Barriers to Adherence to Post-stroke Exercise Program: A Qualitative Study into the Experiences of Patients with Stroke

Abstract

Background and objective: Approximately one-third of stroke patients remain disabled and post-stroke rehabilitation is required. Adherence to an exercise rehabilitation program is considered an important area of interest in the wake of optimizing long-term participation in physical activities after stroke. This study aims to explore the barriers to adherence to exercise program among post-stroke patients.
Methods: A qualitative study was conducted in the Physiotherapy units of Hawler and Rizgary Teaching Hospitals, Erbil, the Kurdistan Region of Iraq including twelve post-stroke participants with limited/ inadequate adherence to a post-stroke exercise program schedule from March to December 2018. Data was collected through face-to-face interviews. All of the interviews were conducted at a time and place that was the most convenient for the participants. Within two months, the categories emerging from the analysis of the inter-views began to repeat, and no new categories emerged, leading to an enrollment of 14 participants. One month after the first interview, the second interview was conducted which included 12 participants. This was done to confirm their previous answers and ensuring that there were no new concepts about this limited adherence. Software for Qualitative Data Analysis was used for managing the data.
Results: More than half of the participants were over 70 years old, male, illiterate, married, and housekeepers from urban areas. Most of the participants had an ischemic stroke for more than four weeks. The barriers to adherence to post-stroke exercise program were categorized into the four main categories of the barriers related to environment and facility, personal (physical and psychological) factors, organizational policies, and contents of exercise program.
Conclusion: Barriers to adherence are different in nature. Environmental barriers and lack of facilities show that a well-organized rehabilitation program in health care system at directorate of health-Erbil is very important to improve and facilitate adherence...