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Table 2 Exercise adherence dialogue response form

From: Study protocol: home-based telehealth stroke care: a randomized trial for veterans

  Teletherapist questions: Responses:   
1. In the last WEEK, has anything happened to your PHYSICAL health or in your life that we should know about that will prevent you from starting your exercise routine? Yes No  
2. If response is Yes: "I am sorry to hear that. If you feel dizzy, have problems with your speech, eyesight, or increased weakness, you should call your doctor or 911."
3. Let's take a look at the exercise plan that we put together. Have you been able to follow this plan? Yes No  
4. If answer is Yes, "That is great! Keep up the good work, and continue to exercise as often as you are able to do so."
5. If answer is No, go to question #28.
6. So, let us take a look at your BALANCE ACTIVITIES. In the past week, did you do the exercises we gave you? Yes No N/A
7. Exactly how many TIMES last week were you able to do the balance activity? Times  
8. Exactly how many MINUTES were you able to do the balance activity each time? Minutes  
9. So, let us take a look at your STRENGTH ACTIVITES. In the past week, did you do the exercises we gave you? Yes No N/A
10. Exactly how many TIMES last week were you able to do the strength activity? Times  
11. Exactly how many MINUTES were you able to do the balance activity each time? Minutes  
12. Please tell me what EXERCISES you have been able to do this week.
  Exercises for non-ambulatory/unable to stand independently:   
13. Did you do the BRIDGING exercise? Yes No N/A
14. Did you do the LEG CROSSOVER exercise? Yes No N/A
15. Did you do the HEEL SLIDES exercise? Yes No N/A
16. Did you do the SIDE-LYING TO SIT exercise? Yes No N/A
17. Did you do the SITTING BALANCE exercise? Yes No N/A
18. Did you do the DYNAMIC SITTING BALANCE exercise? Yes No N/A
19. OK.
20. Exercises for ambulatory/able to stand independently:    
21. Did you do the HIP AND KNEE BENDS exercise? Yes No N/A
22. Did you do the HEEL RAISES exercise? Yes No N/A
23. Did you do the SIT TO STAND exercise? Yes No N/A
24. Did you do the MARCHING IN PLACE exercise? Yes No N/A
25. Did you do the TANDEM WALKING exercise? Yes No N/A
26. Did you do the DYNAMIC STANDING BALANCE exercise? Yes No N/A
27. OK.
28. What is preventing you from doing your PRESCRIBED PHYSICAL ACTIVITIES? 1. Not enough time to exercise
   2. Not enough strength or energy
   3. Do not understand how to do the exercise(s)
   4. I need some help with the exercise(s)
   5. Other:
29. What would make it easier for you to be active on a regular basis? 1. To make more time
   2. Ask someone to explain how to do exercise(s)
   3. Ask for help with exercise(s)
   4. Other:
30. Do you still have trouble with balance activities? Yes No N/A
31. Do you still have trouble with strength activities? Yes No N/A
32. This is important for your recovery, well-being and overall health. Keep going.    
33. Please review the set exercises that we have given you. These exercises will show you how to build back your strength.    
34. Will you agree to do this? Yes No N/A
35. If answer is NO, "I'm sorry to hear that, but don't give up, keep trying during the next week."