Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.
Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India.
BMJ Open. 2022 Jan 6;12(1):e055946. doi: 10.1136/bmjopen-2021-055946.
To develop a set of strategies to enhance adherence to home-based exercises after stroke, and an overarching framework to classify these strategies.
We conducted a four-round Delphi consensus (two online surveys, followed by a focus group then a consensus round). The Delphi panel consisted of 13 experts from physiotherapy, occupational therapy, clinical psychology, behaviour science and community medicine. The experts were from India, Australia and UK.
In round 1, a 10-item survey using open-ended questions was emailed to panel members and 75 strategies were generated. Of these, 25 strategies were included in round 2 for further consideration. A total of 64 strategies were finally included in the subsequent rounds. In round 3, the strategies were categorised into nine domains-(1) patient education on stroke and recovery, (2) method of exercise prescription, (3) feedback and supervision, (4) cognitive remediation, (5) involvement of family members, (6) involvement of society, (7) promoting self-efficacy, (8) motivational strategies and (9) reminder strategies. The consensus from 12 experts (93%) led to the development of the framework in round 4.
We developed a framework of comprehensive strategies to assist clinicians in supporting exercise adherence among stroke survivors. It provides practical methods that can be deployed in both research and clinical practices. Future studies should explore stakeholders' experiences and the cost-effectiveness of implementing these strategies.
制定一套提高脑卒中后居家锻炼依从性的策略，并构建一个总体框架对这些策略进行分类。
我们进行了四轮德尔菲共识（两轮在线调查，随后进行焦点小组讨论和共识轮次）。德尔菲小组由来自物理治疗、职业治疗、临床心理学、行为科学和社区医学领域的 13 名专家组成。专家来自印度、澳大利亚和英国。
在第一轮中，通过电子邮件向小组发送了一份包含开放式问题的 10 项调查，共产生了 75 项策略。其中，25 项策略被纳入第二轮进一步考虑。随后的几轮共纳入了 64 项策略。在第三轮中，这些策略被分为九个领域：（1）患者对中风和康复的教育，（2）运动处方方法，（3）反馈和监督，（4）认知矫正，（5）家庭成员的参与，（6）社会的参与，（7）增强自我效能，（8）激励策略，（9）提醒策略。12 名专家（93%）的共识导致了第四轮框架的制定。
我们开发了一个综合策略框架，以帮助临床医生支持中风幸存者的锻炼依从性。它提供了可以在研究和临床实践中应用的实用方法。未来的研究应该探索利益相关者的经验以及实施这些策略的成本效益。
