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Table 1 Prioritization of strategies targeting challenges to implementing the TIME™ model for people with balance and mobility limitations (n = 42)a

From: Considerations for expanding community exercise programs incorporating a healthcare-recreation partnership for people with balance and mobility limitations: a mixed methods evaluation

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)

  1. a 42 individuals included healthcare professionals (33%), fitness instructors (33%), recreation coordinators/managers (38%), and researchers (10%)
  2. b Italic typeface indicates a strategy rated as a high priority by ≥ 60% of survey respondents