Physiotherapists’ use of aerobic exercise during stroke rehabilitation: a qualitative study using chart-stimulated recall

We aimed to explore the factors that affected physiotherapists’ use of aerobic exercise during stroke rehabilitation for people with stroke. We conducted a qualitative descriptive study using thematic analysis informed by a pragmatic worldview. Physiotherapists attended one on one semi-structured interviews to answer some general questions about aerobic exercise and then discussed the charts of their four most recently discharged clients with stroke. Both deductive and inductive coding were used for analysis. Ten physiotherapists participated. Healthcare policies and limited resources were mostly discussed in general questions while specific profiles of clients with stroke, their goals and preferences were mostly discussed in patient specific questions. Three themes were identified: (1) physiotherapists’ perspectives and practices regarding aerobic exercise; (2) profiles of people with stroke, as well as their goals and their exercise modality preferences; and (3) influence of health system priorities, rehabilitation intensity policy, and resources. Physiotherapists’ behaviours regarding use of aerobic exercise for people with stroke are not a binary behaviour of prescribing or not prescribing aerobic exercise. Their behaviours are better understood on a continuum; between two ends of not prescribing aerobic exercise, and prescribing aerobic exercise with defined intensity, duration, and frequency. Aerobic exercise employment in day to day practice is not a binary behaviour rather, not prescribing aerobic exercise for any client is on one end of the continuum, and prescribing aerobic exercise with sufficient intensity, duration, and frequency to improve cardiorespiratory fitness for any client is on the other end.Aerobic exercise was often less of a priority in stroke rehabilitation because physiotherapists took clients’ physical, cognitive, and social factors, along with their goals into account.We suggest improving the practicality of guidelines by including clients’ preferences and providing adequate instructions on tailoring the care to the clients’ needs and preferences. Aerobic exercise employment in day to day practice is not a binary behaviour rather, not prescribing aerobic exercise for any client is on one end of the continuum, and prescribing aerobic exercise with sufficient intensity, duration, and frequency to improve cardiorespiratory fitness for any client is on the other end. Aerobic exercise was often less of a priority in stroke rehabilitation because physiotherapists took clients’ physical, cognitive, and social factors, along with their goals into account. We suggest improving the practicality of guidelines by including clients’ preferences and providing adequate instructions on tailoring the care to the clients’ needs and preferences.