Impairments, and physical design and culture of a rehabilitation unit influence stroke survivor activity: qualitative analysis of rehabilitation staff perceptions

Abstract

Purpose

This study aimed to investigate rehabilitation staff perceptions of factors influencing stroke survivor activity outside of dedicated therapy time for the purpose of supporting successful translation of activity promoting interventions in a rehabilitation unit.

Materials and methods

Purposive sampling of multi-disciplinary teams from four rehabilitation units was performed, and semi-structured interviews were conducted by telephone, digitally audio-recorded and then transcribed verbatim. A stepped iterative process of thematic analysis was employed until data saturation was reached.

Results

All but one of the 22 participants were female, the majority were either physiotherapists or occupational therapists, with a median of 4 years (interquartile range, 2–10) working at their respective rehabilitation units. Analysis of the data revealed three themes: (i) stroke survivor characteristics influence their activity outside therapy, (ii) the rehabilitation environment influences physical, cognitive, and social activity, and (iii) institutional priorities, staff culture, and attitude can be barriers to activity. Rehabilitation units were perceived to be unstimulating, and visitors considered enablers of activity when resources were perceived to be scarce.

Conclusions

Our results suggest careful consideration of the involvement of visitors, an individual’s needs and preferences, and the institution’s priorities and staff attitude may result in greater stroke survivor activity during rehabilitation.

Implications for rehabilitation

• Staff should consider stroke survivor impairments and a rehabilitation unit’s institutional priorities and staff attitudes when aiming to enhance stroke survivor engagement in activity.

• The physical and social environment of a rehabilitation unit can be optimised by rehabilitation staff to promote activity.

• Utilisation of visitors of stroke survivors on a rehabilitation unit may be one way to enhance engagement in activity.

• Discussion within the rehabilitation team concerning “ownership” of the role of supporting stroke survivor activity outside of structured therapy time may support better engagement in same.

Keywords:

• Stroke
• qualitative
• rehabilitation
• activity
• barriers
• environment

Acknowledgements

We thank all staff who contributed their time. We thank occupational therapy honours students who assisted with data collection: Hayley Kopko from the University of Newcastle and Serene Lim from the University of South Australia. We also thank other members of the AREISSA Research Collaboration not specifically mentioned in this paper who supported processes associated with this sub-study of AREISSA. HJ, JL, AMc, JBlennerhassett, JBernhardt, and NJS designed the study and interview guide; JL, BS, and AB performed data analysis; HJ and MLB wrote the manuscript with support from LA and all authors were involved in manuscript revision.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was a sub-study within the University of Newcastle sponsored Phase II Trial, Altering the Rehabilitation Environment to Improve Stroke Survivor Activity (AREISSA). Funding for AREISSA and this study was through the New South Wales Cardiovascular Research Network Project Grant 2014 [CVRN100334], Greater Charitable Foundation Fellows in Stroke Research [G1300508]), Philanthropic Funding from Kiriwina Investments through Hunter Medical Research Institute [G1300569], University of Newcastle Priority Research Centre for Stroke and Brain Injury, and a Clinical Stipend from NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery [APP1077898]. NJS was supported by a co-funded Australian NHMRC/NHF Career Development/Future Leader Fellowship GNT1110629/100827.