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BACKGROUND: Intensity refers to the amount of effort or rate of work undertaken during exercise. People receiving rehabilitation after stroke frequently do not reach the moderate to high intensity exercise recommended to maximise gains. OBJECTIVE: To explore the factors that influence the acceptability of, and engagement with, a high intensity group-based exercise programme for people with stroke. METHODS: This qualitative descriptive study included 14 people with stroke who had completed a 12-week, high intensity group-based exercise rehabilitation programme. Semi-structured interviews were used to explore the acceptability of high intensity exercise and the barriers and facilitators to engagement. Interviews were recorded, transcribed and analysed using qualitative content analysis. RESULTS: The participants found high intensity exercise rehabilitation acceptable despite describing the exercise intensity as hard and reporting post-exercise fatigue. Participants accepted the fatigue as a normal response to exercise, and it did not appear to negatively influence engagement. The ease with which an individual engaged in high intensity exercise rehabilitation appeared to be mediated by inter-related factors, including: seeing progress, sourcing motivation, working hard, the people involved and the fit with the person and their life. Participants directly related the intensity of their effort to the gains that they made. CONCLUSIONS: In this study, people with stroke viewed training at higher intensities as a facilitator, not a barrier, to engagement in exercise rehabilitation. The findings may challenge assumptions about the influence of exercise intensity on engagement. [ABSTRACT FROM AUTHOR]

Stroke is a major cause of death and disability in many countries. Early access to the most appropriate medical treatment can improve health outcomes. Despite this, only 30–60% of people who experience a stroke seek medical help within the recommended 3-hour timeframe. This study used open-ended interviews to explore patients’ views on factors that influenced their decision to seek help at the time of stroke. Twenty participants were recruited from five centres: three hospitals, a community-based stroke support service and a primary healthcare service focused on providing health care for Maori. A qualitative methodology drawing on Grounded Theory informed data collection and analysis. Four main themes influenced the decision to seek help: making sense of symptoms, maintaining a sense of normality, presence and influence of another person and perception of medical services. Participants appeared to go through a process of recognition, interpretation and negotiation during their decision-making. Each of the four themes seemed to influence this process, either assisting or delaying help-seeking behaviour. The more time spent going through this process (or repeating each step), the longer the delay appeared to be. Our key findings which add to current help-seeking literature, include: (1) people tended to prioritise everyday commitments and responsibilities over their own health; (2) at times the presence and influence of another person contributed to delays in seeking help; and (3) people had different personal thresholds for when they perceived themselves to be ‘sick enough’ to seek medical help. [ABSTRACT FROM AUTHOR]

Understanding how people adjust following stroke is essential to optimise recovery and ensure services are responsive to people's needs. This study aimed to explore people's experiences over the first three years post-stroke and identify what helped or hindered recovery. As part of a longitudinal, qualitative descriptive study, 55 people and 27 significant others purposefully selected from a population-based stroke incidence study were interviewed 6, 12, 24 and 36 months post-stroke. Interviews were audio taped and transcribed verbatim. Participants described an ongoing process of shock, disruption, and fear, making sense of what happened, needing to fit in with what's offered, finding what works for them and evolving a new normal, whilst managing the ups and downs of life. This process needed to be re-negotiated over time, as people experienced changes in their recovery, comorbidities and/or wider circumstances. The adjustment process continued over the three years post-stroke, even for those who perceived that they were recovering well. Rehabilitation services need to support patients to make sense of their stroke, navigate the health system, address individual concerns and priorities and to know what, when and how much to challenge themselves. Rehabilitation plans need to be revised as circumstances change to facilitate adjustment following a stroke. [ABSTRACT FROM AUTHOR]

Background Qualitative data can add value and understanding to more traditional epidemiological studies. This study was designed to complement the quantitative data from the incidence study the Auckland Regional Community Stroke Study or ARCOS-IV by using qualitative methods to uncover the richer detail of life as a stroke survivor, thereby extending our understanding of the impact of stroke. Aims The aims of the study were to identify how the experience of recovery and adaptation changes over time after stroke; and to elicit the strategies people with stroke and their whānau/family use and find helpful in living life after stroke. The aim of this paper is to describe the methodology and also the challenges and advantages of embedding qualitative research into a large epidemiological study. Methods Longitudinal study utilizing a Qualitative Description design in a subset of those taking part in the incidence study. Participants will be interviewed at 6, 12, 24, and 36 months after stroke. Semistructured interviews will explore three key areas: (1) issues of importance to people following a stroke and their whānau/family; (2) the perceived impact on people's sense of recovery, adaptation, and hopes; and (3) key strategies that people with stroke and their whānau/family use and find most helpful in living life after stroke. Thematic analysis will be conducted using iterative constant comparative methods. Conclusions This methodology paper demonstrates the application of mixed methods in epidemiology. It also considers some of the practical and methodological issues that have emerged and may provide a useful framework for other qualitative projects in population-based studies. [ABSTRACT FROM AUTHOR]