Co-design of a physical activity maintenance intervention for people with stroke: a study protocol (Preprint)

Background:

Stroke is a global health problem that often causes physical disability and mental health issues in the survivor. Whilst physical activity improves patient outcomes post-stroke, it can be challenging to maintain. Barriers to maintaining physical activity post-stroke include setting of physical activity (PA), motivation, and impairments from the stroke. There is often a desire to maintain physical activity after stroke, but effective interventions are currently limited.

Objective:

The aim of this study is to co-produce an intervention to support long term PA maintenance for adults with stroke in Northern Ireland. The objectives of this study are as follows: 1. Understand the perspectives of key stakeholders on the components, structure, and content of an intervention to support PA maintenance ensuring the intervention is relevant, acceptable, and feasible for all stakeholders. 2. Co-production and refine a prototype intervention using an iterative process, actively involving stakeholders in the development and customisation of the intervention to meet their specific needs and preferences.

Methods:

A mixed methods study will be conducted consisting of three stages informed by the DECIPHer co-production framework. Stage 1 will include a scoping review on PA maintenance in survivors of stroke and stakeholder consultation via focus groups to gain understanding from their perspective of PA. Survivors of stroke and their carers, care coordinators and physiotherapists will be recruited from ongoing Post Rehabilitation Enablement Programme (PREP) classes. Additional healthcare professionals with experience in physical activity and stroke will also be recruited via relevant organisations. Individuals who complete stage 1 focus groups will be invited to take part in stage 2 co-design workshops to develop a physical activity maintenance programme for participants post-PREP. Stage 3 will involve expert review of the co-production programme by members of the Project Advisory Board via a questionnaire survey.

Results:

Qualitative data will undergo reflexive thematic analysis from data collected in stage 1 and 2. Data from the scoping review will help shape the questions for the focus groups and data from the focus groups will help inform questions for the three workshops. All stages will involve the stakeholders to gain feedback and suggestions for the next wave.

Conclusions:

This study provides necessary information in regards to PA amongst survivors of stroke once they stop community rehabilitation. To our knowledge, there is no further support for the survivors to help maintain their PA levels once they finish the 6-12 week community programme. Engaging with survivors of stroke and their carers, PREP staff, and other exercise professionals will help shape the beginning stages of this study. Upcoming results from the pilot study will provide vital information on how to help PA maintenance in this population. Clinical Trial: The study is registered with clinicalTrials.gov - due to restriction in government funding we are awaiting the trial registration number.