Challenge | Strategy | n | Priority rating n (%) | |||
---|---|---|---|---|---|---|
Not a priority | Low | Medium | Higha | |||
1. Insufficient funding for recreation providers to run the exercise program and for healthcare providers to offer training and support | 1. Submit a proposal to your regional health authority (e.g., Local Health Integration Network) to fund exercise programs in the region | 42 | 0 (0) | 2 (5) | 9 (21) | 31 (74) |
2. Make the case to hospital managers to fund physical therapists to partner with recreation providers to deliver CBEPs as an investment in public health | 42 | 2 (5) | 5 (12) | 14 (33) | 21 (50) | |
3. Leverage existing resources of the Canadian Stroke Strategy (e.g., Provincial coordinators could educate hospital staff to refer patients to exercise programs) | 40 | 1 (3) | 5 (13) | 14 (35) | 20 (50) | |
4. Approach condition-specific charities (e.g., MS Society, Heart & Stroke Foundation, etc.) | 42 | 1 (2) | 9 (21) | 16 (38) | 16 (38) | |
2. Maintenance of program integrity: this refers to delivering the exercise program as intended both at start up and over time | 1. Consistent use of training materials (e.g., slides in toolkit for instructor training and task-related exercise program guidelines | 42 | 0 (0) | 1 (2) | 11 (26) | 30 (71) |
2. Exercise program/facility certification (e.g., programs need to meet safety/quality criteria similar to Heart Wise certification) | 42 | 1 (2) | 2 (5) | 15 (36) | 24 (57) | |
3. Funding for a healthcare position in the community to refer patients to exercise programs and collaborate with exercise providers | 42 | 2 (5) | 4 (10) | 15 (36) | 21 (50) | |
4. Physical therapist visits to exercise programs to consult with fitness instructors at recreation centers | 42 | 0 (0) | 3 (7) | 20 (48) | 19 (45) | |
3. Sustainability of exercise programs: this refers to the continued provision of CBEPs over time | 1. Ongoing inter-professional communication/collaboration between rehabilitation and recreation providers | 41 | 0 (0) | 0 (0) | 5 (12) | 36 (88) |
2. Availability of ongoing training of new fitness instructors | 42 | 0 (0) | 1 (2) | 11 (26) | 30 (71) | |
3. Canadian stroke system representatives in each province advocate for exercise programs across regions | 42 | 0 (0) | 2 (5) | 17 (40) | 23 (55) | |
4. Canadian stroke system representatives in each province help patients overcome barriers to exercise participation to enable access to exercise programs across regions | 42 | 0 (0) | 7 (17) | 17 (40) | 18 (43) | |
4. Marketing of the program | 1. Links with physicians and healthcare providers | 42 | 0 (0) | 1 (2) | 13 (31) | 28 (67) |
2. Links with key stakeholder groups such as peer support groups (e.g., stroke support groups), condition-specific groups (e.g., MS Society, Heart & Stroke Foundation), and homecare services (e.g., Community Care Access Centers) | 42 | 0 (0) | 1 (2) | 14 (33) | 27 (64) | |
3. Standardised marketing materials (e.g., videos, pamphlet, community of practice) | 42 | 0 (0) | 3 (7) | 13 (31) | 26 (62) | |
4. Links with key systems (e.g., Healthline (a website that lists healthcare and community services in Ontario), TIME™ website) | 42 | 0 (0) | 4 (10) | 14 (33) | 24 (57) | |
5. Staff training: refers to the challenge of training instructors to have the multiple skills required to deliver these exercise programs (e.g., adapting exercise difficulty to account for participant ability or injury) | 1. Consulting with key people as problems arise (e.g., TIME™ educators) | 41 | 0 (0) | 1 (2) | 12 (29) | 28 (68) |
2. Regular meetings of fitness instructors across sites to share issues and problem solve (e.g., Skype, conference call) | 42 | 0 (0) | 5 (12) | 19 (45) | 18 (43) | |
3. Webinars for educational opportunities | 42 | 0 (0) | 5 (12) | 20 (48) | 17 (40) | |
4. Online discussion forum (e.g., social media) | 42 | 0 (0) | 9 (21) | 19 (45) | 14 (33) | |
6. No access to recruit exercise participants directly from rehabilitation hospital programs | 1. Form links between rehabilitation and recreation providers (network meetings and promotional visits between community-based exercise providers and rehabilitation clinics) | 42 | 1 (2) | 0 (0) | 4 (10) | 37 (88) |
2. Bridging with other community based programs (e.g., joint advertisement/accreditation for Heart Wise and TIME™) | 41 | 0 (0) | 3 (7) | 18 (44) | 20 (49) | |
3. Marketing through newspaper, magazines, pamphlet distribution | 41 | 0 (0) | 11 (27) | 12 (29) | 18 (44) | |
4. Advertisement targeted at adult living communities | 42 | 1 (2) | 7 (17) | 22 (52) | 12 (29) | |
5. Online forum: e.g., municipal recreation fitness/supervisor and instructors across provinces for Q & A | 42 | 0 (0) | 7 (17) | 25 (60) | 10 (24) | |
7. Exercise program full and not open to new registrants: refers to when exercise participants re-register and there are no or few spaces in the class for new registrants | 1. Offer additional programs at same or other locations | 42 | 0 (0) | 3 (7) | 10 (24) | 29 (69) |
2. Offer maintenance program at various levels for graduates and people with more severe deficits | 42 | 0 (0) | 3 (7) | 13 (31) | 26 (62) | |
3. Educate exercise participants about other available programs offered at the facility (know options) | 42 | 0 (0) | 2 (5) | 18 (43) | 22 (52) | |
4. Where space is the issue, network with other organizations or providers to find space to launch more programs | 42 | 0 (0) | 1 (2) | 20 (48) | 21 (50) |