Research Report
Population: Adult
Kari Dunning, PT, PhD, Associate Professor, Department of Rehabilitation Sciences, University of Cincinnati, Cincinnati, OH kari.dunning@uc.edu
Pierce Boyne, PT, DPT, NCS, assistant professor, Department of Rehabilitation Sciences, University of Cincinnati, Cincinnati, OH pierce.boyne@uc.edu
Sandra Billinger, PT, PhD, FAHA, assistant professor, Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS sbillinger@kumc.edu
Marilyn MacKay-Lyons, PT, PhD, Professor, School of Physiotherapy, Dalhousie University, Nova Scotia, Canada M.MacKay-Lyons@Dal.Ca
Brian Barney, BS, Student, Department of Rehabilitation Sciences, University of Cincinnati, Cincinnati, OH barneybe@mail.uc.edu
Keywords: Participation, Prevention, Stroke, Exercise
Purpose/Hypothesis: Stroke is one of the leading causes of disability and aerobic deconditioning is a major barrier to recovery. Aerobic exercise (AE) improves aerobic fitness, mobility and cardiovascular health after stroke. However, studies suggest that AE may be underutilized in clinical practice. The utilization of AE post stroke and factors influencing its use remain unknown among U. S. therapists. Therefore, the purpose of this study was to assess the utilization and barriers of AE by U.S. physical therapists for their clients with stroke.
Subjects: 476 physical therapists (70% female) with an average of 17 years in practice in the following settings: acute (78), inpatient rehabilitation (51), outpatient (215), home health (72) and skilled nursing facility (60).
Materials/Methods: An invitation to complete an electronic survey was emailed to physical therapists from 5 states across the U.S. Response data were collected and stored in a Research Electronic Data Capture (REDCap) database. Eligibility for this analysis included therapists who had treated at least one client with stroke in the last 3 months.
Results: Out of 32,544 invitations sent, 1,209 therapists completed the survey (3.7%), of whom 476 were eligible for this analysis. While 87.3% of therapists agreed that AE should be incorporated into stroke rehabilitation, only 51.6% said they do so with more than half of their clients with stroke. Therapists reported several institutional barriers to AE, including lack of exercise equipment (42.0%), time (34.5%) and short length of stay (34.0%). Lack of monitoring equipment was also identified as a limiting factor by 30.5% of skilled nursing facility therapists and 25.0% of home health therapists. Leading patient characteristics that limited AE use included inability to exercise at a training level (67.5%), cognitive/perceptual impairments (64.2%), fatigue (49.6%), reduced motivation (49.1%), balance impairments (43.5%), older age (42.5%) and low current fitness level (42.2%). Low physical activity prior to stroke was also identified as a limiting factor by 51.3% of acute care therapists and 45.1% inpatient rehabilitation therapists. The main safety issues limiting AE use were concerns about medical stability (48.4%) and cardiac status (40.6%).
 Conclusions: These results suggest a discrepancy between the desired and actual use of AE for clients with stroke. Although the sample size and response rate limit the generalizability of the findings, identification of barriers can be helpful in developing resources to educate therapists and institutional administrators on current best practices for safe and effective AE prescription post stroke.
Clinical Relevance: The barriers identified in this study may prevent physical therapists from using AE for clients with stroke. Future studies should investigate AE program development and implementation, exercise monitoring, screening guidelines and time-effective training methods for persons with stroke.
Citation:
Dunning, Kari , PT, PhD; Boyne, Pierce , PT, DPT, NCS; Billinger, Sandra , PT, PhD, FAHA; MacKay-Lyons, Marilyn , PT, PhD; Barney, Brian , BS. Utilization of Aerobic Exercise in Stroke Rehabilitation: A Survey Study of U.S. Physical Therapists.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online. https://u.osu.edu/ivstep/poster/abstracts/005-dunning-et-al/