Exploring home rehabilitation therapists’ experiences of supporting older persons to physical exercise after acute hospitalization: a qualitative interview study

The aim of this study was to explore home rehabilitation therapists’ experiences of supporting physical exercise after acute hospitalization, including exercise programs initiated during hospital stay. The participants experienced that they were striving for individualized support to physical exercise, although limited resources and a fragmented home care risk to direct support away from those who need it the most. Transitional care interventions need to be individualized, support motivation for exercise during hospitalization, and be adapted to the patient’s situation at home, as well as involve relevant stakeholder in the design and implementation. After hospitalization, older persons may face a decline in physical function and daily independence. In-hospital exercise interventions can mitigate this decline, and continued support from primary healthcare post-discharge may enhance sustainability. This study aimed to explore home rehabilitation therapists’ experiences of supporting physical exercise after acute hospitalization, including exercise programs initiated during hospital stay. This qualitative study was conducted alongside a randomized-controlled trial to investigate prerequisites for a transitional care intervention. Twelve interviews were conducted with physiotherapists, occupational therapists, and managers across seven rehabilitation therapy services in Stockholm, Sweden. Data were analyzed using reflexive thematic analysis. The analysis generated the theme Striving for individualized support for physical exercise, although limited resources and a fragmented home care risk to direct support away from those who need it the most. It was based on four subthemes: The starting point is always the patient's current needs, goals, and prerequisites, Continuing the exercise initiated during hospitalization by adapting it to the patient’s situation at home, Work premises not tailored to patients with complex care needs, and A home care organization that lacks coordination and unified purpose. Interventions supporting older persons to physical exercise after acute hospitalization need to be tailored to the individual, support motivation, and be adapted to the patient’s home situation. Challenges may arise when care recourses lack alignment with the patients’ needs, and when the collaboration among care providers is limited. The findings contribute valuable insights for future studies incorporating transitional care interventions in similar context.