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Table 2 Proximal objectives and strategies for programme content

From: Synthesising practice guidelines for the development of community-based exercise programmes after stroke

Proximal objectives & recommended strategies

Ev

count

Au

Ca1

Ca2

Ca3

Ca4

Ca5

Eu

Ne

NZ

SA

Si

UK1

UK2

UK3

US1

US2

US3

US4

US5

[41]

[37]

[42]

[38]

[43]

[1]

[44]

[3]

[48]

[36]

[49]

[45]

[47]

[35]

[39]

[40]

[34]

[2]

[46]

1

Increase muscle strength

 

10

X

 

X

 

X

  

X

X

  

X

 

X

X

X

 

X

 
 

a. Lower limb strengthening

1

8

  

X

 

X

X

 

X

     

X

 

X

X

X

 
 

b. Upper limb strengthening

1

10

 

X

X

 

X

X

 

X

   

X

 

X

 

X

X

X

 
 

c. Trunk and core muscle strengthening

2

3

  

X

          

X

 

X

   

2

Increase aerobic endurance

 

12

 

X

X

 

X

X

X

X

X

  

X

 

X

X

X

 

X

 
 

a. Treadmill training

1

6

 

X

X

 

X

  

X

       

X

 

X

 
 

b. Use of static bicycle

1

3

  

X

          

X

 

X

   
 

c. Other large muscle group aerobic activity

2

2

  

X

          

X

     

3

Regain and maintain normal joint range of movement

 

5

  

X

        

X

 

X

 

X

 

X

 
 

a. Lower limb stretching

2

3

 

X

X

          

X

     
 

b. Upper limb stretching

1

4

 

X

X

  

X

 

X

           
 

c. Trunk stretching

2

2

  

X

          

X

     
 

d. Lower limb movement through range

2

2

 

X

           

X

     
 

e. Upper limb movement through range

2

3

 

X

 

X

         

X

     
 

f. Unspecified stretch/ range of movement exercises

3

5

  

X

X

       

X

   

X

 

X

 

4

Enhance sensorimotor functions required for functional activity

 

7

 

X

X

X

       

X

 

X

X

X

   
 

a. Standing balance training

1

5

  

X

 

X

X

       

X

   

X

 
 

b. Sitting balance training

1

4

  

X

 

X

  

X

         

X

 
 

c. Aquatic balance training

1

2

     

X

           

X

 
 

d. Unspecified balance training

1

3

     

X

     

X

   

X

   
 

e. Cyclic movements of paretic arm

2

3

       

X

     

X

   

X

 
 

f. Proprioceptive & kinaesthetic training

2

6

 

X

 

X

X

  

X

X

        

X

 
 

g. Mental rehearsal of upper limb movements

1

8

X

X

 

X

X

X

  

X

  

X

     

X

 

5

Enhance functional ability

 

12

X

X

X

X

X

  

X

X

  

X

 

X

 

X

X

X

 
 

a. Standing up & sitting down practice

1

7

 

X

X

 

X

  

X

X

  

X

 

X

     
 

b. Step training / stair climbing

1

5

  

X

 

X

        

X

 

X

 

X

 
 

c. Walking (including treadmill training)

1

11

X

X

X

 

X

X

  

X

  

X

 

X

 

X

X

X

 
 

d. Walking with rhythmic cueing

1

6

X

   

X

X

 

X

X

        

X

 
 

e. Paretic upper limb task-related training

1

11

X

X

 

X

X

X

 

X

X

  

X

 

X

  

X

X

 
 

f. Bilateral upper limb task-related training

1

5

X

   

X

   

X

  

X

     

X

 

6

Establish & maintain motivation for regular physical exercise

 

6

X

 

X

     

X

  

X

X

X

     
 

a. Address personal beliefs & attitudes

2

1

             

X

     
 

b. Promote personal goal-setting

2

3

        

X

  

X

 

X

     
 

c. Use motivational interviewing

2

1

           

X

       
 

d. Promote use of personal reflective diaries

3

1

             

X

     
 

e. Promote use of personal exercise record including repetitions, load and time spent

3

2

             

X

X

    
 

f. Use positive feedback

2

1

           

X

       
 

g. Emphasise enjoyment

3

2

  

X

          

X

     

7

Develop self-management skills for ongoing physical exercise

 

1

  

X

                
 

a. Educate for self-monitoring for adverse events

3

1

             

X

     
 

b. Promote active problem-solving

3

3

        

X

  

X

     

X

 
 

c. Develop self-efficacy skills

3

2

  

X

        

X

       
 

d. Encourage self-monitoring to set appropriate exercise levels

3

2

  

X

          

X

     
 

e. Encourage independent practice of exercises

3

2

  

X

          

X

     
 

f. Provide guidance booklets

3

1

             

X

     
  1. Ev = highest level of evidence presented for strategy.
  2. n = number of guidelines explicitly including objective or strategy.
  3. Au = Australia; Ca = Canada; Eu = Europe; Ne = Netherlands, NZ = New Zealand; SA = South Africa; Si = Singapore.
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Implementation Science

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