Experiences of an Exercise Referral Scheme from the perspective of people with chronic stroke: a qualitative study

Abstract

Introduction: Following stroke, physical activity is important to maximise recovery. Increasingly, patients are referred to Exercise Referral Schemes (ERS). Numerous studies have demonstrated the effectiveness of group exercise, but there is a lack of data on user views. This qualitative study aimed to explore the experience of an ERS by people with chronic stroke. Method: Located within the constructivist paradigm, this study focused on individual participants' values and meanings. Non-random sampling identified important sources of knowledge. Inclusion criteria were diagnosis of stroke and previous participation in a neuro-specific ERS in South London. Semi-structured interviews were transcribed verbatim and thematically analysed in a rigorous manner, incorporating respondent validation, peer checking of support for themes and reflexivity. Results: Nine community-dwelling adults participated (mean age 51, range 37-61 years; time post stroke 1-4 years). Following the ERS, all participants experienced improved physical and psychological well-being and associated ERS with increased physical activity participation, physical improvement, more internalised perceptions of control and improved confidence. Participants believed the ERS instigated subsequent improvements in lifestyle, work and social roles. Thus, the master theme 'One small step on the treadmill- one giant leap towards independence' emerged, encompassing descriptions of the ERS as a pivotal stage in regaining independence. Discussion: This exploratory study demonstrates the value of evaluating user views. These should be assessed alongside physical and psychological outcomes in ERS research and service evaluation. Conclusion: This study supports ERS as a method of targeted rehabilitation for people with chronic stroke, through which they can achieve personally-valued improvements towards greater independence.