Altering the rehabilitation environment to improve stroke survivor activity (AREISSA): Patient perception of activity during environmental enrichment.

Background: Use of environmental enrichment significantly improves sensorimotor recovery in experimental stroke. The AREISSA trial, a multi-site (N=4), cluster, cross-over trial, determined whether a patient-driven model of environmental enrichment reduced stroke survivor inactivity and was safe in the clinical setting. Aim(s): This qualitative sub-study within AREISSA sought to describe stroke survivor perceived barriers and enablers to engaging in activity during rehabilitation in a site that had implemented a patientdriven model of environmental enrichment. Method(s): The environmental enrichment under investigation in AREISSA included access to communal and individual physical, cognitive and social stimulation. Face to face semi-structured interviews were conducted (by a speech pathologist) with stroke survivors (n=31) following discharge from rehabilitation. Descriptive content qualitative methods using thematic analysis were used. Result(s): Seven main themes arose: (i) poor communication between staff and patients regarding activity options limits awareness and subsequent engagement, (ii) family provides lots of support and facilitates engagement, (iii) stroke related disability limits capacity for activity, (iv) personal preferences, beliefs and personality types influence activity choice, (v) socialisation (involving patients, visitors and staff) promotes activity, (vi) hospital rules, real or perceived can limit activity, and (vii) wayfinding and hospital layout has an effect on engagement. Conclusion(s): Stroke survivor heterogeneity (stroke & personality related factors), hospital culture and the built environment were perceived to impede activity in an enriched rehabilitation environment. Future iterations of this model of environmental enrichment must address these barriers and build in greater involvement of family and opportunities for socialisation.