Factors influencing adherence to intensive upper limb exercise programs: Stroke survivors’ perspectives

Mrs Tamina Levy1, Ms Lauren Christie3, Dr Maggie Killington2, A/Professor Kate Laver1,2, Professor Maria Crotty1,2, Professor Natasha Lannin4

1Flinders Medical Centre, Adelaide, Australia, 2Flinders University, Adelaide, Australia, 3St Vincents Health Network, Sydney, Australia, 4Monash University, Melbourne, Australia

Rationale and Aim: Intensive upper limb exercise programs are recommended within stroke guidelines to optimise recovery, however, there has been limited research exploring the experiences of stroke survivors participating in intensive upper limb programs. This research aimed to identify factors influencing adherence to an intensive upper limb exercise program in people with stroke.

Method: Qualitative design using semi-structured interviews. Twenty stroke survivors who had participated in an intensive upper limb rehabilitation program as part of a randomised controlled trial (the InTENSE trial) were interviewed to explore their perspectives of participation, including perceived barriers and enablers to exercise program adherence.

Interviews were audio-recorded, transcribed and imported into Nvivo for analysis. Using deductive coding, themes were mapped to the Capabilities, Opportunities, Motivation- Behaviour (COM-B) behaviour change model to identify barriers and enablers to program adherence and engagement.

Results: Enablers influencing adherence included routine practice times (Motivation – automatic), accountability to staff (Motivation – reflective), social support (Opportunity – social) and face to face contact with staff (Opportunity – physical). Barriers to adherence included exercises being too difficult, reliance on others to help, fatigue (Capability – physical) and difficulty ‘fitting it in’ (Motivation – reflective).

Conclusion: This research provides health professionals with an in-depth understanding of barriers and enablers to adherence to intensive exercise programs in stroke survivors, and findings will inform recommendations for the delivery of programs to improve adherence, and ultimately assist rehabilitation services to deliver programs that enable self-directed practice by stroke survivors.


Tamina is a physiotherapist of over 30 years experience, currently working as Advanced Practitioner, Neurological Rehabilitation at Flinders Medical Centre, Rehabilitation and Palliative Services. She also works at Flinders University and is committed to evidence-based practice. She has recently submitted her PhD which explored adherence to exercise in stroke survivors.

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