|dc.contributor.author||Nicholson, Sarah Louise||en
Globally stroke remains the leading cause of adult disability. An aging population
and a reduction in stroke case fatality has led to an increasing number of people
living with stroke i.e. stroke survivors. The ability to perform important day-to-day
activities, such as walking and housework, is frequently impaired in stroke survivors.
Therefore, it has become essential to address the long-term needs of stroke survivors,
prompting focussed research on life after stroke.
A reduction in physical fitness after stroke may contribute to stroke related disability.
It is possible to improve physical fitness by regular, structured physical activity.
Improving physical fitness after stroke and increasing physical activity are aspects of
life after stroke that are increasingly being researched. Although the evidence base
for the benefits of physical fitness training is growing, research has indicated that
benefits gained are not always maintained at follow-up. To facilitate the uptake and
maintenance of physical activity after stroke, it is essential to understand why many
stroke survivors do not undertake regular physical activity. Understanding this
difficult concept will enable the tailoring of behaviour change interventions to
promote and maintain physical activity after stroke. However, there has been limited
work in developing theory driven behaviour change interventions to increase
physical activity in stroke survivors.
Therefore, the aim of this thesis was to develop and test a behaviour change
intervention to increase physical activity after stroke. Methods
In order to address the above aim, six interlinking studies were conducted within the
development and feasibility stages of the MRC framework for the development of
complex interventions. A systematic review (study one) examined barriers and
facilitators to physical activity perceived by stroke survivors. This study showed a
lack of literature in this area, and that the already published studies had limited
generalisability to the UK stroke population. Therefore, it was deemed appropriate to
conduct a qualitative study (study two) to examine the perceived barriers and
facilitators to physical activity in the local stroke population. Both studies one and
two highlighted the influence of self-efficacy towards increasing physical activity.
As part of earlier work conducted prior to this PhD, there was previously unanalysed
data on perceived barriers and facilitators to physical activity after stroke. These
quantitative data encompassed specific questions exploring self-efficacy and
intention to physical activity post stroke. In light of the evidence it was deemed
necessary to analyse these data (study three). It was envisaged that the behaviour
change intervention would incorporate a feedback device, so participants could
clearly see how much daily physical activity they were undertaking. An opportunity
arose to collaborate with a team at Newcastle University who had developed an
accelerometer that incorporated an immediate feedback screen. Therefore, a device
validation study was conducted as study four. Results from studies one to four were
combined, with the use of the Theoretical Domains Framework, and the behaviour
change intervention was developed. Two uncontrolled pilot studies (studies five and
six) were conducted to determine the feasibility and acceptability of the behaviour
change intervention to the stroke population. Results
The systematic review included six articles, providing data on 174 stroke survivors.
Commonly reported barriers were environmental factors, health concerns and stroke
impairments. Commonly reported facilitators were social support and the need to be
able to perform daily tasks. Qualitative interviews were conducted with 13 stroke
survivors, at which point data saturation was reached. The most commonly reported
TDF domains were ‘beliefs about capabilities’, ‘environmental context and
resources’ and ‘social influence’. The quantitative study provided data from 50
stroke survivors. Intention and self-efficacy were high, with self-efficacy graded as
either 4 or 5 (highly confident) on a five-point scale by [34 (68%)] participants,
whilst 42 (84%) participants “strongly agreed” or “agreed” that they intended to
increase their walking after their stroke.
Ten participants were recruited to validate the new accelerometer. Mean time since
stroke was 29 days (SD =27.9 days). The 10 participants walked a mean distance of
245 meters (SD=129m) and their mean walking speed was 0.79ms-1 (SD=0.34ms-1).
The Culture Lab were unable to develop the accelerometer in the necessary time
frame and therefore no accelerometer was available for trialling the behaviour
change intervention. Therefore, pedometers were used to record step count during the
behaviour change intervention.
A total of four participants took part in the 12 week behaviour change intervention,
over two study periods. All participants managed to increase their step counts during
this time. The studies had problems both with recruitment and retention of
participants. These issues have been discussed. Conclusions
This work has enhanced the understanding of the barriers and facilitators perceived
by stroke survivors to increase physical activity. This work has allowed the
development of a theoretically driven, complex behaviour change intervention that
was successfully trialled with a small group of stroke survivors. Areas of further
research have been discussed.||en
|dc.publisher||The University of Edinburgh||en
|dc.relation.hasversion||NICHOLSON, SL., GREIG, CA., SNIEHOTTA, F., JOHNSTON, M., LEWIS, SJ., MCMURDO, MET., JOHNSTON, D., SCOPES, J. and MEAD, GE. 2017. Quantitative data analysis of perceived barriers and motivators to physical activity in stroke survivors. J R Coll Physicians Edinb. 47, 231-236||en
|dc.relation.hasversion||NICHOLSON, SL., DONAGHY, M., JOHNSTON, M., SNIEHOTTA, FF., VAN WIJCK, F., JOHNSTON, D., GREIG, C., MCMURDO, MET. and MEAD, G. 2013. A qualitative theory guided analysis of stroke survivors' perceived barriers and facilitators to physical activity. Disabil Rehabil. 36, 1857-68||en
|dc.relation.hasversion||FIELD, MJ., GEBRUERS, N., SUNDARAM, TS., NICHOLSON, S. and MEAD, G. 2013. Physical Activity after Stroke: A Systematic Review and Meta-Analysis. ISRN Stroke, Article ID 464176. doi:10.1155/2013/464176||en
|dc.relation.hasversion||NICHOLSON, S., SNIEHOTTA, FF., VAN WIJCK, F., GREIG, CA., JOHNSTON, M., MCMURDO, MET., DENNIS, M. and MEAD, GE. 2013. A systematic review of perceived barriers and motivators to physical activity after stroke. Int J Stroke. Jul;8(5):357-64. doi: 10.1111/j.1747- 4949.2012.00880.x.||en
|dc.relation.hasversion||CARROLL, S., SNIEHOTTA, F., VAN WIJCK, F., GREIG, C. and MEAD, G. UK Stroke Forum. A systematic review of perceived barriers and motivators to physical activity after stroke. November 2011. International Journal of Stroke. Special Issue: UK Stroke Forum 2011 Abstracts, 29 November 2011–1 December 2011, Volume 6, Issue Supplement s2, pages 66–68, December 2011||en
|dc.title||Development and testing of a behavioural change intervention to increase physical activity, predominantly through walking, after stroke||en
|dc.type||Thesis or Dissertation||en
|dc.type.qualificationname||PhD Doctor of Philosophy||en