The acceptability of and adherence to a high-dose walking booster program after stroke (HiWalk): a multi-method study of stroke survivors’ experiences nested within a randomised controlled trial

PURPOSE: To evaluate the acceptability of a high-dose walking booster program for community-dwelling stroke survivors by examining adherence and identifying barriers and facilitators to participation. The program was a short duration, high-dose motor training program for walking, delivered up to three hours daily over three weeks. MATERIALS AND METHODS: A multi-method study was conducted parallel to a Phase II randomised trial (HiWalk). Adherence to the program was measured using attendance and repetition counts. Nineteen participants from the experimental group were interviewed using a schedule informed by the Theoretical Framework of Acceptability (TFA). Interviews were thematically analysed to interpret acceptability of the program. RESULTS: Participants attended 91% (SD 13) of sessions and averaged 567 repetitions per hour (SD 171). Qualitative data indicated program acceptability, with participants recommending the program to peers. Participants reported facilitators for the high-dose walking booster program included the opportunity to attend (Intervention Coherence), strong motivation (Affective Attitude) and support networks (Burden). Barriers described included fatigue (Burden) and competing life responsibilities (Opportunity Cost). CONCLUSIONS: HiWalk was acceptable to stroke survivors, supported by high adherence to the program. Despite barriers including fatigue and managing life responsibilities, participants were motivated to attend HiWalk and felt it was worthwhile. Implications for RehabilitationStroke survivors demonstrated high levels of adherence to a high-dose, short duration walking booster program.Stroke survivors expressed a strong desire to address walking related goals and viewed a high-dose walking booster program as an opportunity to work on these goals.Stroke survivors reported that support of therapists, family and carers helped them participate in the program.Some of the barriers to the high-dose walking booster program were addressed by the therapists tailoring the program to stroke survivor physical ability and fatigue levels.Advanced scheduling of the high-dose walking booster program allowed stroke survivors to manage the time commitment of the program with life roles and responsibilities.