From physical and functional towards identity enhancing and life-fulfilling: exploring stroke survivors, carers and physiotherapists experiences of physical activity after stroke

Introduction: Participation in physical activity (PA) after stroke is known to benefit survivors' health and wellbeing. However post-stroke disability means that support for survivors' engagement in PA is frequently necessary. This study explored whether and how physiotherapists and carers support survivors to be physically active.

Method: Sample and data collection: Semi-structured interviews with community dwelling stroke survivors (n = 38), two focus groups each with carers (n = 12) and rehabilitation physiotherapists (n = 12). The purpose and outcomes of PA and roles played by carers and physiotherapists to support engagement in PA were explored. Data Analysis: Framework analysis structured the analytic process. Constant comparison was used to identify themes and facilitate interpretation.

Results: Survivors and carers prioritised prevention of future health problems, restoration of pre-stroke identity and return to participation in valued activities as outcomes of PA. Carers used motivating, monitoring and problem-solving strategies to support survivors' PA and facilitate participation in shared life activities. Adopting a deficit reduction model, physiotherapists tended to see physical restoration and function as primary goals of PA. They viewed survivors as motivated or not, adopting strategies to support survivors' participation in PA that were typically directive. They discussed carers' roles mainly with reference to risk assessment and safety.

Conclusion: Roles adopted by physiotherapists and carers to support survivors' PA can be competing rather than complementary, which may hinder survivors' engagement in PA. Physiotherapists should adopt person-centred, psychosocially relevant approaches, to support survivors' identity continuity and recognise and encourage the pragmatic and facilitatory role played by carers.