OT Research Article Spotlight: Occupational therapy’s use of yoga in post-stroke care.

Article

Occupational therapists’ use of yoga in post-stroke care: A descriptive qualitative study.

Authors

Alexandra P. Andrews, Karen E. Atler, Jennifer Dickman Portz; Marieke VanPuymbroeck; Caroline M. Rose; Arlene A. Schmid.

Journal

British Journal of Occupational Therapy

Research Design

Descriptive qualitative study.

Purpose

Specifically, the purpose of the study was to (1) provide insight into occupational therapists’ rationale for choosing to use yoga for rehabilitation after stroke and (2) understand how yoga is viewed and used within occupational therapy.

Methods

Recruitment, Inclusion, and Sample Size.  
Participants were recruited through an online survey shared with yoga and occupational therapy groups and through convenience sample.  
Inclusion criteria from survey respondents to participate in study:  

Practicing occupational therapy for at least 1 year

Identified as someone regularly using yoga in occupational therapy practice with clients who had a stroke.
Qualifying survey respondents who met inclusion criteria were contacted via email for interview.
Participants:

Ten occupational therapists were recruited from the survey, three more occupational therapists were included in the study through snowball sampling for a total of 13 participants.

Of the 13 participants that qualified to be included in the study, 10 participants provided consent and their responses were included in the data analysis.  
Procedures
6-months total of data collection.
Completed “Yoga in Clinical Practice” online survey, created to obtain information on how and why practitioners used yoga in treatment.
After completing the survey, participants completed a 30 to 60-minute semi structured interview—nine interviews were completed over the phone and one in person.  
Participants were asked 15-20 questions focused on their experience using yoga for their clients who had a stroke, including why and how the occupational therapists integrated yoga into rehabilitation and changes observed in clients after yoga.  
Applicable demographics of participants:  

8/10 participants were yoga instructors prior to being an occupational therapist.

9/10 participants had been practicing yoga for 10-20+ years;

1/10 had been practicing yoga for 4-10 years.

Settings: Outpatient, Neuro-rehab, Inpatient, Psychiatric, Skilled Nursing Facility    
Examples of interview questions:  

How did you incorporate yoga for intervention for individuals who had a stroke?

Describe a treatment session where you were using yoga with a client who had a stroke?

What has yoga done for your clients who had a stroke? What outcomes have you seen?  

Data Analysis

  • Iterative, cyclical process was used for coding.
  • Codes were created from interview questions using a deductive approach. Refinement of coding by researchers through discussion until a consensus was met.
  • As analysis continued, an inductive approach was applied, allowing additional codes to emerge from the data.

Results

  • Three major themes emerged from the content analysis of the occupational therapists’ responses to interview questions. With each major theme, subthemes also emerged that further clarified occupational therapy intervention using yoga with clients who had strokes.
  • Three major themes:
  1. Yoga promotes client-centered recovery
  2. Yoga brings context to occupational therapy.
  3. Yoga addresses multiple needs after stroke.

Figure 1. Major Themes and Sub-themes of occupational therapists interview responses.

Applications to occupational therapy practice:

  • If client had issues with mobility, yoga can be used to evaluate client’s flexibility, balance, perception, and body awareness to guide intervention.

  • Communication and understanding of feelings, key principles of yoga, can be used to increase empowerment to allow clients to make their needs known with their new physical abilities post stroke.

  • Intervention using yoga can focus on muscle activation with key yoga poses with a focus on improving muscle strength/endurance for specific functional tasks.

  • Yoga poses can be used to prepare for movements that clients would like to do throughout their day to reinforce muscle memory.

  • Yoga addresses multiple deficits common after stroke such as changes in physical, emotional, cognitive, sensory, and physiological abilities.

  • Yoga can be used in the acute care settings for its psychosocial benefits, including attention to breath, mindfulness, and meditation to reduce anxiety and stress.

Limitations of study

  • The results of this study are specific to the participants’ perceptions and experiences using yoga with occupational therapy intervention with clients post-stroke and cannot be generalized to the greater occupational therapist population.

  • The experiences of occupational therapists that did not use yoga with clients post-stroke was not collected. Therefore, there is no comparison of responses of occupational therapists that used yoga and those that did not use yoga with the post-stroke client population.

  • The demographics of the participants was homogenous in many areas.  The majority (8/10) participants were yoga instructors prior to becoming occupational therapists. Therefore, their belief that yoga is beneficial may be due to their status as yoga instructors and not their role as an occupational therapist.

  • The majority (8/10) participants practice yoga for 10-20+ years and their thoughts on the benefits of yoga could be biased due to their belief that yoga is beneficial and not the actual benefit of the intervention. It is difficult to determine the feasibility of therapists that are not yoga instructors providing yoga with clients post-stroke.

  • There were a small number of participants. Also,the researchers also did not provide information on the number of survey respondents from which the participants were pooled. Ten participants form a pool of 50 has different statistical implications compared to 10 participants from a pool of 500 or 10 from a pool of 5000 and so on.

Takeaways for Clinician

  • The principles of yoga have many client benefits and can be implemented in everyday occupational therapy practice in a variety of ways. With respect to client benefit, yoga allows for empowerment through a deeper mind-body understanding and connection. Yoga also supports the psychosocial needs of the client as part of the intervention process. Therefore, this holistic intervention not only strengths the physical body, but it also strengthens the mind. The mind-body connection should not be underestimated, especially with clients post stroke where only 25% of clients return home with their prior level of function (Lai et al., 2002).

  • With respect to implementation of yoga in everyday occupational therapy practice, implementation of yoga can be incorporated through modification of poses and utilization of breathing and meditation principles based on client needs and abilities. 

  • The information presented in this qualitative study supports occupational therapists expanding their intervention skills in this practice area through continuing education as a starting point for growth.

Takeaways for Student

  • The responses from this research study shows that yoga is an intervention that can be used for clients post stroke for both physical and psychosocial needs. For further research, study modification can include a larger sample size, completion of quantitative research for greater generalizability, and studying the areas that are addressed by the therapists to determine outcomes using yoga as an intervention in said areas.

  • From an intervention standpoint, recognizing that yoga can be used with clients post-stroke is a consideration for fieldwork and clinical practice.  

Takeaway for academic instructors

  • Present this type of intervention to students to provide current methods of treatment to clients post-stroke.

  • Reach out to clinicians in the community that use yoga as an intervention as a way of connecting theory and clinical practice. These individuals can provide guest lectures or lead student labs.

  • Expand intervention skills by gaining knowledge with this practice area to present to students from an evidence-based and clinical experience standpoint.

For more information on this article, please find the citation below. With this being a qualitative study, there is a wealth of information on the verbal responses of the participants. The article also contains all the questions that were asked of the therapists, a great foundation for a future research study or questions to address if you are a therapist interested in using yoga in your practice.

Citation

Andrews, A. P., Atler, K. E., Dickman Portz, J., VanPuymbroeck, M., Rose, C. M., & Schmid, A. A. (2020). Occupational therapists’ use of yoga in post-stroke care: A descriptive qualitative study. British Journal of Occupational Therapy. https://doi.org/10.1177/0308022620910371

Lai WSM, Studenski WS, Duncan WP, et al. (2002) Persisting consequences of stroke measured by the stroke impact scale. Stroke: Journal of the American Heart Association 33(7): 1840–1844.

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