From physical and functional to continuity with pre-stroke self and participation in valued activities: a qualitative exploration of stroke survivors', carers' and physiotherapists' perceptions of physical activity after stroke

Purpose: Physical activity (PA) improves fitness, functioning, health and wellbeing after stroke. However, many survivors are inactive. This study explored survivors', carers' and physiotherapists' beliefs about PA to identify how these support or hinder PA participation.

Methods: Semi-structured in-depth interviews with community dwelling stroke survivors (n = 38); two focus groups involving six carers each; two focus groups, respectively, involving seven and eight stroke rehabilitation physiotherapists from clinical and community settings. Data were audio-recorded and transcribed. Analysis was structured using the Framework Approach to identify themes and a dynamic, conceptual model.

Findings: Desired outcomes and control over outcome achievement were key concepts. For survivors and carers, PA supported participation in valued activities, providing continuity with pre-stroke sense of self. Carers adopted motivating strategies for PA to support recovery and participation in shared activities. In contrast, physiotherapists prioritised physical and functional outcomes and viewed survivors' control of outcomes as limited which was reflected by the support they provided.

Conclusions: Individualised interventions that account for social and environmental influences on behaviour appear vital to enabling survivors to participate in meaningful physical activities. Such interventions should facilitate development of shared perspectives among physiotherapists, carers and survivors of PA and related outcomes and provide tailored strategies to facilitate PA participation. Implications for Rehabilitation Physical activity after stroke rehabilitation is important for fitness, health, functioning and well-being. Reasons for survivors participating or not in physical activity after stroke are complex and varied. Physiotherapists and carers influence survivors' participation in physical activity but their views about how to do this do not always match, or do they always complement the views of survivors. Integrated approaches to supporting physical activity that account for survivors' preferences and recognise the carers' role should be developed and applied by physiotherapists and other health professionals.