Aerobic exercise in adult neuromuscular rehabilitation
Questionnaire design
Study design and participants
METHODS
A cross-sectional survey among healthcare specialists involved
in adult neuromuscular rehabilitation care in the Netherlands
was conducted using a self-designed web-based questionnaire.
The study focused primarily on rehabilitation specialists and
physical therapists working in specialized centres (i.e. rehabilita-
tion centres or rehabilitation outpatient clinics of university or
general hospitals). In addition, physical therapists working in
primary care (i.e. community-based physical therapy practices)
were contacted. To guide reporting, the Checklist for Reporting
Results of Internet E-Surveys (CHERRIES) was used for quality
reporting of web-based surveys (17).
In designing the questionnaire, we made use of 2 previous sur-
veys on the application of AE in neurological rehabilitation (e.g.
stroke, cerebral palsy, spinal cord injury) in Canada (18) and the
USA (19) and of a qualitative study on the experiences of patients
and physical therapists with AE in post-polio syndrome (16).
The questionnaire was designed by 2 researchers (EV and
MB) in cooperation with 3 experienced clinicians practicing in
neuromuscular rehabilitation. It contained 27 questions cove-
ring 4 categories: [category 1] respondent profile (e.g. practice
setting and experience in neuromuscular rehabilitation) {n = 8
questions}, [2] application of AE (e.g. training dose in terms
of the FITT factors) {n = 12}, [3] barriers to prescribing AE
{n = 4}, and [4] need for support to improve application of AE
{n = 3}. All questions were close-ended with a list of response
options. Two questions in category 2 regarding the respondent’s
perception of the role of AE in adult neuromuscular rehabilita-
tion were scored on a 5-point Likert scale (with 1 = strongly
disagree and 5 = strongly agree). Several questions contained
“other, please specify”, or “please specify” to ensure the most
appropriate response (see Appendix S1 1 for the questionnaire).
Prior to distribution of the questionnaire, the time to complete
the questionnaire was tested. This took approximately 15 min,
similar to the completion time of 13 min found to optimize
response rates in online surveys (20).
Questionnaire distribution
A web-based tool, Google Forms (https://docs.google.com/
forms/u/0/) was used to distribute the questionnaire. Respon-
dents could complete the questionnaire only once, thus pre-
venting duplication of respondents. Queries prevented missing
items, and respondents were able to review and change their
answers. In addition, a percentage completion bar made re-
spondents aware of their progress, which is known to enhance
response rates (21).
Initially, the questionnaire was distributed through the network
of specialized neuromuscular rehabilitation centres acknow-
ledged by the Dutch patient organization for neuromuscular
disease (Spierziekten Nederland; SN). All rehabilitation spe-
cialists (n = 53) and physical therapists (n = 34) working in these
acknowledged rehabilitation centres received the questionnaire.
Potential respondents were contacted multiple times. First, an
advance notice of the pending questionnaire was issued. Later
that week, an invitation letter was distributed via email, outlining
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the rationale for conducting the survey, the definition of AE (i.e.
planned, structured, and repetitive physical activity performed
for extended periods of time and at sufficient intensity to im-
prove or maintain physical fitness), ethical issues (i.e. voluntary
participation, anonymity, and no incentives), and containing an
electronic questionnaire link. The invitation was sent prior to
09.00 h in order to optimize the response rate. A reminder email
with the survey link was sent 2 weeks after the initial invitation,
and a second reminder was issued one week later (22).
In order to also reach physical therapists working in a primary
care setting, the questionnaire was distributed via the newsletter
and LinkedIn profile of the Royal Dutch Society for Physical
Therapy (Koninklijk Nederlands Genootschap voor Fysio
therapie; KNGF).
The survey was made available for 4 months; for specialized
centres between November 2016 and February 2017, and for
primary care centres between April and July 2017. Based on a
mean response rate for web-based surveys of 50%, and given
the known number of invitations that were sent via SN, at least
44 respondents were expected.
Data analysis
Categorical variables were summarized using frequencies and
percentages. Percentages were calculated by dividing the fre-
quency of a particular response by the total number of responses
for that question. Responses to questions in which “other, please
specify” was selected, were reviewed to identify categories and
their respective frequencies and percentages were determined.
The data from the questions that were scored on a 5-point Likert
scale, were reduced by combining “agree” and “strongly agree”
responses to form an “agree” category, and response options
of “strongly disagree” and “disagree” were combined to form
“disagree”. Data analysis was performed with SPSS software
(version 24.0.0.1).
RESULTS
Respondent profile
From the 87 invitations sent via SN, 13 rehabilitation
specialists and 27 physical therapists returned the
questionnaire (46% response rate). In addition, 12
physical therapists practicing in a primary care setting
returned the questionnaire, resulting in a total of 52
respondents. All but 1 (Flevoland) of the 12 provinces
of the Netherlands were represented. Respondents
were predominantly working in specialized centres
(77%) and had mostly practiced for more than 6 years
in neuromuscular rehabilitation (Table I). Nineteen
respondents in specialized centres (48%) reported
being primarily engaged (i.e. >50% practice time) in
neuromuscular rehabilitation, while this was the case
for none of the respondents in primary care.
Application of aerobic exercise
All respondents applied AE and in a wide variety of
NMD (Fig. 1). AE was mostly prescribed in at least 6
patients per year (81%).
J Rehabil Med 51, 2019