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Item Person-centred goal setting for exercise after stroke(Queen Margaret University, Edinburgh, 2014) Sugavanam, Thava PriyaClinical guidelines and policies recommend exercise after stroke. Person-centred goal setting may facilitate the uptake and maintenance of physical activity. The aim of this work was to design and evaluate a goal setting intervention in an exercise after stroke setting. Five interlinked studies were undertaken within the development and feasibility stages of the MRC framework of complex interventions. A systematic review examined 17 observational studies (11 quantitative, six qualitative) for the effects and experiences of goal setting in stroke rehabilitation (study one). Despite some positive effects, no firm conclusion could be reached regarding its effectiveness. Patients and professionals differed in their experiences. Barriers to goal setting outnumbered facilitators. The lack of a standardised goal setting method in stroke rehabilitation was highlighted. A goal setting intervention tailored to exercise after stroke was developed in study two, based on: findings from study one, Bandura’s Social Cognitive Theory and the Canadian Occupational Performance Measure. The intervention components were: dedicated time, patient education, patient involvement, regular follow-up, and a purpose-designed workbook. This intervention was piloted in study three alongside validation of the activPAL™ activity monitor with 12 stroke survivors. The intervention did not require modification. Only two variables of the activPAL™ (time spent in sitting and upright) had acceptable validity and reliability. Feasibility of the intervention and users’ experiences were investigated in study four with four stroke survivors, using mixed methods case studies. Intervention delivery and compliance were acceptable with no adverse effects. Findings regarding acceptability and content suggested a need for further work. Participants’ interest and engagement in goal setting were influenced by their familiarity with goal setting, interest in physical activity, functional ability and levels of self-efficacy, highlighting the individualisation required within goal setting. Experiences of exercise professionals involved in exercise after stroke regarding goal setting were explored in study five through three focus groups (n=6; n=6; n=3). Although goal setting was viewed positively, participants felt that its potential effectiveness was not always translated into practice due to barriers encountered: clients’ readiness to change, professionals’ lack of knowledge about stroke and a number of organisational factors. Suggestions to improve goal setting in practice were discussed. This work has enhanced our understanding of goal setting as a complex intervention. Recognition of the potential benefits of goal setting by both service users and providers, amidst the challenges, argues in favour of goal setting in the exercise after stroke setting. Areas for further research have been discussed.Item A study of a home exercise programme for community dwelling people with late stage stroke(Queen Margaret University, 2011) Baer, GillBACKGROUND Many people living with chronic stroke are not involved in any form of ongoing rehabilitation, despite having ongoing impairments and limitations in activity and participation. The approach to structuring practice of functional tasks, as part of ongoing rehabilitation, can incorporate diverse techniques. Current texts advocate that physiotherapists construct stroke rehabilitation programmes that incorporate Motor Learning principles, however the evidence to support this is limited. No evidence related to stroke exists as to whether functional tasks should be practised in their entirety (whole practice) or in component parts (part practice). The primary aim of the work reported in this thesis was to investigate the effects of a home exercise programme based on Motor Learning principles of part practice (PP) or whole practice (WP) of selected functional tasks for people at least six months after a stroke. METHODOLOGY A single blind, randomised controlled trial was undertaken, with participants allocated to either a part practice experimental group (PP), a whole practice experimental group (WP) or a control (Con) group. Both experimental groups followed a four week exercise intervention programme of functional tasks based on PP or WP. Outcome measures were undertaken at baseline, at the end of a four week intervention (wk 4), at short-term follow-up (wk 4.5) and at long-term follow-up (wk 16). Outcome measures utilised were the Barthel Index (BI), Motor Assessment Scale (MAS), Timed Up and Go over 2 metres (TUG2m), Step Test, Frenchay Arm Test (FAT), Hospital Anxiety and Depression Scale (HADS), Frenchay Activities Index (FAI)and the Stroke Impact Scale (SIS). Differences between the groups at each measurement point were examined using a Kruskal Wallis test. Differences within each group over time were analysed using a Friedman's Anova, followed up by a Wilcoxon's Signed Ranks test using a Bonferroni correction where a significant difference was found. RESULTS Sixty four people with late-stage stroke were recruited and provided informed consent. Data were available for analysis for 60 participants (median time since stroke 21 months). No statistically significant differences were found between the three groups at any point for any of the dependent outcome variables. A number of statistically significant within group changes were found in all groups. Most statistically significant changes were demonstrated by PP including on the BI from baseline to wk 4.5; on the MAS from baseline to weeks 4, 4.5 and 16; on the Step Test from baseline to weeks 4, 4.5 and 16 and on the FAT from baseline to week 4. On more global measures the PP group reported statistically significant improvements on the SIS in the domains of strength, mood and mobility from baseline to wk 4; and in the SIS participation domain from baseline to wk 16; as well as a statistically significant within group improvements on FAI from baseline to wk 4. CONCLUSIONS People with late-stage stroke demonstrated capacity for improvements in a number of measures of impairment, activity, participation and mood. The PP group demonstrated improvements, over time, in more of the outcome measures relating to physical ability than either WP or Con groups. Implications for clinical practice and further research are discussed.