title: Similar barriers and facilitators to physical activity across different clinical groups experiencing lower limb spasticity.
abstract: Purpose Given the importance of physical activity in maintaining health and wellness, an improved understanding of physical activity patterns across different clinical populations is required. This study examines the facilitators for, and barriers to, participation in physical activity across multiple contexts for three clinical groups with chronic lower limb spasticity (individuals with stroke, multiple sclerosis and incomplete spinal cord injury). Method This cross-sectional study employed quantitative measures for spasticity, ankle range of motion, pain, falls, cognition, mobility, and physical activity as well as qualitative semi-structured interviews. Results There were similar impairments in body functions and structures and limitations in activities across the clinical groups. These impairments and limitations negatively impacted participation in physical activity, which was low. Environmental and personal factors exacerbated or mitigated the limiting effects of body functions and structures and activities on physical activity in many areas of life. Conclusions In this population, participation in physical activity includes activities such as housework which are different than what is typically considered as physical activity. Further, the presence of similar barriers and facilitators across the groups suggests that support and services to promote valued forms of physical activity could be organised and delivered based on limitations in mobility and functioning rather than clinical diagnosis. Implications for rehabilitation Physical activity is of utmost importance in maintaining health and wellness in clinical populations. This research highlights the desired and actual physical activity for these populations can look different than what may traditionally be considered as physical activity (e.g. housework is not typically considered participation physical activity). Therefore, rehabilitation interventions need to be directly designed to enhance clients' ability to perform these activities and these activities should be an integral focus of ongoing physical activity programs. Individuals who have lower limb spasticity shared similar impairments in body structures and functions and limitations in activities across the clinical groups and these impairments and limitations negatively impacted participation in physical in a similar way in all groups. Further, the environmental and personal factors exacerbated or mitigated the limiting effects of body functions and structures and activities on physical activity in many areas of life in a similar way in all groups. The presence of similar barriers and facilitators across the clinical groups suggests that rehabilitation assessment and treatment as well as support and services to promote valued forms of physical activity could be organised and delivered based on limitations in mobility and functioning rather than clinical diagnosis. This work affirms that a mixed methods research approach is critical for completely understanding the complexities of the barriers and facilitators engaging in physical activity across clinical groups, including multiple sclerosis, stroke, and incomplete spinal cord injury who have chronic lower limb spasticity.
authors.affiliation: a School of Exercise Science, Physical and Health Education , University of Victoria , Victoria , British Columbia , Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Hundza
authors.affiliation: b Queen Alexandra Spasticity Clinic , Vancouver Island Health Authority , Victoria , British Columbia , Canada.
authors.forename: Caroline
authors.initials: C
authors.lastname: Quartly
authors.affiliation: a School of Exercise Science, Physical and Health Education , University of Victoria , Victoria , British Columbia , Canada.
authors.forename: Jasmine M
authors.initials: JM
authors.lastname: Kim
authors.affiliation: b Queen Alexandra Spasticity Clinic , Vancouver Island Health Authority , Victoria , British Columbia , Canada.
authors.forename: James
authors.initials: J
authors.lastname: Dunnett
authors.affiliation: a School of Exercise Science, Physical and Health Education , University of Victoria , Victoria , British Columbia , Canada.
authors.forename: Jill
authors.initials: J
authors.lastname: Dobrinsky
authors.affiliation: a School of Exercise Science, Physical and Health Education , University of Victoria , Victoria , British Columbia , Canada.
authors.forename: Iris
authors.initials: I
authors.lastname: Loots
authors.affiliation: a School of Exercise Science, Physical and Health Education , University of Victoria , Victoria , British Columbia , Canada.
authors.forename: Kim
authors.initials: K
authors.lastname: Choy
authors.affiliation: a School of Exercise Science, Physical and Health Education , University of Victoria , Victoria , British Columbia , Canada.
authors.forename: Brayley
authors.initials: B
authors.lastname: Chow
authors.affiliation: b Queen Alexandra Spasticity Clinic , Vancouver Island Health Authority , Victoria , British Columbia , Canada.
authors.forename: Alexis
authors.initials: A
authors.lastname: Hampshire
authors.affiliation: a School of Exercise Science, Physical and Health Education , University of Victoria , Victoria , British Columbia , Canada.
authors.forename: Viviene A
authors.initials: VA
authors.lastname: Temple
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D015444:Exercise; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D035002:Lower Extremity / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000209:etiology / Q000503:physiopathology* / Q000534:rehabilitation; D055815:Young Adult
keywords: Multiple sclerosis; participation; physical activity; spasticity; spinal cord injury; stroke