Opening the Black box of Self-Directed Exercise after Stroke

Abstract

Introduction: Delivering the intensity of exercise required to promote upper limb recovery after stroke is challenging within resource limited health systems. Self-directed exercise may be a way of increasing rehabilitation intensity. Developing an understanding of the hows, whys, and in what contexts self-directed upper limb therapy is successfully prescribed and performed is key to developing implementable interventions, and potentially supporting those that already exist.

Method: We are undertaking a realist review to identify and test, (1) What supports and constrains people doing self-directed upper limb exercise after stroke, (2) How, why and in what context and for whom it improves outcomes. A realist review differs from a traditional systematic review in that it focuses on an explanation of an intervention’s causal mechanisms and how they work in different contexts, as well as its outcomes. Consisting of two phases, Phase 1 involves identifying stakeholder theories about self-directed upper limb exercise from the literature. We have searched Embase, CINAHL, PEDro, PsycINFO, Epistemonikos, TRIP database, trade journals (e.g., Frontline, OTnews) and Google. In Phase 2, we will test these theories, allowing them to be refined, refuted or confirmed, using empirical evidence from databases and websites appropriate to the theory being tested. As an iterative process, areas of focus will develop dependent upon the theories found and based on stakeholder consultation.

Results: N/A

Conclusion: The resulting programme theory and logic model for self-directed exercise after stroke will be further refined through fieldwork, providing the basis for co-design of a toolkit to support self-directed exercise.