Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
Physical activity and dietary-related behaviors are important for enhancing health and quality of life among adults with stroke, yet the prevalence of these healthy behaviors is low. In this qualitative study, adults with stroke identified how stroke-related physical, cognitive, and sensory deficits impact performance of these healthy behaviors and identified specific adaptive and accessible equipment and compensatory strategies for overcoming these barriers that can be utilized in clinical practice.
Primary Author and Speaker: Ryan Bailey
Contributing Authors: Jennifer Stevenson
PURPOSE: Physical activity and healthy diet are recommended for improving the health, well-being, and quality of life for adults with stroke; yet, prevalences of these healthy behaviors among stroke survivors are low. Understanding barriers and potential facilitators to these healthy behaviors could inform development of health behavior interventions for adults with stroke. Therefore, the purpose of this study was to explore facilitators and barriers to physical activity and dietary-related behaviors among a sample of adults with stroke.
DESIGN: Phenomenological study consisting of adults with stroke and available care-partners. Participants with stroke were recruited from two stroke support groups. Inclusion criteria were aged 30-80 years, >6 months post-stroke, ability to walk >150 feet, community-dwelling, and ability to provide informed consent. Care-partners were encouraged but not required to participate in the study.
METHOD: Recruited participants attended one of four focus groups, and provided data on sociodemographic characteristics and disability (Modified Rankin Scale). Focus groups were audio-recorded and transcribed. An interview guide was used to guide each focus group. Audio transcripts were coded by the PI and a graduate student, and inductive content analysis was used to analyze the data in the identification of key themes. Triangulation of data across focus groups and use of two coders enhance dependability (i.e. reliability) of study findings.
RESULTS: Fifteen adults with stroke and 10 care-partners participated. Participants were mostly male, non-Hispanic White, and married. Most stroke participants reported moderate disability. Three key themes emerged from the data: stroke-related deficits impact healthy behaviors, adaptive/accessible equipment can facilitate healthy behaviors, and compensatory strategies can facilitate healthy behaviors. Stroke-related deficits negatively impact healthy behaviors: physical deficits (hemiparesis, spasticity) make it difficult to walk, exercise, and prepare meals; cognitive deficits (concentration, comprehension) create difficulty problem solving ways to overcome healthy behaviors challenges; and sensory deficits (vision, taste, neglect) impact food preferences and cooking abilities. Participants identified adaptive/accessible equipment as a facilitator of healthy behaviors. For physical activity, accessible gym equipment (NuStep, VitaGlide) was noted. For dietary-related behaviors, participants identified adaptive kitchen equipment (one-handed can opener, rocker knives, cutting board with spikes) to facilitate meal preparation. Finally, compensatory strategies were identified. For physical activity, participants preferred performing daily physical activity (performing ADLs and IADLs) to exercise because it was more feasible and achievable, and chair-based activities (yoga, stretching) and using theraband or weighted objects at home was preferred to going to the gym. For dietary-related behaviors, participants suggested using canned or frozen foods to simplify meal preparation, using spices to flavor food instead of salt and butter, and using compensatory techniques (e.g. prop jar against fridge or leg for stabilization) in the absence of equipment.
CONCLUSION: Participants identified stroke-related deficits that impair their ability to engage in healthy behaviors, and identified adapted/accessible equipment and compensatory strategies for overcoming these deficits. Occupational therapy practitioners can use this first-hand information to inform clinical treatment planning.
IMPACT STATEMENT: Clients with stroke should be instructed in adaptive equipment and compensatory strategies for performing physical activity and dietary-related behaviors.
References
Bailey, R. R., Phad, A., McGrath, R., & Haire-Joshu, D. (2019). Prevalence of five lifestyle risk factors among U.S. adults with and without stroke. Disability Health Journal, 12(2), 323-327. https://doi.org/10.1016/j.dhjo.2018.11.003
Bailey, R. R., Stevenson, J. L., Driver, S., & McShan, E. (2020). Health behavior change following stroke: Recommendations for adapting the Diabetes Prevention Program–Group Lifestyle Balance Program. American Journal of Lifestyle Medicine, 0(0), 1559827619897252. https://doi.org/10.1177/1559827619897252
