Influences on Physical Activity After Stroke: Understanding Patient Perceptions and Practices in an Urban Underserved Setting
Imama Naqvi1, Keri Fisher2, Kevin Strobino1, Carmen Castillo1, Adriana Arcia3, Clare Bassile4, Mitchell Elkind1, Ian Kronish1, Lori Quinn2
1Columbia University, 2Teachers College, Columbia University, 3Hahn School of Nursing and Health Science, 4Columbia University, Programs in Physical Therapy
Objective:
We sought to understand influences on PA from stroke patients who reside in an urban underserved community
Background:
PA facilitates recovery after stroke. Yet, significant gaps exist between professional guidelines and practice among patients discharged home after a minor stroke. Stakeholder perspectives are needed to inform implementation and sustainably improve outcomes.
Design/Methods:
We conducted structured qualitative interviews with a purposive sample of minor stroke patients (n=14) discharged home from a comprehensive stroke center. We assessed knowledge of recommendations, and perceived barriers and facilitators influencing PA for community reintegration. Social Cognitive Theory framework informed a deductive approach. Socio-demographics and patient-reported surveys included the International Physical Activity Questionnaire (IPAQ) and Patient Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF) Short Form.
Results:
Participants included 57% Black, 29% Hispanic and 50% women with mean age 58.9 (±9.6) yrs. A third had ≤ high school education, and 43% had Medicaid or no insurance. PROMIS-PF mean score was less than average at 44.6 (10.1) but 46% self-reported high PA levels in the IPAQ. We identified three key themes as influencing PA: 1. Positive outcome expectations for PA, either affective, social or physical, 2. Self-efficacy: confidence to navigate socio-structural barriers, and 3. Agency: being in charge of own actions, out of necessity or by choice. While all participants identified PA with recovery, there was limited knowledge of recommended goals and target levels. Psychological needs of autonomy were tied to environmental barriers specific to urban living such as navigating stairs, or neighborhood crime risk. Low balance confidence was the most stated barrier to PA participation in the community, with two-thirds reporting fear of falling after returning home.
Conclusions:
Positive outcome expectations, self-efficacy, and agency influence PA after minor stroke. However, gaps in patients’ knowledge together with environmental barriers such as perceived safety walking in the street must be addressed to improve outcomes.