Development of Recommendations for a Water-Based Therapeutic Exercise Program for Community Stroke Survivors

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.