Barriers and Facilitators to Aerobic Exercise Testing Practices of Physiotherapists in In-Patient Stroke Rehabilitation Settings Across Canada: A Theory-Informed Web-Based Survey

Abstract

Background and Purpose: Stroke best practice guidelines recommend aerobic exercise (AEx) testing once patients post-stroke are medically stable and before initiating AEx training. This study describes current AEx testing practice of physiotherapists (PTs) in in-patient stroke rehabilitation (SR) and the barriers and facilitators to this practice. Methods: We conducted a cross-sectional web-based survey of registered PTs working in Canadian in-patient SR settings, guided by the Theoretical Domains Framework (TDF). Results: Fifteen of 37 (41%) participants reported conducting AEx testing with people post-stroke. A field test (92%) involving walking was the most commonly used test type. Barriers and facilitators to AEx testing practice from all 14 TDF domains were endorsed. While 73% ( n = 19/26) participants recognized that AEx testing supports therapy goals, over 60% reported lacking maximal and submaximal AEx testing knowledge and skills, and 58% did not perceive AEx testing to be an organizational priority due to the focus on function and mobility during in-patient SR. Discussion and Conclusion: Less than half of participants performed AEx testing despite recognizing its value for people post-stroke. Predominantly, practitioner- and organisation-related factors influenced participants’ use of AEx testing in in-patient SR. An understanding of how PTs can navigate the complex barriers to AEx testing is needed.