Use of the Capability, Opportunity and Motivation Behaviour model (COM-B) to Understand Interventions to Support Physical Activity Behaviour in People with Stroke: An Overview of Reviews.
Sarah Paterson, Helen Dawes, Charlotte Winward and 5 others
PMID 38192225WHAT IT FOUND
Interventions combining at least two COM-B elements (capability, opportunity, motivation) improved physical activity after stroke, while single-element interventions often failed.
Most evidence involved adults with mild stroke in community settings, leaving gaps for those with severe disability.
Key findings
01Interventions incorporating at least two elements of the COM-B model were more likely to be effective than those using only one element.
02The combination of capability and motivation was frequently evaluated and found effective in ten of twelve intervention syntheses.
03Most evidence came from adults with mild stroke living in the community, with scarce data on those with more severe symptoms.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The evidence is heavily weighted towards adults with mild stroke in community settings, so it may not apply to patients with severe disability or those in inpatient care. Included reviews varied in quality, with several rated as low or critically low. Interventions were complex and heterogeneous, making it difficult to isolate the effect of specific components. No reviews considered cost-effectiveness, which is a key factor for clinical implementation. The impact of impairments such as cognition, fatigue, and mood was not reflected in the synthesis.
Declared interests
The authors declared no potential conflicts of interest. Funding for the doctoral programme of one author was provided by Health Education England, Salisbury NHS Foundation Trust, and the Chartered Society of Physiotherapy. Other authors received support from NIHR Biomedical Research Centres.
The easy way to misread this
Do not assume that all complex interventions are effective. The study found that interventions combining capability and motivation were largely successful, but general lifestyle interventions not specifically focused on physical activity were ineffective. Furthermore, the findings should not be generalised to patients with severe stroke or significant cognitive or mood impairments, as the evidence base is limited to those with mild stroke.