Rehabilitation to support leisure participation following stroke: a national survey of clinical practice in Australia

To describe how allied health clinicians assess and treat leisure participation after stroke and identify factors influencing their practice. Allied health clinicians working in health and disability settings completed an online survey. Assessment and intervention approaches were collected with survey questions aligned to the TIDieR checklist. Perceived barriers to providing leisure rehabilitation were captured using the 26-item Determinants of Implementation Behaviour Questionnaire. Among the 131 clinicians who completed the survey, the largest proportion of respondents were occupational therapists (35%), physiotherapists (35%), and speech pathologists (18%). Most referred to clinical guidelines to inform their leisure rehabilitation practice. Of the 105 assessments reportedly used, only seven included a leisure-specific item or scale. Common intervention approaches included targeting underlying impairments (upper limb [44%] and mobility [44%]) and modifying activities (54%). Barriers to providing leisure rehabilitation included limited funding, training and resources. Allied health clinicians rely on guidelines that do not meaningfully inform leisure rehabilitation, leaving practice dependent on individual reasoning and inconsistent access to resources. Further research to understand clinicians’ clinical reasoning and training needs can inform the design of effective leisure-focused interventions and help address a clear gap in stroke rehabilitation. Allied health clinicians rely on clinical guidelines to inform their practice, however the limited specificity within leisure rehabilitation recommendations may limit a guideline’s usefulness to inform clinical practiceWhile allied health clinicians address the underlying impairments impacting leisure participation, there is scope for interventions to better address the specific barriers to leisure participation that have been identified by survivors of strokeAccess to leisure rehabilitation-specific training and resources may support allied health clinicians to provide effective leisure rehabilitationFurther studies are needed to understand the context of leisure rehabilitation in current practice and to establish the effective components of leisure rehabilitation Allied health clinicians rely on clinical guidelines to inform their practice, however the limited specificity within leisure rehabilitation recommendations may limit a guideline’s usefulness to inform clinical practice While allied health clinicians address the underlying impairments impacting leisure participation, there is scope for interventions to better address the specific barriers to leisure participation that have been identified by survivors of stroke Access to leisure rehabilitation-specific training and resources may support allied health clinicians to provide effective leisure rehabilitation Further studies are needed to understand the context of leisure rehabilitation in current practice and to establish the effective components of leisure rehabilitation