were included, of which seven evaluated effects while ten explored experiences of goal setting. No eligible randomized controlled trials were identified. Most of the included studies had weak to moderate methodological strengths. The design, methods of goal setting and outcome measures differed, making pooling of results difficult. Goal setting appeared to improve recovery, performance and goal achievement, and positively influenced patients' perceptions of self-care ability and engagement in rehabilitation. However, the actual extent of patient involvement in the goal setting process was not made clear. Patients were often unclear about their role in this process. Professionals reported higher levels of collaboration during goal setting than patients. Patients and professionals differed on how they set goals, types of goals set, and on how they perceived goal attainment. Barriers to goal setting outnumbered the facilitators. CONCLUSION: Due to the heterogeneity and quality of included studies, no firm conclusions could be made on the effectiveness, feasibility and acceptability of goal setting in stroke rehabilitation. Further rigorous research is required to strengthen the evidence base. Better collaboration and communication between patients and professionals and relevant education are recommended for best practice.

Predicting health related quality of life 6 months after stroke: the role of anxiety and upper limb dysfunction.

PURPOSE: This study examined the role of anxiety and upper limb dysfunction, amongst other variables, as predictors of health related quality of life (HRQOL) 6 months after stroke. PARTICIPANTS: Stroke survivors (n = 85) who had previously participated in a randomised controlled trial of a physiotherapy intervention. Dependent variable: HRQOL - Nottingham Health Profile (NHP). PREDICTOR VARIABLES: Mood - Hospital Depression and Anxiety Scale; Upper Limb Functioning - Action Research Arm Test; Rivermead Motor Assessment; Activities of Daily Living - Modified Barthel Index; Clinical and demographic factors. RESULTS: Anxiety and depression significantly predicted 49% of variance in overall HRQOL (p < 0.05), but only anxiety significantly predicted NHP pain (13% variance, p < 0.001), emotional reactions (41% variance, p < 0.001), sleep (19% variance, p = 0.02) and social isolation (23% variance, p = 0.02). Depression and anxiety together significantly predicted 30% variance in energy level (p < 0.001). UL motor impairment and activities of daily living predicted 36% of variance in NHP physical activity score (p < 0.001). CONCLUSIONS: This study indicates that where anxiety is assessed, it appears more important in determining HRQOL than depression. UL impairment and ADL independence predicted perceived physical activity. Management strategies for anxiety and therapy for UL recovery long after stroke onset are likely to benefit perceived HRQOL.

Personal meanings, values and feelings relating to physical activity and exercise participation in female undergraduates: a qualitative exploration.

Understanding was sought of the ways that female students understand and feel about physical activity and exercise participation, to inform effective and ethical intervention. Sixteen women participated in semi-structured interviews which were analysed thematically, using QSR NUD*IST 4. Physical activity and exercise proved emotive topics and meant different things to different people. Some women associated physical activity and exercise with enjoyment, or achieving their goals. Others saw exercise in particular as a duty, associated with feelings of guilt and inadequacy. Findings supported the value of promoting realistic goals, and careful choice of activities according to individual preferences.

A prospective qualitative exploration of views about attending pulmonary rehabilitation.

BACKGROUND AND PURPOSE: Pulmonary rehabilitation has been found to be an effective strategy for managing chronic obstructive pulmonary disease (COPD). However, attendance at such programmes is not optimal, therefore, this study aimed to develop an in-depth understanding of views regarding attendance at pulmonary rehabilitation and experiences which may have shaped these views. METHODS: An inductive qualitative study was carried out within the framework of Interpretative Phenomenological Analysis. Five female and four male individuals with COPD who had been referred for pulmonary rehabilitation participated in semi-structured interviews. Interviews were conducted prior to participation in pulmonary rehabilitation. RESULTS: Three main themes were identified that related to views about attending pulmonary rehabilitation. The first is entitled 'Desired benefits of attending pulmonary rehabilitation', which described realistic hopes about impact on daily life. The second theme was called 'Evaluating the threat of exercise', and it encompassed both positive and negative evaluations; some interviewees described fear and avoidance of exercise, while others were determined to overcome symptoms. These attitudes extended to views about pulmonary rehabilitation. The third theme was called 'Attributing value to pulmonary rehabilitation'. Contrasting opinions about the value of attending pulmonary rehabilitation appeared to be influenced by the nature of prior interactions with health personnel and systems as well as information about the programme provided at referral. The referrer's attitude towards pulmonary rehabilitation appeared to be particularly influential. CONCLUSION: In summary, when considering rehabilitation attendance, potential participants are able to identify possible benefits, but previous experiences of symptoms and attitudes towards their condition can influence views both positively and negatively. Information and enthusiasm conveyed by the referring clinician, as well as previous interactions with health professionals can have powerful impact on views about attending. Referral practices should be informative and enthusiastic to increase the likelihood of uptake.

Processes in the development of international specialist competencies and standards: the Sports Physiotherapy for All Project.

UNLABELLED: In a world of rapidly developing knowledge it is important that professions describe their roles and capabilities. The need for a thorough description of sports physiotherapy was addressed through collaboration between the International Federation of Sports Physiotherapy (IFSP) and five European higher education institutions. This resulted in the Sports Physiotherapy for All Project, which has been successful in developing internationally accepted competencies and standards for sports physiotherapists. This article describes and reflects on the process to communicate useful lessons. METHODS: A competency model was chosen to facilitate differentiation and communication of aspects of sports physiotherapy practice. Documentation relating to sports physiotherapy practice was collected from 16 countries and analysed thematically. A cut and paste method was used by a panel of experts to allocate themes to areas of practice within the competency model. Theme groups were used to select areas of practice for description in competency form. Standards were derived from competencies following in depth discussion with the expert panel, and triangulation with themes derived from international documentation. RESULTS: A rigorous process of international review and revision led to the final list of 11 competencies and related standards, both accepted by the IFSP. IMPLICATIONS: This work provides a foundation for the development of an audit toolkit to guide demonstration and evaluation of competencies and standards. This provides a foundation for targeted career development activities, appropriate provision of training opportunities, and quality enhancement. The experiences gained during this project can inform other health professions and their specialisms when embarking on a similar journey.

An evaluation of a framework for facilitating and assessing physiotherapy students' reflection on practice.

Reflective practice is promoted in the health care professions as a developmental process leading to competent and effective practice, although the link between reflection and enhancement of physiotherapy practice remains speculative and conjectural. This article provides evidence that reflection can influence developing practice based on the evaluation of a reflective framework for students on clinical placement. The evaluation explored, in depth, students' experiences and perceptions of its benefits and limitations. Thematic analysis of response data from five focus groups (n = 43) representing three student cohorts resolved significant outcomes-related themes: personal insight, linking reflection to the physiotherapy process, and learning and personal change. Process-related themes focused on strengths and weaknesses of the framework and associated issues. Evidence supports the effectiveness of the framework in facilitating reflection and in linking reflection to higher order cognitive processes such as gaining new insights and understandings, facilitation of systematic enquiry, problem solving, and decision making. Feedback from students indicated that the experience was meaningful and valuable in preparation for practice because they were guided to question themselves and could see the relevance and value of that for their practice. We recommend that educators consider this approach to facilitating reflection in physiotherapy undergraduate education.

Descriptors and accounts of alcohol consumption: methodological issues piloted with female undergraduate drinkers in Scotland.

Excessive drinking among young women continues to attract adverse media attention and is the target of UK government-led initiatives. Reliable research on alcohol consumption is needed to inform/evaluate public health interventions. This pilot study, investigating descriptors of alcohol drinking in female Scottish undergraduate students, comprised: (i) self-completed questionnaire survey (n = 95) and (ii) interview plus test pouring of a 'drink' (n = 19). Self-reports by 70% of drinkers (n = 90) indicated alcohol consumption for the 'week past' meriting classification as 'binge' drinking, and 83% of this group reported drinking in this fashion at least fortnightly. However, binge drinking may be underestimated since poured drinks were measured to be on average double the alcohol content of a standard drink, drinking often occurred outwith licensed premises and respondents preferred to quantify consumption in (fractions of) bottles, rather than glasses. Qualitative analysis showed that interviewees oriented to drinking as an accountable practice but were unaware of the clinical definition of binge drinking. They defined it in terms of the effect of alcohol consumed on individual behaviour, not in absolute quantities. Given the unreliability of self-reported consumption, future health surveys and initiatives should consider 'quantifying' alcohol in a way more meaningful to the population of interest, in terms of effect.

Variation in the alcohol content of a 'drink' of wine and spirit poured by a sample of the Scottish population.

The standard UK alcohol unit is used to record alcohol consumption and, in health promotion, as a useful yardstick by which the public may be encouraged to monitor their own drinking levels. To investigate the correspondence between this standard unit and the actual amount contained in the 'usual' drink poured by a sample of the Scottish public, participants (n=251) were recruited from three employers in a major city--a manufacturer, an academic and a financial institution. Following a brief questionnaire, participants were asked to pour their usual drink of wine, and then spirit, into a glass. Among drinkers (n=238), the mean amount of alcohol in a drink of wine corresponded to not 1, but 1.92 UK units. For spirit, the corresponding figure was 2.3 UK units. For wine, 43% of the sample poured more than 2 units, for spirit, 55%. (Males poured significantly more spirit than females.) These findings may have important implications for individuals who wish to promote and to adopt sensible drinking practices when consuming wine and spirit at home. Also, the reliability of many consumption surveys, where there is often the implicit assumption that a 'drink' is equivalent to a 'standard unit', must be questioned.