Influences on the physical activity behaviour of inpatients after stroke outside of staff-led rehabilitation sessions: a systematic review.

Objective: To use behavioural science frameworks to synthesise evidence on the factors influencing physical activity of patients hospitalised after stroke outside of staff-led rehabilitation sessions.

Data sources: A systematic review of qualitative and mixed-methods studies. MEDLINE, PsycINFO, CINAHL, and AMED were searched from inception to October 2024 for studies that explored influences on the physical activity of patients hospitalised after stroke.

Review methods: Data were coded with reference to the Theoretical Domains Framework and the COM-B ('capability', 'opportunity', 'motivation' and 'behaviour') model. Thematic analysis was used to group data extracts into themes within each Theoretical Domains Framework domain. Risk of bias was assessed using the Mixed Methods Appraisal Tool.

Results: We identified 17 studies. There was no significant risk of bias concerns. We identified 19 themes across eight Theoretical Domains Framework domains and all COM-B model categories. The most frequently recognised themes were found in three Theoretical Domains Framework domains: Environmental Context and Resources (themes: 1 -- availability of sufficient skilled staff to facilitate physical activity; 2 - design and use of the physical environment; 3 - lack of opportunities or incentives; 4 - passivity and institutionalisation; 5 - perceived and actual rules and culture of the ward); Skills (theme: physical impairments); and Social Influences (theme: activity influenced by family and friends).

Conclusions: The review highlights the complexity of the influences on the physical activity of patients hospitalised after stroke outside of staff-led rehabilitation sessions. It is likely multi-component interventions addressing a number of influences will be required to effectively improve physical activity. PROSPERO ID: CRD42022383506.