Development of Recommendations for a Water-Based Therapeutic Exercise Program for Community Stroke Survivors
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Authors
Manning, Olivia Jean
Date
2024-10-02
Type
thesis
Language
eng
Keyword
stroke , cerebrovascular accident , hydrotherapy , water-based exercise , complex health intervention , modified delphi , scoping review , mixed methodology , pragmatic , implementation , water-based therapeutic exercise , Rehabilitation Science
Alternative Title
Abstract
Background: Upon discharge from formal rehabilitation*, stroke survivors are encouraged to continue with exercise to maintain and continue to improve function. However, many stroke survivors are not sufficiently active and describe transitions to community as sudden and challenging. Inactivity in this population can lead to many negative health outcomes. Water-based therapeutic exercise (WBTE) offers numerous benefits and has the potential to support individuals in the transition from formal rehabilitation to community living. While there is evidence of the effectiveness of WBTE in stroke, few programs are available, and it is challenging to determine the exact content and structure that will maximize the benefits while fostering ongoing activity.
Objective: To systematically develop evidence-informed recommendations for a community WBTE program based on current research and perspectives of those with lived and professional expertise.
Methods: This dissertation used a multiphase mixed-methods design with each phase informing the next. The work included three distinct phases: (1) a scoping review, (2) 12 semi-structured interviews with stroke survivors and/or caregivers, and (3) a Modified Delphi study with 30 experts in the field. Guidance from the Medical Research Council’s Framework for Complex Health Interventions (CHI) and the Consolidated Framework for Implementation Research (CFIR) informed methodology at each stage.
Results: Each phase of this work contributed to the development of recommendations for a community WBTE program. Scoping review data provided an overview of existing knowledge, while interview and survey data were used to validate and expand on knowledge for practical application. Recommendations included the involvement of a healthcare professional (HCP) in a group setting with level-based programming. Individuals with moderate-severe impairment expressed interest in WBTE, and professionals endorsed the inclusion of these individuals. The participation of other populations, including those with various neurological conditions or with similar goals was recommended given the anticipated benefits to a broader population.
Conclusions: Key recommendations related to program participants/personnel, structure/content, and practical considerations for implementation. Future work should pilot the program while continuing to evaluate and optimize the intervention. Program developers should address the specific context of the community setting and individual needs of stroke survivors to maximize program success.
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Attribution-NonCommercial-NoDerivatives 4.0 International
ProQuest PhD and Master's Theses International Dissemination Agreement
Intellectual Property Guidelines at Queen's University
Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.
Attribution-NonCommercial-NoDerivatives 4.0 International