Developing a Stroke Rehabilitation Exercise Adherence Measure:

StREAM
Jessica Bollen
1&2
, Victoria Goodwin
1&2
, Richard J Siegert
3
, Sarah G Dean
1&2
Background
There is a paucity of self-report adherence measures for exercise based rehabilitation that have been
tested for their reliability and validity
1
. Due to the potential positive effect that stroke rehabilitation
can have when adhered to
2
, this condition was targeted for measure development.
What has been done so far...
Semi-structured interviews were conducted with 16 stroke survivors (F=7, M=9) and five exercise
trainers or physiotherapists (F=4, M=1). Interviews were conducted over the period of one year
(August 2012-July 2013) until data saturation was reached. The interviews were then analysed using a
combination of modified Grounded Theory and Thematic Analysis to determine the pertinent issues
relating to adherence. Verbatim phrases were selected and wording was changed only when necessary.
These phrases were then considered by a focus group to identify which items they thought would be
the most relevant in a measure regarding adherence; what they understood the items to mean and;
how would they like to respond to the items- a dichotomous or Likert based scoring system.
What will this mean?
If this measure proves to be valid and reliable, it will provide clinicians with a questionnaire to give to
stroke survivors which should help provide a more accurate way to ascertain how much of their
exercise programmes are being completed. If their patient appears to be non adherent, interventions
can then be put in place to hopefully improve their levels of adherence and thus, their outcome.
1
University of Exeter Medical School
2
Peninsula Collaboration for Leadership in Applied Health Research and Care
3
Auckland University of Technology
References;
1
Bollen et al under review.
2
Naci H, Ioannidis JPA. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. BMJ 2013;347 doi: 10.1136/bmj.f5577[published Online First: Epub Date]|.
3
Terwee CB, Bot SD, de Boer MR, et al. Quality criteria were proposed for measurement properties of health status questionnaires.
Journal of clinical epidemiology 2007;60(1):34-42 doi: 10.1016/j.jclinepi.2006.03.012[published Online First: Epub Date]|.
This is a summary of independent research funded by the National Institute for Health Research (NIHR) Collaboration for Leadership for Applied Health Research and Care (CLAHRC) South West Peninsula (PenCLAHRC). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHRor the Department of Health.
Formatting
The questionnaire was formatted
to look professional and
appealing to fill in. The number of
items in the draft measure
totalled 70. Based on feedback
from the focus group a five point
Likert scale was selected ranging
from strongly disagree to
strongly agree and items with
double negatives and more than
one interpretation were
removed.
ensure that the questionnaire is brief, reliable and unidimensional with interval measurement
categories. It will also be possible to assess whether people, regardless of gender or age, respond in
the same way to items depending on how adherent they are. Structural equation modelling, using the
adjunct measurement data, will be undertaken with the second stage questionnaires to examine
possible causal relationships and test hypothesis relating to what factors influence adherence.
What next...
The draft measure will be
disseminated in two stages to 300
and 200 participants respectively.
The questionnaires in the second
stage will be accompanied with
adjunct measures relating to
fatigue, QoL and depression. On
the return of completed measures
the content validity, internal
consistency, construct validity,
reliability and floor and ceiling
effects will be established
3
. Rasch
analysis will be conducted to