Implementation considerations of aquatic therapy post-stroke: A qualitative study from Ontario, Canada

Aquatic therapy is an effective alternative approach to therapy on land in facilitating mobility and independence after a stroke. Despite the evidence reporting on the effectiveness of many aquatic interventions, there is a lack of studies elucidating essential implementation factors for aquatic therapy post-stroke.

A purposive sample of people with lived experience of stroke and healthcare providers participated in semi-structured interviews about their experiences with aquatic therapy. A deductive content analysis approach using the Consolidated Framework for Implementation Research (CFIR) was used to identify the essential aspects of aquatic therapy implementation post-stroke.

Twenty-three participants (9 people with stroke experience and 14 healthcare providers) participated in the study, from across the province of Ontario in Canada. The interview data were all relevant to the five main CFIR constructs and to some of the sub-constructs. Although participants were highly favorable to aquatic therapy, several implementation considerations in terms of costs, program structure, provider qualifications, and pool access were identified at the patient, provider, and system level.

The CFIR proved valuable in identifying contextual factors relevant to implementing aquatic therapy with the stroke population. These factors included the importance of education, barriers to accessing aquatic therapy in rehabilitation and community settings, and internal and external factors influencing the application of aquatic therapy post-stroke.