1
|
Ito K, Uehara S, Yuasa A, Ushizawa K, Tanabe S, Otaka Y. Gamified exercise for the distal upper extremity in people with post-stroke hemiparesis: feasibility study on subjective perspectives during daily continuous training. Ann Med 2024; 56:2306905. [PMID: 38294958 PMCID: PMC10833108 DOI: 10.1080/07853890.2024.2306905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/13/2024] [Indexed: 02/02/2024] Open
Abstract
INTRODUCTION Dose (number of repetitions) has been suggested as a key element in the effectiveness of rehabilitation exercises to promote motor recovery of the hemiparetic upper limb. However, rehabilitation exercises tend to be monotonous and require significant motivation to continue, making it difficult to increase the exercise dose. To address this issue, gamification technology has been implemented in exercises to promote self-engagement for people with hemiparesis in continuing monotonous repetitive movements. This study aimed to investigate how subjective perspectives, specifically enjoyability, motivation to continue, and expectancy of effectiveness, change through continuous daily exercise using a developed gamified exercise system. MATERIALS AND METHOD Ten people with stroke suffering upper limb dysfunction underwent daily gamified exercise for seven days. The gamified exercise consisted of an electromyography (EMG)-controlled operating system that enabled users to play virtual games using repetitive finger movements. The participants performed conventional self-exercise on the same day as the control exercise, and rated their subjective perspectives on both exercises on a numerical rating scale on each exercise day. RESULTS Ratings for enjoyability and motivation to continue consistently showed significantly higher scores for the gamified exercise than for conventional self-exercise on all exercise days. A similar trend was observed in the ratings for the expectancy of effectiveness. No changes over time were found in any of the ratings throughout the exercise period. CONCLUSIONS Exercise using the developed EMG-controlled gamified system may have the potential to maintain motivation and enjoyment in people with stroke to continue monotonous repetitive finger movements.
Collapse
Affiliation(s)
- Kazuki Ito
- Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
- Fujita Health University Graduate School of Health Sciences, Aichi, Japan
| | - Shintaro Uehara
- Faculty of Rehabilitation, Fujita Health University School of Health Sciences, Aichi, Japan
| | - Akiko Yuasa
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Aichi, Japan
| | - Kazuki Ushizawa
- Fujita Health University Graduate School of Health Sciences, Aichi, Japan
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Aichi, Japan
| | - Shigeo Tanabe
- Faculty of Rehabilitation, Fujita Health University School of Health Sciences, Aichi, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Aichi, Japan
| |
Collapse
|
2
|
Makihara A, Kanai M, Izawa KP, Kubo H, Inamoto A, Ogura A, Kubo I, Shimada S. The Association between fatigue and physical activity in patients hospitalized with subacute stroke. Top Stroke Rehabil 2024; 31:457-463. [PMID: 38159262 DOI: 10.1080/10749357.2023.2293337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Little is known about the association between fatigue and physical activity in patients hospitalized with subacute stroke. OBJECTIVES The aim of this study was to investigate the association between fatigue and physical activity in patients hospitalized with subacute stroke. METHODS This cross-sectional study enrolled 244 consecutive patients with stroke who were admitted to a subacute rehabilitation ward at our hospital. We assessed fatigue with the Fatigue Assessment Scale (FAS) and used an accelerometer (Active style Pro HJA750-C, OMRON) to record the mean duration of sedentary behavior, light-intensity physical activity (LIPA), and moderate-to-vigorous-intensity physical activity (MVPA). We assessed all factors at 1 month after stroke. Multivariate linear regression analysis revealed the associations between FASscore and objectively measured physical activity. RESULTS In total, we analyzed 85 patients. The duration of the sedentary behavior was significantly associated with the FAS score (β = 1.46, p = 0.037) and the Functional Balance Scale score (β = -1.35, p = 0.045). The LIPA time was significantly associated only with the FBS score (β = 1.38, p = 0.045), whereas MVPA was not associated with any variable.
Collapse
Affiliation(s)
- Ayano Makihara
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
- Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Masashi Kanai
- Graduate School of Health Sciences, Kobe University, Kobe, Japan
- Institute of Transdisciplinary Sciences for Innovation, Kanazawa University, Kanazawa, Japan
| | - Kazuhiro P Izawa
- Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Hiroki Kubo
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan
| | - Asami Inamoto
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Asami Ogura
- Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Ikko Kubo
- Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Shinichi Shimada
- Department of Neurosurgery, Itami Kousei Neurosurgical Hospital, Itami, Japan
| |
Collapse
|
3
|
Larsson P, Bidonde J, Olsen U, Gay CL, Lerdal A, Ursin M, Mead GE, Edvardsen E. Association of post-stroke fatigue with physical activity and physical fitness: A systematic review and meta-analysis. Int J Stroke 2023; 18:1063-1070. [PMID: 36622013 PMCID: PMC11044520 DOI: 10.1177/17474930231152132] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/03/2023] [Indexed: 01/10/2023]
Abstract
BACKGROUND It has been hypothesized that post-stroke fatigue (PSF) is associated with reduced physical activity (PA) and impaired physical fitness (fitness). Understanding associations between PSF and PA, and/or fitness could help guide the development of targeted exercise interventions to treat PSF. AIMS Our systematic review and meta-analysis aimed to investigate PSF's associations with PA and fitness. SUMMARY OF REVIEW Following a registered protocol, we included studies with cross-sectional or prospective observational designs, published in English or a Scandinavian language, which reported an association of PSF with PA and/or fitness in adult stroke survivors. We searched MEDLINE, Embase, AMED, CINAHL, PsycINFO, ClinicalTrials.gov, and World Health Organization's International Clinical Trials Registry Platform from inception to November 30, 2022. Risk of bias was assessed using Quality in Prognosis Studies. Thirty-two unique studies (total n = 4721 participants, 55% male), and three study protocols were included. We used random-effects meta-analysis to pool data for PA and fitness outcomes, and vote-counting of direction of association to synthesize data that could not be meta-analyzed. We found moderate-certainty evidence of a weak association between higher PSF and impaired fitness (meta r = -0.24; 95% confidence interval (CI) = -0.33, -0.15; n = 905, 7 studies), and very low-certainty evidence of no association between PSF and PA (meta r = -0.09; 95% CI = -0.34, 0.161; n = 430, 3 studies). Vote-counting showed a higher proportion of studies with associations between higher PSF and impaired fitness (pˆ = 0.83; 95% CI = 0.44, 0.97; p = 0.22, n = 298, 6 studies), and with associations between higher PSF and lower PA (pˆ = 0.75; 95% CI = 0.51, 0.90; p = 0.08, n = 2566, 16 studies). Very low- to moderate-certainty evidence reflects small study sample sizes, high risk of bias, and inconsistent results. CONCLUSIONS The meta-analysis showed moderate-certainty evidence of an association between higher PSF and impaired fitness. These results indicate that fitness might protect against PSF. Larger prospective studies and randomized controlled trials evaluating the effect of exercise on PSF are needed to confirm these findings.
Collapse
Affiliation(s)
- Petra Larsson
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Surgical Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Julia Bidonde
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Canada
| | - Unni Olsen
- Surgical Department, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Caryl L Gay
- Department of Family Health Care Nursing, University of California, San Francisco, CA, USA
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Anners Lerdal
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Marie Ursin
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Gillian Elizabeth Mead
- Geriatric Medicine, Division of Health Sciences, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Elisabeth Edvardsen
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Pulmonary Medicine, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
4
|
Lo SHS, Chau JPC, Choi KC, Wong RYM, Kwan JCY, Iu IHL. Health Professional- and Volunteer-partnered Self-management Support (COMBO-KEY) to Promote Self-efficacy and Self-management Behaviors in People with Stroke: A Randomized Controlled Trial. Ann Behav Med 2023; 57:866-876. [PMID: 37260291 PMCID: PMC10498819 DOI: 10.1093/abm/kaad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Multiple systematic reviews have reported that self-management interventions are associated with positive impacts on self-efficacy and health-related quality of life (HRQoL) of people with stroke. PURPOSE This article reports the effects of an enhanced stroke self-management program. METHODS Eligible adults with stroke were recruited from community-based organizations and a support group for a two-arm, assessor-blinded randomized controlled trial. Participants in the control group received usual care, while those in the intervention group also received the 8-week self-management program, Coaching Ongoing Momentum Building On stroKe rEcovery journeY (COMBO-KEY), consisting of four individual home visits and five follow-up phone calls, delivered by healthcare professionals and trained volunteers. Assessments were conducted at baseline and after the intervention, for outcomes of self-efficacy, satisfaction with the performance of self-management behaviors, HRQoL, and community reintegration, which were analyzed using generalized estimating equations (GEEs). RESULTS 134 Participants were recruited [mean age = 64.1 years, standard deviation (SD) = 12.7]. Over 80% of the participants had a first-ever stroke [mean years after first stroke: 4.2 (SD = 5.1)]. The GEE analysis revealed that the intervention group participants showed significantly greater improvements in self-efficacy, satisfaction with their performance of self-management behaviors, HRQoL, and community reintegration at 8-week follow-up with respect to their baseline levels. CONCLUSIONS The COMBO-KEY program showed effective improvements in recovery outcomes of people with stroke. Future research should explore the inclusion of virtual/hybrid sessions, strategies to assess health conditions of people with stroke via online modes, and assessment of goal attainment and actual performance of self-management behaviors.
Collapse
Affiliation(s)
- Suzanne H S Lo
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
| | - Janita P C Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
| | - Kai C Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
| | - Rebecca Y M Wong
- New Territories East Cluster, Hospital Authority, Hong Kong SAR (Former)
| | - Jackie C Y Kwan
- The Hong Kong Society for Rehabilitation, Hong Kong SAR (Former)
| | - Issac H L Iu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
| |
Collapse
|
5
|
Machado N, Williams G, Olver J, Johnson L. The safety and feasibility of early cardiorespiratory fitness testing after stroke. PM R 2023; 15:291-301. [PMID: 35156779 DOI: 10.1002/pmrj.12787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cardiorespiratory fitness testing is recommended as part of a pre-exercise evaluation to aid the programming of safe, tailored cardiorespiratory fitness training after stroke. But there is limited evidence for its safety and feasibility in people with stroke with varying impairment levels in the early subacute phase of stroke recovery. OBJECTIVE To assess the safety and feasibility of cardiorespiratory fitness testing in the early subacute phase after stroke. DESIGN A sub-study of a larger single service, multi-site, prospective cohort feasibility study (Cardiac Rehabilitation in Stroke Survivors to Improve Survivorship [CRiSSIS]). SETTING Private subacute inpatient rehabilitation facilities. PARTICIPANTS Consecutive admissions of people with ischemic stroke admitted to subacute rehabilitation facilities. INTERVENTION Not applicable. MAIN OUTCOME(S) Safety was determined by the occurrence of adverse or serious adverse events. Feasibility was determined by assessing the (1) number of participants recruited and (2) number of participants able to complete the fitness test. RESULTS Between April 2018 and December 2019, a total of 165 people with stroke were screened to participate; 109 were eligible and 65 were recruited. Of the 62 who completed testing, 41 participants were able to complete a submaximal fitness test at a median of 12 days post-stroke. One minor adverse event was recorded. Of the 21 participants unable to complete the fitness test; 4 declined to complete the test, 9 were unable to commence the test, and 8 were unable to complete the first stage of the protocol due to stroke-related impairments. Participants with mild stroke, greater motor and cognitive function, and fewer depressive symptoms were more likely to be able to complete the cardiorespiratory fitness test. CONCLUSION Cardiorespiratory fitness testing was safe for most people with mild-to-moderately severe ischemic stroke and transient ischemic attack in the early subacute phase, but only two-thirds of the participants could complete the test.
Collapse
Affiliation(s)
- Natasha Machado
- Rehabilitation, Epworth Healthcare, 89 Bridge Road, Richmond, Victoria
- Physiotherapy Department, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, Victoria
| | - Gavin Williams
- Rehabilitation, Epworth Healthcare, 89 Bridge Road, Richmond, Victoria
- Physiotherapy Department, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, Victoria
| | - John Olver
- Rehabilitation, Epworth Healthcare, 89 Bridge Road, Richmond, Victoria
- Physiotherapy Department, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, Victoria
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Liam Johnson
- Rehabilitation, Epworth Healthcare, 89 Bridge Road, Richmond, Victoria
- Physiotherapy Department, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, Victoria
- Faculty of Exercise Science, Australian Catholic University, Fitzroy, Victoria, Australia
| |
Collapse
|
6
|
Feng F, Luo XC, Chen YJ, Li JJ, Kang H, Yan BH. Effects of Tai Chi Yunshou on upper-limb function and balance in stroke survivors: A systematic review and meta-analysis. Complement Ther Clin Pract 2023; 51:101741. [PMID: 36868000 DOI: 10.1016/j.ctcp.2023.101741] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 01/31/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND AND PURPOSE Physical rehabilitation plays an important role in the recovery of motor function after a stroke. This study aimed to evaluate the effects of Tai Chi Yunshou (TCY), a form of physical therapy, on upper-limb function and balance in stroke survivors. METHODS MEDLINE, Embase, CENTRAL and five Chinese databases were retrieved from inception to July 1, 2020 (updated on March 31, 2022). Randomized controlled trials of TCY versus no-treatment for stroke were included. The RoB-2 was used to evaluate the quality of included studies. Upper-limb motor impairment, balance, and activities of daily living (ADLs) were measured by Fugl-Meyer Assessment Upper Extremity Scale (FMA-UE), Berg Balance Scale (BBS), and Barthel Index (BI), respectively. Data synthesis was performed using RevMan (v5.3), and expressed as mean difference (MD) with 95% confidence intervals (CI). RESULTS Seven studies with 529 participants were included. Compared with no-treatment, TCY improved FMA-UE (MD = 7.31, 95% CI: 5.86-8.77, minimal clinically important difference [MCID]: 9-10), BBS (MD = 4.68, 95% CI: 0.28-9.07, MCID: 4), and BI (MD = 4.12, 95% CI: 3.28-4.96, MCID: 1.85) in stroke survivors. CONCLUSION TCY may benefit balance and ADLs in rehabilitation after a stroke, but it may not improve upper-limb function clinically.
Collapse
Affiliation(s)
- Fen Feng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiao-Chao Luo
- Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China; Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Ya-Jie Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jia-Jia Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hua Kang
- Nursing School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Bo-Hua Yan
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| |
Collapse
|
7
|
Chen Y, Yang H, Chen Y, Wei H, Lan M. Limb heaviness as a sensorimotor disorder alters rehabilitation adherence after a stroke. Front Neurol 2022; 13:840808. [PMID: 36061991 PMCID: PMC9433699 DOI: 10.3389/fneur.2022.840808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction To the best of our knowledge, it is still unknown how perceived limb heaviness affects rehabilitation adherence. As rehabilitation adherence is very important for the functional recovery of patients with stroke, it is important to explore the relationship between perceived limb heaviness and rehabilitation adherence. Methods We retrospectively reviewed the data of patients with consecutive stroke recruited in the CIRCLE study. The influence of age, gender, time from onset to enrollment, educational background, hypertension, diabetes, Modified Rankin Scale (MRS), and National Institutes of Health Stroke Scale (NIHSS) on rehabilitation adherence was analyzed. Multiple linear regression analysis was used to examine the association between perceived limb heaviness and rehabilitation adherence changes. Results A total of 108 participants completed the study. About 40 (37.0%) participants felt limb heaviness. The mean scores on the Medical Research Council (MRC) scale for the upper affected limb strength were 3.05 ± 1.7, and the mean score on the exercise adherence questionnaire (EAQ) was 34.27 ± 8.9. Univariate analysis showed that rehabilitation adherence levels differed in upper limb muscle strength and whether they perceived limb heaviness. After adjustment for independent predictors, we found that perceived limb heaviness was associated with rehabilitation adherence (B = −9.681 ± 1.494, p < 0.05) and R2 was 0.332 and 0.074 if the muscle strength of the upper limb and perceived limb heaviness were included in the model and the model was without perceived limb heaviness, respectively. Conclusion By identifying patients with stroke with limb heaviness, it led to lower levels of motor functional rehabilitation adherence. We must pay more attention to limb heaviness and provide effective interventions to improve rehabilitation adherence and promote patient recovery.
Collapse
|
8
|
Surface Electromyography-Driven Therapeutic Gaming for Rehabilitation of Upper Extremity Weakness: A Pilot Study. Plast Reconstr Surg 2022; 150:125-131. [PMID: 35544314 DOI: 10.1097/prs.0000000000009208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
SUMMARY In patients with severe upper extremity weakness that may result from peripheral nerve injuries, stroke, and spinal cord injuries, standard therapy in the earliest stages of recovery consists primarily of passive rather than active exercises. Adherence to prescribed therapy may be poor, which may contribute to suboptimal functional outcomes. The authors have developed and integrated a custom surface electromyography device with a video game to create an interactive, biofeedback-based therapeutic gaming platform. Sensitivity of the authors' custom surface electromyography device was evaluated with simultaneous needle electromyography recordings. Testing of this therapeutic gaming platform was conducted with a single 30-minute gameplay session in 19 patients with a history of peripheral nerve injury, stroke, spinal cord injury, and direct upper extremity trauma, including 11 patients who had undergone nerve and/or tendon transfers. The device was highly sensitive in detecting low levels of voluntary muscle activation and was used with 10 distinct muscles of the arm, forearm, and hand. Nerve and tendon transfer patients successfully activated the donor nerve/muscle and elicited the desired movement to engage in gameplay. On surveys of acceptability and usability, patients felt the system was enjoyable, motivating, fun, and easy to use, and their hand therapists expressed similar enthusiasm. Surface electromyography-based therapeutic gaming is a promising approach to rehabilitation that warrants further development and investigation to examine its potential efficacy, not only for building muscle strength and endurance but also for facilitating motor relearning after nerve and tendon transfer surgical procedures. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
Collapse
|
9
|
Inness EL, Jagroop D, Andreoli A, Bayley M, Biasin L, Danells C, Hall J, Mansfield A, McDonald A, Nishri D, Salbach NM, Taylor D, Wong K, Tang A. Factors That Influence the Clinical Implementation of Aerobic Exercise in Stroke Rehabilitation: A Theory-Informed Qualitative Study. Phys Ther 2022; 102:6534400. [PMID: 35194641 DOI: 10.1093/ptj/pzac014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 10/14/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Best practice guidelines recommend that aerobic exercise (AEx) be implemented as early as possible poststroke, yet the prescription of AEx remains limited in stroke rehabilitation settings. This study used theoretical frameworks to obtain an in-depth understanding of barriers and enablers to AEx implementation in the stroke rehabilitation setting. METHODS A qualitative, descriptive study was conducted. Participants were recruited from 4 stroke rehabilitation settings in Ontario, Canada, that have participated in an implementation study to provide structured AEx programming as part of standard care. Six clinician focus groups (with 19 physical therapists and 5 rehabilitation assistants) and one-to-one interviews with 7 managers and 1 physician were conducted to explore barriers and enablers to AEx implementation. The Theoretical Domains Framework and Consolidated Framework for Implementation Research informed content analysis for clinician and manager perspectives, respectively. RESULTS Barriers specific to resource constraints and health care system pressures, combined with patient goals, led to interventions to improve function being prioritized over AEx. Successful implementation was enabled through an interprofessional approach and team engagement in the planning and implementation process. Health care providers described concerns about patient safety, but confidence and capability for implementing AEx were enabled by education, skill development, use of exercise tests, and consultation with individuals with content expertise. Participants described the development of supportive processes that enabled AEx implementation within team workflows and shared resources. CONCLUSION Strategies to support implementation of AEx in stroke rehabilitation should incorporate knowledge and skills, the provision of clinical decision-making tools, access to expert consultation, the roles and social influence of the interprofessional team and formal and informal leaders, and supportive processes adapted to the local context. IMPACT Results from this study will inform the development of a clinical implementation toolkit to support clinical uptake of AEx in the stroke rehabilitation setting.
Collapse
Affiliation(s)
- Elizabeth L Inness
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - David Jagroop
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Angie Andreoli
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Mark Bayley
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Louis Biasin
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Cynthia Danells
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Jayne Hall
- Regional Rehabilitation Outpatient Services, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Avril Mansfield
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Evaluative Clinical Sciences, Hurvtiz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Alison McDonald
- Nova Scotia Rehabilitation & Arthritis Centre, Halifax, NS, Canada
| | - Diane Nishri
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Nancy M Salbach
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Denise Taylor
- St Joseph's Care Group, Thunder Bay, ON, Canada.,Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Karl Wong
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Ada Tang
- McMaster University, School of Rehabilitation, Hamilton ON, Canada
| |
Collapse
|
10
|
Mahmood A, Deshmukh A, Natarajan M, Marsden D, Vyslysel G, Padickaparambil S, Ts S, Direito A, Kumaran S, N G, Sachdev H, Kumar Veluswamy S, Karthikbabu S, Unnikrishnan B, English C, Solomon JM. Development of strategies to support home-based exercise adherence after stroke: a Delphi consensus. BMJ Open 2022; 12:e055946. [PMID: 34992120 PMCID: PMC8739434 DOI: 10.1136/bmjopen-2021-055946] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To develop a set of strategies to enhance adherence to home-based exercises after stroke, and an overarching framework to classify these strategies. METHOD We conducted a four-round Delphi consensus (two online surveys, followed by a focus group then a consensus round). The Delphi panel consisted of 13 experts from physiotherapy, occupational therapy, clinical psychology, behaviour science and community medicine. The experts were from India, Australia and UK. RESULTS In round 1, a 10-item survey using open-ended questions was emailed to panel members and 75 strategies were generated. Of these, 25 strategies were included in round 2 for further consideration. A total of 64 strategies were finally included in the subsequent rounds. In round 3, the strategies were categorised into nine domains-(1) patient education on stroke and recovery, (2) method of exercise prescription, (3) feedback and supervision, (4) cognitive remediation, (5) involvement of family members, (6) involvement of society, (7) promoting self-efficacy, (8) motivational strategies and (9) reminder strategies. The consensus from 12 experts (93%) led to the development of the framework in round 4. CONCLUSION We developed a framework of comprehensive strategies to assist clinicians in supporting exercise adherence among stroke survivors. It provides practical methods that can be deployed in both research and clinical practices. Future studies should explore stakeholders' experiences and the cost-effectiveness of implementing these strategies.
Collapse
Affiliation(s)
- Amreen Mahmood
- Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
- Center for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
| | - Anagha Deshmukh
- Clinical Psychology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Manikandan Natarajan
- Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- Center for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
| | - Dianne Marsden
- Hunter Stroke Service, Hunter New England Local Health District, New Lambton, New South Wales, Australia
- Priority Research Centre Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia
- Brain and Mental Health Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Glade Vyslysel
- Westlakes Community Rehabilitation Team, Hunter New England Local Health District, Toronto, NSW, Australia
| | - Sebastian Padickaparambil
- Clinical Psychology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Shwetha Ts
- Clinical Psychology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Artur Direito
- Centre for Behaviour Change, University College London, London, UK
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Senthil Kumaran
- Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- Center for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
| | - Girish N
- Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Harpreet Sachdev
- Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Suruliraj Karthikbabu
- Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Bangalore, Karnataka, India
| | - B Unnikrishnan
- Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Coralie English
- Priority Research Centre Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia
- School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - John M Solomon
- Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- Center for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
11
|
Brauer SG, Kuys SS, Paratz JD, Ada L. High-intensity treadmill training and self-management for stroke patients undergoing rehabilitation: a feasibility study. Pilot Feasibility Stud 2021; 7:215. [PMID: 34876235 PMCID: PMC8650326 DOI: 10.1186/s40814-021-00941-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 10/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity undertaken by stroke survivors is generally low. This trial investigated the feasibility of delivering a high-intensity treadmill and self-management program to people with stroke undergoing inpatient rehabilitation and determine whether physical activity, walking ability and cardiorespiratory fitness could be increased. METHOD A phase I, single-group, pre-post intervention study was conducted with stroke survivors undergoing inpatient rehabilitation who could walk. Participants undertook a high-intensity treadmill and self-management program for up to 30 min, three times a week for 8 weeks under the supervision of their usual physiotherapist. Feasibility was determined by examining compliance, satisfaction and adverse events. Clinical outcomes were amount of physical activity, walking ability, and cardiorespiratory fitness collected pre-training (week 0), post-training (week 8), and at follow-up (week 26). RESULTS Forty stroke survivors participated, completing 10 (SD 6) sessions, 94% at the specified training intensity, with high satisfaction and no adverse events related to the intervention. At week 8, participants completed 2749 steps/day (95% CI 933 to 4564) more physical activity than at week 0. Walking distance increased by 110 m (95% CI 23 to 196), walking speed by 0.24 m/s (95% CI 0.05 to 0.42), and VO2 peak by 0.29 ml/kg/min (95% CI 0.03 to 0.56). At week 26, increases in physical activity, walking distance and speed, and cardiorespiratory fitness were maintained. CONCLUSIONS A high-intensity treadmill training program embedded within a self-management approach during inpatient rehabilitation appears feasible and potentially may offer sustained improvements in physical activity, walking ability, fitness, and quality of life. A randomised trial is warranted. TRIAL REGISTRATION This feasibility study was registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12613000764730 ).
Collapse
Affiliation(s)
- Sandra G Brauer
- Discipline of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
| | - Suzanne S Kuys
- School of Physiotherapy, Australian Catholic University, Banyo, Queensland, Australia
| | - Jennifer D Paratz
- Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Queensland, Australia.,School of Allied Health Sciences, Griffith University, Southport, Queensland, Australia
| | - Louise Ada
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| |
Collapse
|
12
|
Nayak P, Mahmood A, Kumaran D S, Natarajan M, Unnikrishnan B, Solomon JM. Adaptive sports for promoting physical activity in community-dwelling adults with stroke: A feasibility study. J Bodyw Mov Ther 2021; 28:341-347. [PMID: 34776162 DOI: 10.1016/j.jbmt.2021.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/01/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite proven health benefits of regular participation in physical activities (PA), adults with stroke fail to achieve recommended levels of PA. Sports being an enjoyable activity is more likely to encourage participation. Therefore, the objectives of the present study are i) to develop and test the feasibility of adaptive sports for promoting PA and Quality of Life (QoL) in community-dwelling adults with stroke, and ii) to explore the participants perception and experiences of playing adaptive sports. METHODS Two focus groups were conducted among the eight experts and a person with stroke to develop adaptive sports. To test the feasibility of these adaptive sports, in a multi methods study eighteen community dwelling adults with stroke were recruited. Participants played adaptive sports twice a week for two months in a community center. Participants pre and post intervention PA levels and QoL were measured. Participants were also interviewed at the end of the program to explore their experiences of participation in adaptive sports. RESULTS At the end of the program retention rate of the participants was 83.33% and there was a significant improvement in PA levels, while the improvement in QoL was not statistically significant. Participants expressed positive experience with the program. There were no adverse events during or after the participation. Health benefits, fitness, and fun were reported as facilitators, while lack of access to the sporting facility and lack of caregiver support were reported as barriers to participation. CONCLUSION Adaptive sports appear to be safe, feasible, and well accepted by the adults with stroke.
Collapse
Affiliation(s)
- Pradeepa Nayak
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India; Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Amreen Mahmood
- Department of Physiotherapy, Kasturba Medical College, Mangalore, India; Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Senthil Kumaran D
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India; Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Manikandan Natarajan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India; Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Bhaskaran Unnikrishnan
- Manipal Academy of Higher Education, Manipal, Karnataka, India; Department of Community Medicine, Kasturba Medical College, Mangalore, India.
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India; Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, Karnataka, India.
| |
Collapse
|
13
|
Reinsdorf DS, Mahan EE, Reinkensmeyer DJ. Proprioceptive Gaming: Making Finger Sensation Training Intense and Engaging with the P-Pong Game and PINKIE Robot. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:6715-6720. [PMID: 34892649 PMCID: PMC9153391 DOI: 10.1109/embc46164.2021.9631041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Proprioceptive deficits are common after a stroke and are thought to negatively impact motor learning. Despite this, there is a lack of practical robotic devices for assessing proprioception, as well as few robotic rehabilitation techniques that intensely and engagingly target proprioception. This work first presents the design of a simple robotic device, PINKIE, developed to assess and train finger proprioception. PINKIE uses low-cost actuators and sensors and is fabricated completely from 3D printed, laser cut, and off-the-shelf components. We then describe the design and testing of a gamified proprioceptive training technique, Proprioceptive-Pong (P-Pong), implemented with PINKIE. In P-Pong, players must continuously make game decisions based on sensed index and middle finger positions, as the game robotically moves their fingers instead of screen pixels to express the motion of the ball and paddle. We also report the results of a pilot study in which we investigated the effect of a short bout of P-Pong play on proprioceptive acuity, and quantified user engagement and intrinsic motivation of game play. We randomly assigned 15 unimpaired human participants to play 15 minutes of P-Pong (proprioceptive training group) or a similar but video-only version of Pong (control group). We assessed finger proprioception acuity before and after game play using the Crisscross assessment previously developed by our laboratory, engagement using the User Engagement Scale, and motivation using the Intrinsic Motivation Inventory survey. Following game play, there was a significant improvement in proprioceptive acuity (2.2 ± 2.6 SD mm, p = 0.023) in the proprioceptive training group but not the control group (0.5 ± 0.9 SD mm, p = 0.101). Participants rated P-Pong highly on all survey subscales, and as highly as visual Pong, except in the Perceived Usability and Competence subscales, a finding we discuss. To our knowledge, this work presents the first computer gaming approach for providing intense and engaging finger proprioception training, by splitting the feedback of game elements between the visual and proprioceptive senses. The pilot experiment indicates that the human sensory motor system has the ability to at least temporarily improve proprioception acuity with such game-based training.
Collapse
|
14
|
Antico M, Balletti N, Laudato G, Lazich A, Notarantonio M, Oliveto R, Ricciardi S, Scalabrino S, Simeone J. Postural control assessment via Microsoft Azure Kinect DK: An evaluation study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 209:106324. [PMID: 34375852 DOI: 10.1016/j.cmpb.2021.106324] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/25/2021] [Indexed: 05/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Equipments generally used for entertainment, such as Microsoft Kinect, have been widely used for postural control as well. Such systems-compared to professional motion tracking systems-allow to obtain non-invasive and low-cost tracking. This makes them particularly suitable for the implementation of home rehabilitation systems. Microsoft has recently released a new version of Kinect, namely Azure Kinect DK, that is meant for developers, not consumers, and it has been specifically designed to implement professional applications. The hardware of this new version of the Kinect has been substantially improved as compared with previous versions. However, the accuracy of the Azure Kinect DK has not been evaluated yet in the context of the assessment of postural control as done for its predecessors. METHODS We present a study to compare the motion traces of the Azure Kinect DK with those of a Vicon 3D system, typically considered the gold standard for high-accuracy motion tracking. The study involved 26 subjects performing specific functional reach and functional balance exercises. RESULTS The results clearly indicates that the Azure Kinect DK provides a very accurate tracking of the main joints of the body for all the recording taken during the lateral reach movement. The Root Mean Square Error (RMSE) between the two tracking systems obtained is approximately 0.2 for the lateral and forward exercises while for the balance exercise it is around 0.47 considering the average of the results among all the joints. The angular Mean Absolute Error is approximately in the range 5-15 degrees for all the upper joints and independently on the exercise. The lower body joints show a higher angular error between the two systems. Not surprisingly, it was found that results are much better in correspondence of slow movements. CONCLUSIONS The results achieved that the Azure Kinect DK has an incredibly high potential to be used in applications of home rehabilitation, where the assessment of postural control is a fundamental and crucial activity.
Collapse
Affiliation(s)
| | - Nicoletta Balletti
- Defense Veterans Center, Ministry of Defense, Rome, Italy; STAKE Lab, University of Molise, Pesche, IS, Italy
| | | | - Aldo Lazich
- Defense Veterans Center, Ministry of Defense, Rome, Italy; DIAG, University of Rome "Sapienza", Rome, Italy
| | | | - Rocco Oliveto
- STAKE Lab, University of Molise, Pesche, IS, Italy; Datasound srl, Pesche, IS, Italy.
| | | | - Simone Scalabrino
- STAKE Lab, University of Molise, Pesche, IS, Italy; Datasound srl, Pesche, IS, Italy
| | | |
Collapse
|
15
|
Ito K, Uehara S, Yuasa A, Kim CM, Kitamura S, Ushizawa K, Tanabe S, Otaka Y. Electromyography-controlled gamified exercise system for the distal upper extremity: a usability assessment in subacute post-stroke patients. Disabil Rehabil Assist Technol 2021:1-6. [PMID: 34102940 DOI: 10.1080/17483107.2021.1936663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Movement repetition is known to play a key role in promoting functional improvements or maintaining functional levels in post-stroke hemiparetic patients. However, repetitive movements tend to be monotonous, making it challenging for patients to continue. Here, we developed a new gamified system to allow patients perform repetitive movements with enjoyment. The present study aimed to examine the usability of the system in subacute stroke patients. METHOD The exercise system comprised an electromyography-controlled operating system that enabled users to play a virtual game by repetitive finger and wrist movements on the affected side. A total of 13 patients with upper-limb hemiparesis underwent a single bout of exercise using the system and assessed its usability, satisfactoriness, enjoyability, etc. using the System Usability Scale (SUS), Quebec User Evaluation of Satisfaction with assistive Technology (QUEST)-like questionnaire, and numerical rating scale (NRS). RESULTS All the participants, who had a wide range of paretic levels, were able to perform the exercise using the system. Participants scored the system a median of 85.0 for SUS and 4.2 for the QUEST-like questionnaire, with an "excellent" in usability and "satisfied" in user satisfaction with the system. The median NRS scores for enjoyability, potential for continuous use, and effectiveness were 8.0, 9.0, and 9.0, respectively, which were greater than the scores for usual rehabilitation training for the upper extremity. CONCLUSIONS The novel electromyography-controlled gamified exercise system may have sufficient usability and enjoyability to motivate patients with a wide range of paretic levels to perform repetitive finger and wrist movements.IMPLICATIONS FOR REHABILITATIONThe electromyography-controlled gamified exercise system had overall positive perspectives on the usability of the system.This exercise system could help motivate patients with a wide range of paretic levels to perform repetitive finger and wrist movements.
Collapse
Affiliation(s)
- Kazuki Ito
- Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
| | - Shintaro Uehara
- Faculty of Rehabilitation, Fujita Health University School of Health Sciences, Aichi, Japan
| | - Akiko Yuasa
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Aichi, Japan
| | | | - Shin Kitamura
- Faculty of Rehabilitation, Fujita Health University School of Health Sciences, Aichi, Japan
| | - Kazuki Ushizawa
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Aichi, Japan
| | - Shigeo Tanabe
- Faculty of Rehabilitation, Fujita Health University School of Health Sciences, Aichi, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Aichi, Japan
| |
Collapse
|
16
|
Mediano MFF, Mok Y, Coresh J, Kucharska-Newton A, Palta P, Lakshminarayan K, Rosamond WD, Matsushita K, Koton S. Prestroke Physical Activity and Adverse Health Outcomes After Stroke in the Atherosclerosis Risk in Communities Study. Stroke 2021; 52:2086-2095. [PMID: 33784831 PMCID: PMC8154698 DOI: 10.1161/strokeaha.120.032695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/26/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE The association of physical activity (PA) before stroke (prestroke PA) with long-term prognosis after stroke is still unclear. We examined the association of prestroke PA with adverse health outcomes in the ARIC study (Atherosclerosis Risk in Communities). METHODS We included 881 participants with incident stroke occurring between 1993 and 1995 (visit 3) and December 31, 2016. Follow-up continued until December 31, 2017 to allow for at least 1-year after incident stroke. Prestroke PA was assessed using a modified version of the Baecke questionnaire in 1987 to 1989 (visit 1) and 1993 to 1995 (visit 3), evaluating PA domains (work, leisure, and sports) and total PA. We used Cox proportional hazards models to quantify the association between tertiles of accumulated prestroke PA levels over the 6-year period between visits 1 and 3 and mortality, risk of cardiovascular disease, and recurrent stroke after incident stroke. RESULTS During a median follow-up of 3.1 years after incident stroke, 676 (77%) participants had adverse outcomes. Highest prestroke total PA was associated with decreased risks of all-cause mortality (hazard ratio, 0.78 [95% CI, 0.63-0.97]) compared with lowest tertile. In the analysis by domain-specific PA, highest levels of work PA were associated with lower risk for all-cause (hazard ratio, 0.77 [95% CI, 0.62-0.96]) and cardiovascular mortality (hazard ratio, 0.45 [95% CI, 0.29-0.70]), and highest levels of leisure PA were associated with lower all-cause mortality (hazard ratio, 0.72 [95% CI, 0.58-0.89]) compared with lowest tertile of PA. No significant associations for sports PA were observed. CONCLUSIONS Higher levels of total prestroke PA as well as work and leisure PA were associated with lower risk of mortality after incident stroke. Public health strategies to increase lifetime PA should be encouraged to decrease long-term mortality after stroke.
Collapse
Affiliation(s)
- Mauro F. F. Mediano
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Department of Research and Education, National Institute of Cardiology, Rio de Janeiro, Brazil
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Yejin Mok
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Anna Kucharska-Newton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Priya Palta
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Kamakshi Lakshminarayan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Wayne D. Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Silvia Koton
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
17
|
Regan EW, Handlery R, Stewart JC, Pearson JL, Wilcox S, Fritz S. Feasibility of integrating survivors of stroke into cardiac rehabilitation: A mixed methods pilot study. PLoS One 2021; 16:e0247178. [PMID: 33780477 PMCID: PMC8007047 DOI: 10.1371/journal.pone.0247178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/02/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Survivors of stroke are often deconditioned and have limited opportunities for exercise post-rehabilitation. Cardiac Rehabilitation (CR), a structured exercise program offered post-cardiac event in the United States (U.S.), may provide an opportunity for continued exercise. The purpose of this study was to examine the feasibility of integrating survivors of stroke into an existing, hospital-based CR program through an assessment of (1) recruitment, uptake and retention, (2) adherence and fidelity, (3) acceptability and (4) safety. METHODS A mixed methods design combined a single group, pre-post design, pilot feasibility study with an imbedded qualitative inquiry. Survivors of stroke were recruited into a standard 12-week, 36 visit CR program. RESULTS Fifty-three survivors were referred, 29 started and 24 completed the program. Program uptake rate was 55% and completion rate was 83%. Eleven completers and one non-completer participated in the qualitative interviews. Program completers attended an average of 25.25 (SD 5.82) sessions with an average of 38.93 (SD 5.64) exercise minutes per session while reaching targeted rate of perceived exertion levels. Qualitative themes included perceived benefits of an individualized program in a group setting, positive interactions with qualified staff, opportunities for socialization, and regular monitoring and staff attentiveness promoting feelings of safety. CONCLUSIONS Survivors of stroke were able to meet Medicare standard dosage (frequency and session duration) and rate of perceived intensity goals, and perceived the program as needed regardless of their mobility limitations or previous exercise experience. Primary challenges included managing referrals and uptake. Results support feasibility and benefit for survivors to integrate into U.S. CR programs.
Collapse
Affiliation(s)
- Elizabeth W. Regan
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States of America
| | - Reed Handlery
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States of America
| | - Jill C. Stewart
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States of America
| | - Joseph L. Pearson
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, South Carolina, United States of America
| | - Sara Wilcox
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States of America
| | - Stacy Fritz
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States of America
| |
Collapse
|
18
|
Nayak P, Kumaran D S, Mahmood A, Manikandan N, Unnikrishnan B, Solomon JM. Feasibility of context-specific activities for improving physical activity levels among Indian adults with stroke. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2020.1866663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Pradeepa Nayak
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Senthil Kumaran D
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Amreen Mahmood
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, India
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Natarajan Manikandan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Bhaskaran Unnikrishnan
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education (MAHE), Manipal, India
| |
Collapse
|
19
|
Almhdawi KA, Jaber HB, Khalil HW, Kanaan SF, Shyyab AA, Mansour ZM, Alazrai AH. Post-stroke fatigue level is significantly associated with mental health component of health-related quality of life: a cross-sectional study. Qual Life Res 2021; 30:1165-1172. [PMID: 33387289 DOI: 10.1007/s11136-020-02714-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE Individuals post-stroke might have high levels of post-stroke fatigue (PSF) which might affect their quality of life. This study aimed to investigate the prevalence of post-stroke fatigue in Jordan and to comprehensively identify its possible associated factors. METHODS A cross-sectional design was implemented through one-hour face-to-face assessment sessions. The modified fatigue impact scale, 12-item Short-Form Health Survey, Montreal Cognitive Assessment, Motor Assessment Log, Upper Extremity Fugl Meyer assessment, Nine Hole Peg Test, 10 Meter Walk Testing, active and passive goniometry, Hand-held dynamometry, and modified Ashworth scale were used as outcome measures. Prevalence of post-stroke fatigue and levels of quality of life were reported using descriptive analyses. Multiple variable linear regression analysis was used to identify PSF associated factors of post-stroke fatigue. P < 0.05 was considered significant for all statistical tests. RESULTS 153 individuals with stroke participated in the study. A total of 117 participants (69.9%, 95% CI = 62.0-77.1%) were fatigued. Fatigue was significantly predicted by mental component of quality of life (β -0.42 [95% CI -0.53--0.31]; p < 0.001), cognition (β -0.69 [95% CI -1.08--0.29], p = 0.001), weekly sport hours (β -0.94 [95% CI -1.73--0.14], p = 0.022), and shoulder abduction spasticity (β -1.81 [95% CI -3.38--0.24], p = 0.024. The model explained 51% of the variation in the fatigue (F = 29.006, p < 0.001). CONCLUSION Jordanian individuals with stroke have a high prevalence of fatigue. Mental related quality of life was significantly associated with PSF levels. Other factors significantly associated with PSF included cognition status, sport participation, and spasticity. Healthcare practitioners working in neurorehabilitation should take PSF and its significant correlates into consideration when treating individuals with stroke.
Collapse
Affiliation(s)
- Khader A Almhdawi
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan.
| | - Hanan B Jaber
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Hanan W Khalil
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Saddam F Kanaan
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Awni A Shyyab
- Department of Neurology, King Hussein Centre, Amman, Jordan
| | - Zaid M Mansour
- Department of Physical and Occupational Therapy, Faculty of Allied Health Sciences, The Hashemite University, Zarqa, Jordan
| | - Alza H Alazrai
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
20
|
Walter AA, Van Puymbroeck M, Bosch P, Schmid AA. Complementary and integrative health interventions in post-stroke rehabilitation: a systematic PRISMA review. Disabil Rehabil 2020; 44:2223-2232. [DOI: 10.1080/09638288.2020.1830440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Alysha A. Walter
- Department of Recreation Sciences, East Carolina University, Greenville, SC, USA
| | - Marieke Van Puymbroeck
- Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, SC, USA
| | - Pamela Bosch
- Department of Neurology, University of Arizona, Phoenix, AZ, USA
| | - Arlene A. Schmid
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA
| |
Collapse
|
21
|
Dahlan Tabah FT, Sham F, Zakaria FN, Hashim NK, Dasiman R. Factors influencing stroke patient adherence to physical activity: a systematic review. JOURNAL OF GERONTOLOGY AND GERIATRICS 2020. [DOI: 10.36150/2499-6564-389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
22
|
Schaffer K, Panneerselvam N, Loh KP, Herrmann R, Kleckner IR, Dunne RF, Lin PJ, Heckler CE, Gerbino N, Bruckner LB, Storozynsky E, Ky B, Baran A, Mohile SG, Mustian KM, Fung C. Systematic Review of Randomized Controlled Trials of Exercise Interventions Using Digital Activity Trackers in Patients With Cancer. J Natl Compr Canc Netw 2020; 17:57-63. [PMID: 30659130 DOI: 10.6004/jnccn.2018.7082] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/07/2018] [Indexed: 12/12/2022]
Abstract
Background: Exercise can ameliorate cancer- and treatment-related toxicities, but poor adherence to exercise regimens is a barrier. Exercise interventions using digital activity trackers (E-DATs) may improve exercise adherence, but data are limited for patients with cancer. We conducted a systematic review examining the feasibility of E-DATs in cancer survivors and effects on activity level, body composition, objective fitness outcomes, health-related quality of life (HRQoL), self-reported symptoms, and biomarkers. Methods: We identified randomized controlled trials (RCTs) of E-DATs in adult cancer survivors published in English between January 1, 2008, and July 27, 2017. Two authors independently reviewed article titles (n=160), removed duplicates (n=50), and reviewed the remaining 110 articles for eligibility. Results: A total of 12 RCTs met eligibility criteria, including 1,450 patients (mean age, 50-70 years) with the following cancers: breast (n=5), colon or breast (n=2), prostate (n=1), acute leukemia (n=1), or others (n=3). Duration of E-DATs ranged from 4 to 24 weeks, and the follow-up period ranged from 4 to 52 weeks, with retention rates of 54% to 95%. The technology component of E-DATs included pedometers (n=8); pedometers with smartphone application (n=1), Wii Fit (n=1), heart rate monitor (n=1); and a wireless sensor with accelerometer, gyroscope, and magnetometer (n=1). Adherence by at least one measure to E-DATs was >70% in 8 of 8 RCTs. Compared with controls, E-DATs significantly improved patients' step count in 3 of 5 RCTs, activity level in 6 of 9 RCTs, and HRQoL in 7 of 9 RCTs (all P≤05), with no significant changes in biomarkers (eg, interleukin 6, tumor necrosis factor α, C-reactive protein, c-peptide, lipid panel) in 3 RCTs. Duration of E-DAT was not significantly correlated with adherence or study retention. Conclusions: This systematic review shows that E-DATs are feasible to implement in cancer survivors. Future research should examine the optimal type, dose, and schedule of E-DATs for cancer survivors.
Collapse
|
23
|
Caetano LCG, Pacheco BD, Samora GAR, Teixeira-Salmela LF, Scianni AA. Self-Efficacy to Engage in Physical Exercise and Walking Ability Best Predicted Exercise Adherence after Stroke. Stroke Res Treat 2020; 2020:2957623. [PMID: 32190284 PMCID: PMC7073491 DOI: 10.1155/2020/2957623] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/21/2020] [Indexed: 11/18/2022] Open
Abstract
AIM To describe exercise preferences and to investigate the contribution of exercise preferences, walking ability, and current levels of physical activity in predicting exercise adherence in individuals with chronic stroke. METHODS For this exploratory study, exercise adherence was measured using the first question of the first section of the Exercise Preference Questionnaire (stroke)-Brazil (EPQ (stroke)-Brazil). Nine independent variables were included as potential predictors of exercise adherence: the seven factors of the EPQ (stroke)-Brazil, walking speed, and level of physical activity. RESULTS Participated 93 individuals with stroke, who had a mean age of 62 (SD 12) years and a mean time since the onset of the stroke of 58 (SD 67) months. The most preferable exercise was walking. Logistic regression analysis revealed that self-efficacy to engage in physical exercise and walking ability predicted and explained 80% of the variance in exercise adherence. CONCLUSION The findings showed that feeling able to perform physical exercise and having higher walking ability predicted higher exercise adherences in individuals with chronic stroke. The knowledge of potential contributors to exercise adherence may help in designing exercise programs for individuals with stroke.
Collapse
Affiliation(s)
- Lívia C. G. Caetano
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Bruna D. Pacheco
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Giane A. R. Samora
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Luci F. Teixeira-Salmela
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Aline A. Scianni
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| |
Collapse
|
24
|
Marzolini S, Fong K, Jagroop D, Neirinckx J, Liu J, Reyes R, Grace SL, Oh P, Colella TJF. Eligibility, Enrollment, and Completion of Exercise-Based Cardiac Rehabilitation Following Stroke Rehabilitation: What Are the Barriers? Phys Ther 2020; 100:44-56. [PMID: 31588512 DOI: 10.1093/ptj/pzz149] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/09/2019] [Accepted: 06/09/2019] [Indexed: 11/13/2022]
Abstract
BACKGROUND People after stroke benefit from comprehensive secondary prevention programs including cardiac rehabilitation (CR), yet there is little understanding of eligibility for exercise and barriers to use. OBJECTIVE The aim of this study was to examine eligibility for CR; enrollment, adherence, and completion; and factors affecting use. DESIGN This was a prospective study of 116 consecutive people enrolled in a single outpatient stroke rehabilitation (OSR) program located in Toronto, Ontario, Canada. METHODS Questionnaires were completed by treating physical therapists for consecutive participants receiving OSR and included reasons for CR ineligibility, reasons for declining participation, demographics, and functional level. CR eligibility criteria included the ability to walk ≥100 m (no time restriction) and the ability to exercise at home independently or with assistance. People with or without hemiplegic gait were eligible for adapted or traditional CR, respectively. Logistic regression analyses were used to examine factors associated with use indicators. RESULTS Of 116 participants receiving OSR, 82 (70.7%) were eligible for CR; 2 became eligible later. Sixty (71.4%) enrolled in CR and 49 (81.7%) completed CR, attending 87.1% (SD = 16.6%) of prescribed sessions. The primary reasons for ineligibility included being nonambulatory or having poor ambulation (52.9%; 18/34 patients) and having severe cognitive deficits and no home exercise support (20.6%; 7/34). Frequently cited reasons for declining CR were moving or travel out of country (17.2%; 5/29 reasons), lack of interest (13.8%; 4/29), transportation issues (10.3%; 3/29), and desiring a break from therapy (10.3%; 3/29). In a multivariate analysis, people who declined CR were more likely to be women, have poorer attendance at OSR, and not diabetic. Compared with traditional CR, stroke-adapted CR resulted in superior attendance (66.1% [SD = 22.9%] vs 87.1% [SD = 16.6%], respectively) and completion (66.7% vs 89.7%, respectively). The primary reasons for dropping out were medical (45%) and moving (27%). LIMITATIONS Generalizability to other programs is limited, and other, unmeasured factors may have affected outcomes. CONCLUSIONS An OSR-CR partnership provided an effective continuum of care, with approximately 75% of eligible people participating and more than 80% completing. However, just over 1 of 4 eligible people declined participation; therefore, strategies should target lack of interest, transportation, women, and people without diabetes. An alternative program model is needed for people who have severe ambulatory or cognitive deficits and no home exercise support.
Collapse
Affiliation(s)
- Susan Marzolini
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Canadian Partnership for Stroke Recovery, Toronto, Ontario, Canada; University of Toronto, Ontario, Canada; and York University, Toronto, Ontario, Canada
| | - Karen Fong
- Toronto Rehabilitation Institute, University Health Network
| | - David Jagroop
- Toronto Rehabilitation Institute, University Health Network
| | | | - Jean Liu
- Toronto Rehabilitation Institute, University Health Network
| | - Rina Reyes
- Toronto Rehabilitation Institute, University Health Network
| | - Sherry L Grace
- Toronto Rehabilitation Institute, University Health Network; and York University
| | - Paul Oh
- Toronto Rehabilitation Institute, University Health Network; and Canadian Partnership for Stroke Recovery
| | - Tracey J F Colella
- Toronto Rehabilitation Institute, University Health Network; and University of Toronto
| |
Collapse
|
25
|
Çubukçu B, Yüzgeç U, Zileli R, Zileli A. Reliability and validity analyzes of Kinect V2 based measurement system for shoulder motions. Med Eng Phys 2019; 76:20-31. [PMID: 31882393 DOI: 10.1016/j.medengphy.2019.10.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 10/06/2019] [Accepted: 10/20/2019] [Indexed: 11/15/2022]
Abstract
Telerehabilitation systems provide some advantages against the classic rehabilitation methods. The ability of the shoulders depends on active motion range of them to do activities in daily life and to do sports. To evaluate the shoulder motions, range of motion (ROM) measurement is a basic method. Clinical goniometer and digital goniometer are the most commonly used measurement tools. However, these measurement tools have some deficiencies and difficulties. In this paper, we consider a Kinect One Sensor (Kinect V2) based measurement system for shoulder motions as an alternative method. The aim of this study is to examine the reliability and validity analyzes of the proposed shoulder measurement system. Three systems were used to evaluate validity of the Kinect V2 to measure shoulder motions: Kinect V2 based system, clinical goniometer and digital goniometer. One expert physical therapist measured shoulder abduction, flexion, external rotation, internal rotation and extension ROM values using a clinical goniometer and a digital goniometer in 40 healthy volunteers (22 males, 18 females, and 19-33 years old). All poses for each shoulder motion were captured with the Kinect V2 based system again and the ROM values were calculated. These procedures were carried out with all of the volunteer participants in three repetitions. In reliability for Kinect V2 based shoulder motion measurement system, we used the intraclass correlation coefficients (ICC), standard error of the measure (SEM), minimal detectable change (MDC). The validity test includes the 95% limits of agreement (LOA) and mean difference between the Kinect V2 based system and the both of the goniometer systems for measuring shoulder motions. The high ICC values show that the Kinect V2 based shoulder motion measurement system has very good intra-rater reliability for abduction, flexion, external rotation, internal rotation shoulder poses. For extension pose, it has good reliability result according to the ICC value. The validity analysis gives good results for all shoulder poses except internal rotation between Kinect V2 and clinical/digital goniometer. As a result, Kinect V2 based measurement system is a reliable and valid alternative telerehabilitation tool for shoulder motions.
Collapse
Affiliation(s)
- Burakhan Çubukçu
- Department of Computer Engineering, Bilecik Seyh Edebali University, 11210 Bilecik, Turkey
| | - Uğur Yüzgeç
- Department of Computer Engineering, Bilecik Seyh Edebali University, 11210 Bilecik, Turkey.
| | - Raif Zileli
- School of Health, Bilecik Seyh Edebali University, 11210 Bilecik, Turkey
| | - Ahu Zileli
- Department of Physical Medicine and Rehabilitation, Bilecik State Hospital, Bilecik, Turkey
| |
Collapse
|
26
|
Fuertes Muñoz G, Mollineda RA, Gallardo Casero J, Pla F. A RGBD-Based Interactive System for Gaming-Driven Rehabilitation of Upper Limbs. SENSORS (BASEL, SWITZERLAND) 2019; 19:E3478. [PMID: 31395817 PMCID: PMC6721017 DOI: 10.3390/s19163478] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/30/2019] [Accepted: 08/07/2019] [Indexed: 11/17/2022]
Abstract
Current physiotherapy services may not be effective or suitable for certain patients due to lack of motivation, poor adherence to exercises, insufficient supervision and feedback or, in the worst case, refusal to continue with the rehabilitation plan. This paper introduces a novel approach for rehabilitation of upper limbs through KineActiv, a platform based on Microsoft Kinect v2 and developed in Unity Engine. KineActiv proposes exergames to encourage patients to perform rehabilitation exercises prescribed by a specialist, controls the patient's performance, and corrects execution errors on the fly. KineActiv comprises a web platform where the physiotherapist can review session results, monitor patient health, and adjust rehabilitation routines. We recruited 10 patients for assessing the system usability as well as the system performance. Results show that KineActiv is a usable, enjoyable and reliable system, that does not cause any negative feelings.
Collapse
Affiliation(s)
| | - Ramón A Mollineda
- Institute of New Imaging Technologies, Universitat Jaume I, 12071 Castellón, Spain
| | | | - Filiberto Pla
- Institute of New Imaging Technologies, Universitat Jaume I, 12071 Castellón, Spain
| |
Collapse
|
27
|
Şahin S, Köse B, Aran OT, Bahadır Ağce Z, Kayıhan H. The Effects of Virtual Reality on Motor Functions and Daily Life Activities in Unilateral Spastic Cerebral Palsy: A Single-Blind Randomized Controlled Trial. Games Health J 2019; 9:45-52. [PMID: 31335174 DOI: 10.1089/g4h.2019.0020] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aim: This study was designed to investigate the effects of virtual reality (VR) through Kinect on both gross and fine motor functions and independence in daily living activities in children with unilateral spastic cerebral palsy (USCP). Materials and Methods: This study was designed as a single-blind, randomized, controlled trial. Sixty children with USCP were randomized and split equally between the VR intervention group (10 females and 20 males with a mean age of 10.5 ± 3.62 years) and the traditional occupational therapy (TOT) intervention group (13 females and 17 males with a mean age of 10.06 ± 3.24 years). Both groups were evaluated in terms of motor functioning via the Bruininks-Oseretsky Test of Motor Proficiency-Short Form (BOTMP-SF) and were assessed in accordance with independence in daily activities via the WeeFunctional Independence Measure (WeeFIM). Interventions were conducted for 8 weeks with the main objective of improving motor functions and independence in daily activities. Results: Total motor functions and total independence in daily lives in both groups improved after 8 weeks of intervention. A comparison between groups revealed significantly greater improvements in both gross and fine motor functions and daily activities in the VR group than in the TOT group (P < 0.001). Conclusion: The Kinect-based VR intervention approach is important to improving motor functions and independence in daily activities of children with USCP.
Collapse
Affiliation(s)
- Sedef Şahin
- Department of Occupational Therapy, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Barkın Köse
- Department of Occupational Therapy, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Orkun Tahir Aran
- Department of Occupational Therapy, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Zeynep Bahadır Ağce
- Department of Occupational Therapy, Üsküdar University Faculty of Health Sciences, İstanbul, Turkey
| | - Hülya Kayıhan
- Department of Occupational Therapy, Faculty of Health Sciences, Biruni University, Istanbul, Turkey
| |
Collapse
|
28
|
Débora Pacheco B, Guimarães Caetano LC, Amorim Samora G, Sant'Ana R, Fuscaldi Teixeira-Salmela L, Scianni AA. Perceived barriers to exercise reported by individuals with stroke, who are able to walk in the community. Disabil Rehabil 2019; 43:331-337. [PMID: 31180726 DOI: 10.1080/09638288.2019.1624396] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To identify the perceived barriers to exercise, which could be modified, as well as the associated factors in people at the sub-acute post-stroke stages, who were able to walk in the community. METHODS For this exploratory study, barriers to exercise were identified by the Exercise Barrier sub-scale of the Exercise Benefits/Barriers Scale. Step-wise multiple linear regression analysis was employed to identify which of the clinical and sociodemographic variables, that is, age, walking speed, levels of physical activity, socioeconomic status, and depressive symptoms, could significantly predict the Exercise Barrier sub-scale scores. RESULTS Ninety-five individuals, who had a mean age of 63 (13) years and a mean time since the onset of the stroke of 4 (1) months participated. The main reported barriers to exercise were related to fatigue, as well as availability and distance from the exercise places. Additional reported barriers were "lack of a person to help" and "knowledge on how to practice exercise." Perceived barriers were associated with depressive symptoms and socioeconomic status. Together, they explained 9% of the variance in the Exercise Barrier sub-scale scores (p < 0.01). CONCLUSIONS Fatigue, reduced number of places, and long distances to exercise places were the main reported barriers to exercise. Depressive symptoms and socioeconomic status were the only variables that explained the variance in the Exercise Barrier sub-scale scores. Rehabilitation interventions should include strategies to reduce fatigue during and after exercise, provide guidance regarding both structured and unstructured exercise venues, in addition to screening and managing depressive symptoms. Implications for Rehabilitation Stroke survivors, who are able to walk in the community, should be referred and instructed on how to reduce fatigue through the practice of exercise. Health professionals should guide stroke survivors about the existing places for practice of exercise and how to exercise without structured environments. It is necessary to create or reformulate environments for exercise and provide orientation to practice through qualified professionals. Health professionals should also be able to assess the presence of depressive symptoms and address proper referral and management of the potential barriers to exercise.
Collapse
Affiliation(s)
- Bruna Débora Pacheco
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lívia Cristina Guimarães Caetano
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Giane Amorim Samora
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Romeu Sant'Ana
- Hospital Risoleta Tolentino Neves, Belo Horizonte, Brazil
| | - Luci Fuscaldi Teixeira-Salmela
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Aline Alvim Scianni
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
29
|
Bailey R. Examining daily physical activity in community-dwelling adults with stroke using social cognitive theory: an exploratory, qualitative study. Disabil Rehabil 2019; 42:2631-2639. [PMID: 30973766 DOI: 10.1080/09638288.2019.1568591] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: A better understanding of psychosocial factors underlying daily physical activity (i.e. physical activity performed throughout the day) in stroke survivors could be used to develop interventions to promote post-stroke physical activity, particularly in individuals for whom exercise is difficult.Methods: In-depth qualitative interviews were conducted with 15 ambulatory, community-dwelling stroke survivors. Interview transcripts were analyzed using directed content analysis, guided by Social Cognitive Theory, to investigate outcomes expectations, self-efficacy, self-regulation, and social-support for daily physical activity.Results: Participants reported that physical and mental health, and independence and recovery, were important outcomes expectations. Self-efficacy was enhanced through mental perceptions and mastery experiences. Planning, problem-solving, reviewing performance, and establishing routines that require physical activity were important self-regulation strategies. Social support provided praise and encouragement and physical assistance, but was also a barrier when friends and family were overprotective.Conclusions: Participants reported that the investigated Social Cognitive Theory constructs were important psychosocial factors for daily physical activity. Future research and clinical investigations should empirically test the use of strategies to modify these factors for promoting daily physical activity in community-dwelling adults with stroke.Implications for rehabilitationInterventions to increase physical activity after stroke are needed.Outcomes expectations, self-efficacy, self-regulation, and social support were reported by participants as important psychosocial factors underlying daily physical activity.These psychosocial factors should be explored with individual patients and clients to determine which are most deficient, and where amenable to change, targeted for intervention to promote daily physical activity.
Collapse
Affiliation(s)
- Ryan Bailey
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| |
Collapse
|
30
|
Ocampo R, Tavakoli M. Improving User Performance in Haptics-Based Rehabilitation Exercises by Colocation of User's Visual and Motor Axes via a Three-Dimensional Augmented-Reality Display. IEEE Robot Autom Lett 2019. [DOI: 10.1109/lra.2019.2891283] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
31
|
Bailey RR. Self-Efficacy, Self-Regulation, Social Support, and Outcomes Expectations for Daily Physical Activity in Adults with Chronic Stroke: A Descriptive, Exploratory Study. Occup Ther Health Care 2019; 33:129-141. [PMID: 30648475 PMCID: PMC6527467 DOI: 10.1080/07380577.2018.1558326] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 11/29/2018] [Accepted: 12/08/2018] [Indexed: 01/14/2023]
Abstract
Interventions are needed to increase physical activity throughout the day in adults with chronic stroke, but mechanisms of action for doing so have not been identified. In this descriptive, exploratory study of 36 ambulatory, community-dwelling adults with chronic stroke, participants completed questionnaires investigating self-efficacy, self-regulation, social support, and outcomes expectations for daily physical activity. In the absence of any intervention, participants consistently reported high self-efficacy and outcomes expectations but low use of self-regulation and social support strategies. Discussion of how these results can inform the development of interventions to facilitate daily physical activity in adults with chronic stroke is provided.
Collapse
Affiliation(s)
- Ryan R Bailey
- a Brown School, Washington University in St. Louis , St. Louis , Missouri , USA
| |
Collapse
|
32
|
Ramírez-Moreno JM, Muñoz-Vega P, Alberca SB, Peral-Pacheco D. Health-Related Quality of Life and Fatigue After Transient Ischemic Attack and Minor Stroke. J Stroke Cerebrovasc Dis 2019; 28:276-284. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.09.046] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 09/18/2018] [Accepted: 09/27/2018] [Indexed: 11/27/2022] Open
|
33
|
Gunnes M, Langhammer B, Aamot IL, Lydersen S, Ihle-Hansen H, Indredavik B, Reneflot KH, Schroeter W, Askim T. Adherence to a Long-Term Physical Activity and Exercise Program After Stroke Applied in a Randomized Controlled Trial. Phys Ther 2019; 99:74-85. [PMID: 30329136 DOI: 10.1093/ptj/pzy126] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 07/05/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Persistent physical activity is important to maintain motor function across all stages after stroke. OBJECTIVE The objective of this study was to investigate adherence to an 18-month physical activity and exercise program. DESIGN The design was a prospective, longitudinal study including participants who had had a stroke randomly allocated to the intervention arm of a randomized controlled trial. METHODS The intervention consisted of individualized monthly coaching by a physical therapist who motivated participants to adhere to 30 minutes of daily physical activity and 45 minutes of weekly exercise over an 18-month period. The primary outcome was the combination of participants' self-reported training diaries and adherence, as reported by the physical therapists. Mixed-effect models were used to analyze change in adherence over time. Intensity levels, measured by the Borg scale, were a secondary outcome. RESULTS In total, 186 informed, consenting participants who had had mild-to-moderate stroke were included 3 months after stroke onset. Mean age was 71.7 years (SD = 11.9). Thirty-four (18.3%) participants withdrew and 9 (4.8%) died during follow-up. Adherence to physical activity and exercise each month ranged from 51.2% to 73.1%, and from 63.5% to 79.7%, respectively. Adherence to physical activity increased by 2.6% per month (odds ratio = 1.026, 95% CI = 1.014-1.037). Most of the exercise was performed at moderate-to-high intensity levels, ranging from scores of 12 to 16 on the Borg scale, with an increase of 0.018 points each month (95% CI = 0.011-0.024). LIMITATIONS Limitations included missing information about adherence for participants with missing data and reasons for dropout. CONCLUSIONS Participants with mild and moderate impairments after stroke who received individualized regular coaching established and maintained moderate-to-good adherence to daily physical activity and weekly exercise over time.
Collapse
Affiliation(s)
- Mari Gunnes
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, P.O. Box 8905, N-7491 Trondheim, Norway; and Stroke Unit, Department of Internal Medicine, Trondheim University Hospital, Trondheim, Norway
| | - Birgitta Langhammer
- Department of Physiotherapy, Oslo; Akershus University College, Oslo, Norway; and Sunnaas Rehabilitation Hospital, HF, Nesoddtangen, Norway
| | - Inger-Lise Aamot
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology
| | - Hege Ihle-Hansen
- Department of Internal Medicine, Vestre Viken Hospital Trust, Baerum Hospital, Oslo, Norway
| | - Bent Indredavik
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology; and Stroke Unit, Department of Internal Medicine, Trondheim University Hospital
| | | | - Walburga Schroeter
- Unit for Physiotherapy Services, the Municipality of Trondheim, Trondheim, Norway
| | - Torunn Askim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology
| | | |
Collapse
|
34
|
Brouwer-Goossensen D, van Genugten L, Lingsma HF, Dippel DWJ, Koudstaal PJ, den Hertog HM. Self-efficacy for health-related behaviour change in patients with TIA or minor ischemic stroke. Psychol Health 2018; 33:1490-1501. [DOI: 10.1080/08870446.2018.1508686] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Dorien Brouwer-Goossensen
- Department Neurology and Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Lenneke van Genugten
- Department Neurology and Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Hester F. Lingsma
- Department Neurology and Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Diederik W. J. Dippel
- Department Neurology and Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Peter J. Koudstaal
- Department Neurology and Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | |
Collapse
|
35
|
Sarsfield J, Brown D, Sherkat N, Langensiepen C, Lewis J, Taheri M, McCollin C, Barnett C, Selwood L, Standen P, Logan P, Simcox C, Killick C, Hughes E. Clinical assessment of depth sensor based pose estimation algorithms for technology supervised rehabilitation applications. Int J Med Inform 2018; 121:30-38. [PMID: 30545487 DOI: 10.1016/j.ijmedinf.2018.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 11/05/2018] [Indexed: 11/28/2022]
Abstract
Encouraging rehabilitation by the use of technology in the home can be a cost-effective strategy, particularly if consumer-level equipment can be used. We present a clinical qualitative and quantitative analysis of the pose estimation algorithms of a typical consumer unit (Xbox One Kinect), to assess its suitability for technology supervised rehabilitation and guide development of future pose estimation algorithms for rehabilitation applications. We focused the analysis on upper-body stroke rehabilitation as a challenging use case. We found that the algorithms require improved joint tracking, especially for the shoulder, elbow and wrist joints, and exploiting temporal information for tracking when there is full or partial occlusion in the depth data.
Collapse
Affiliation(s)
- Joe Sarsfield
- Interactive Systems Research Group, School of Science and Technology, Nottingham Trent University, Clifton Lane, Nottingham, NG11 8NS, United Kingdom.
| | - David Brown
- Interactive Systems Research Group, School of Science and Technology, Nottingham Trent University, Clifton Lane, Nottingham, NG11 8NS, United Kingdom
| | - Nasser Sherkat
- Sheffield Hallam University, Howard Street, Sheffield, S1 1WB, United Kingdom
| | - Caroline Langensiepen
- Interactive Systems Research Group, School of Science and Technology, Nottingham Trent University, Clifton Lane, Nottingham, NG11 8NS, United Kingdom
| | - James Lewis
- Interactive Systems Research Group, School of Science and Technology, Nottingham Trent University, Clifton Lane, Nottingham, NG11 8NS, United Kingdom
| | - Mohammad Taheri
- Interactive Systems Research Group, School of Science and Technology, Nottingham Trent University, Clifton Lane, Nottingham, NG11 8NS, United Kingdom
| | - Christopher McCollin
- Interactive Systems Research Group, School of Science and Technology, Nottingham Trent University, Clifton Lane, Nottingham, NG11 8NS, United Kingdom
| | - Cleveland Barnett
- SHAPE Research Centre, School of Science and Technology, Nottingham Trent University, Clifton Lane, Nottingham, NG11 8NS, United Kingdom
| | - Louise Selwood
- Nottingham CityCare, 1 Standard Court, Park Row Nottingham, NG1 6GN, United Kingdom
| | - Penny Standen
- University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom
| | - Pip Logan
- University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom
| | - Christopher Simcox
- Nottinghamshire Healthcare NHS Foundation Trust, Stapleford Care Centre, Nottingham, NG9 8DB, United Kingdom
| | - Catherine Killick
- Nottinghamshire Healthcare NHS Foundation Trust, Stapleford Care Centre, Nottingham, NG9 8DB, United Kingdom
| | - Emma Hughes
- Nottinghamshire Healthcare NHS Foundation Trust, Stapleford Care Centre, Nottingham, NG9 8DB, United Kingdom
| |
Collapse
|
36
|
Fairbairn M, Wicks E, Ait-Ouali S, Drodge O, Brooks D, Huijbregts M, Blonski D. Facilitators of and Barriers to Providing Access to Community-Based Exercise Programmes for Adults with Post-Stroke Aphasia from the Perspective of Programme Representatives. Physiother Can 2018; 70:280-288. [PMID: 30275653 DOI: 10.3138/ptc.2016-103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: Individuals with post-stroke aphasia (PSA) engage in inadequate levels of physical activity (PA), hindering physical and psychosocial recovery. The purpose of this study was to identify the extent to which community-based exercise programmes (CBEPs) in the Greater Toronto Area (GTA) are accessible to adults living with PSA and the characteristics of such programmes from the perspective of CBEP representatives. Methods: A cross-sectional, Web-based survey was administered to representatives of CBEPs open to adults post-stroke in the GTA to identify the CBEPs' relevant characteristics and perceived facilitators of and barriers to accessibility. Results: A total of 17 eligible CBEP representatives completed the survey, for a response rate of 32%. The most commonly used exercise instructors were personal trainers (8; 47%). Of the 17 eligible CBEP representatives, 10 (59%) identified a lack of qualified personnel as the main barrier to providing access to adults with PSA. Verbal strategies were among the most commonly used methods of communication with adults with PSA (16; 94%), and written material was the least used (5; 29%). Conclusion: Understanding the common facilitators of and barriers to providing adults with PSA access to CBEPs will assist programme developers to improve the accessibility of CBEPs and facilitate PA in this population.
Collapse
Affiliation(s)
| | | | | | | | - Dina Brooks
- Department of Physical Therapy.,Faculty of Medicine, University of Toronto
| | | | - Diane Blonski
- Early Intervention Services of York Region - Children's Treatment Network, Markham, Ont
| |
Collapse
|
37
|
Thilarajah S, Mentiplay BF, Bower KJ, Tan D, Pua YH, Williams G, Koh G, Clark RA. Factors Associated With Post-Stroke Physical Activity: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2018; 99:1876-1889. [DOI: 10.1016/j.apmr.2017.09.117] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/06/2017] [Accepted: 09/20/2017] [Indexed: 12/18/2022]
|
38
|
Wentink MM, Meesters J, Berger MAM, de Kloet AJ, Stevens E, Band GPH, Kromme CH, Wolterbeek R, Goossens PH, Vliet Vlieland TPM. Adherence of stroke patients with an online brain training program: the role of health professionals’ support. Top Stroke Rehabil 2018; 25:359-365. [DOI: 10.1080/10749357.2018.1459362] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- M. M. Wentink
- Sophia Rehabilitation, The Hague, The Netherlands
- Faculty of Health, Nutrition and Sports, The Hague University of Applied Sciences, The Hague, The Netherlands
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - J. Meesters
- Sophia Rehabilitation, The Hague, The Netherlands
- Faculty of Health, Nutrition and Sports, The Hague University of Applied Sciences, The Hague, The Netherlands
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - M. A. M. Berger
- Faculty of Health, Nutrition and Sports, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - A. J. de Kloet
- Sophia Rehabilitation, The Hague, The Netherlands
- Faculty of Health, Nutrition and Sports, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - E. Stevens
- Helen Dowling Institute, Bilthoven, The Netherlands
| | - G. P. H. Band
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - C. H. Kromme
- Sophia Rehabilitation, The Hague, The Netherlands
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - R. Wolterbeek
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - P. H. Goossens
- Sophia Rehabilitation, The Hague, The Netherlands
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - T. P. M. Vliet Vlieland
- Sophia Rehabilitation, The Hague, The Netherlands
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands
- Department of Orthopaedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
| |
Collapse
|
39
|
Brauer SG, Kuys SS, Paratz JD, Ada L. Improving physical activity after stroke via treadmill training and self management (IMPACT): a protocol for a randomised controlled trial. BMC Neurol 2018; 18:13. [PMID: 29382298 PMCID: PMC5791375 DOI: 10.1186/s12883-018-1015-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 01/03/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The level of physical activity undertaken by stroke survivors living in the community is generally low. The main objectives of the IMPACT trial are to determine, in individuals undergoing rehabilitation after stroke, if 8 weeks of high-intensity treadmill training embedded in self-management education (i) results in more physical activity than usual physiotherapy gait training and (ii) is more effective at increasing walking ability, cardiorespiratory fitness, self-efficacy, perception of physical activity, participation, and health-related quality of life as well as decreasing cardiovascular risk, and depression, at 8 and 26 weeks. METHODS A prospective, two-arm, parallel-group, randomised trial with concealed allocation, blinded measurement and intention-to-treat analysis, will be conducted. 128 stroke survivors undergoing rehabilitation who are able to walk independently will be recruited and randomly allocated to either the experimental or control group, who will both undergo gait training for 30 min, three times a week for 8 weeks under the supervision of a physiotherapist. Outcomes will be measured at baseline (Week 0), on completion of the intervention (Week 8) and beyond the intervention (Week 26). This study has obtained ethical approval from the relevant Human Research Ethics Committees. DISCUSSION Improving stroke survivors' walking ability and cardiorespiratory fitness is likely to increase their levels of physical activity. Furthermore, if education in self-management results in sustained high levels of physical activity, this should result in improved participation and quality of life. TRIAL REGISTRATION This trial was registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12613000744752 ) on 4th July, 2013.
Collapse
Affiliation(s)
- Sandra G. Brauer
- Discipline of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD Australia
| | - Suzanne S. Kuys
- School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Banyo, QLD Australia
| | - Jennifer D. Paratz
- School of Allied Health Sciences, Griffith University, Southport, QLD Australia
| | - Louise Ada
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, NSW Australia
| |
Collapse
|
40
|
Self-Reported Exercise Prevalence and Determinants in the Long Term After Stroke: The North East Melbourne Stroke Incidence Study. J Stroke Cerebrovasc Dis 2017; 26:2855-2863. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/15/2017] [Accepted: 07/10/2017] [Indexed: 11/18/2022] Open
|
41
|
Caetano LCG, Teixeira-Salmela LF, Samora GAR, Scianni AA. Cross-cultural adaptation and measurement properties of the Brazilian version of the Exercise Preference Questionnaire (stroke). Braz J Phys Ther 2017; 21:336-343. [PMID: 28716366 PMCID: PMC5628371 DOI: 10.1016/j.bjpt.2016.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/01/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The Exercise Preference Questionnaire (EPQ(stroke)) captures exercise preferences and measures personal factors, that influence motivation and adherence to exercise in stroke subjects. OBJECTIVES To perform the cross-cultural adaptation of the EPQ(stroke) into the Brazilian-Portuguese language and to evaluate its measurement properties. METHODS The EPQ(stroke) was cross-culturally adapted and primarily tested in 30 chronic stroke subjects. After the final version of the EPQ(stroke)-Brazil was created, its test-retest reliability was verified, using Kappa indices and intra-class correlation coefficients (ICCs) (n=50), and internal consistency was verified using Cronbach's alpha coefficients (n=101). Construct validity was assessed using exploratory factor analysis (n=101), content validity using the content validity index (CVI) (n=8), and face validity using the rate of agreement regarding the clarity, wording, ability to answer the questions, and lay-out and style of the questionnaire with two groups, including individuals with stroke (n=81) and multidisciplinary health professionals (n=32). RESULTS The pre-final version required revisions (items 9, 29, and 30) and, after another pre-test, it was shown to be appropriate. The Kappa indices ranged from 0.58 to 0.95; the ICCs from 0.35 to 0.93, and the Cronbach's alpha coefficient was 0.82 (0.768-0.869 CI), showing adequate internal consistency. The exploratory factor analysis and CVI confirmed the validity of the EPQ(stroke)-Brazil. The rate of agreement was greater than 80% for both groups. CONCLUSION The EPQ(stroke)-Brazil was found to be a valid and reliable measure for verifying exercise preferences of Brazilian individuals with stroke.
Collapse
Affiliation(s)
- Lívia C G Caetano
- Programa de pós-graduação em Ciências da Reabilitação, Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Luci F Teixeira-Salmela
- Programa de pós-graduação em Ciências da Reabilitação, Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Giane A R Samora
- Programa de pós-graduação em Ciências da Reabilitação, Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Aline A Scianni
- Programa de pós-graduação em Ciências da Reabilitação, Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
| |
Collapse
|
42
|
Ballester BR, Nirme J, Camacho I, Duarte E, Rodríguez S, Cuxart A, Duff A, Verschure PFMJ. Domiciliary VR-Based Therapy for Functional Recovery and Cortical Reorganization: Randomized Controlled Trial in Participants at the Chronic Stage Post Stroke. JMIR Serious Games 2017; 5:e15. [PMID: 28784593 PMCID: PMC5565792 DOI: 10.2196/games.6773] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 04/04/2017] [Accepted: 04/29/2017] [Indexed: 11/25/2022] Open
Abstract
Background Most stroke survivors continue to experience motor impairments even after hospital discharge. Virtual reality-based techniques have shown potential for rehabilitative training of these motor impairments. Here we assess the impact of at-home VR-based motor training on functional motor recovery, corticospinal excitability and cortical reorganization. Objective The aim of this study was to identify the effects of home-based VR-based motor rehabilitation on (1) cortical reorganization, (2) corticospinal tract, and (3) functional recovery after stroke in comparison to home-based occupational therapy. Methods We conducted a parallel-group, controlled trial to compare the effectiveness of domiciliary VR-based therapy with occupational therapy in inducing motor recovery of the upper extremities. A total of 35 participants with chronic stroke underwent 3 weeks of home-based treatment. A group of subjects was trained using a VR-based system for motor rehabilitation, while the control group followed a conventional therapy. Motor function was evaluated at baseline, after the intervention, and at 12-weeks follow-up. In a subgroup of subjects, we used Navigated Brain Stimulation (NBS) procedures to measure the effect of the interventions on corticospinal excitability and cortical reorganization. Results Results from the system’s recordings and clinical evaluation showed significantly greater functional recovery for the experimental group when compared with the control group (1.53, SD 2.4 in Chedoke Arm and Hand Activity Inventory). However, functional improvements did not reach clinical significance. After the therapy, physiological measures obtained from a subgroup of subjects revealed an increased corticospinal excitability for distal muscles driven by the pathological hemisphere, that is, abductor pollicis brevis. We also observed a displacement of the centroid of the cortical map for each tested muscle in the damaged hemisphere, which strongly correlated with improvements in clinical scales. Conclusions These findings suggest that, in chronic stages, remote delivery of customized VR-based motor training promotes functional gains that are accompanied by neuroplastic changes. Trial Registration International Standard Randomized Controlled Trial Number NCT02699398 (Archived by ClinicalTrials.gov at https://clinicaltrials.gov/ct2/show/NCT02699398?term=NCT02699398&rank=1)
Collapse
Affiliation(s)
- Belén Rubio Ballester
- Laboratory of Synthetic Perceptive, Emotive and Cognitive Systems, Center of Autonomous Systems and Neurorobotics, Department of Information and Communication Technologies, Pompeu Fabra, Barcelona, Spain
| | - Jens Nirme
- Laboratory of Synthetic Perceptive, Emotive and Cognitive Systems, Center of Autonomous Systems and Neurorobotics, Department of Information and Communication Technologies, Pompeu Fabra, Barcelona, Spain
| | - Irene Camacho
- Servei de Medicina Física I Rehabilitació, Institut Hospital del Mar d'Investigacions Mèdiques, Hospitals del Mar I l'Esperança, Barcelona, Spain
| | - Esther Duarte
- Servei de Medicina Física I Rehabilitació, Institut Hospital del Mar d'Investigacions Mèdiques, Hospitals del Mar I l'Esperança, Barcelona, Spain
| | - Susana Rodríguez
- Servei de Medicina Física i Rehabilitació, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Ampar Cuxart
- Servei de Medicina Física i Rehabilitació, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Armin Duff
- Laboratory of Synthetic Perceptive, Emotive and Cognitive Systems, Center of Autonomous Systems and Neurorobotics, Department of Information and Communication Technologies, Pompeu Fabra, Barcelona, Spain
| | - Paul F M J Verschure
- Laboratory of Synthetic Perceptive, Emotive and Cognitive Systems, Center of Autonomous Systems and Neurorobotics, Department of Information and Communication Technologies, Pompeu Fabra, Barcelona, Spain.,ICREA, Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain.,Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Baldiri Reixac 10-12, 08028, Barcelona, Spain
| |
Collapse
|
43
|
Signal N, McPherson K, Lewis G, Kayes N, Saywell N, Mudge S, Taylor D. What influences acceptability and engagement with a high intensity exercise programme for people with stroke? A qualitative descriptive study. NeuroRehabilitation 2017; 39:507-517. [PMID: 27689610 DOI: 10.3233/nre-161382] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Intensity refers to the amount of effort or rate of work undertaken during exercise. People receiving rehabilitation after stroke frequently do not reach the moderate to high intensity exercise recommended to maximise gains. OBJECTIVE To explore the factors that influence the acceptability of, and engagement with, a high intensity group-based exercise programme for people with stroke. METHODS This qualitative descriptive study included 14 people with stroke who had completed a 12-week, high intensity group-based exercise rehabilitation programme. Semi-structured interviews were used to explore the acceptability of high intensity exercise and the barriers and facilitators to engagement. Interviews were recorded, transcribed and analysed using qualitative content analysis. RESULTS The participants found high intensity exercise rehabilitation acceptable despite describing the exercise intensity as hard and reporting post-exercise fatigue. Participants accepted the fatigue as a normal response to exercise, and it did not appear to negatively influence engagement. The ease with which an individual engaged in high intensity exercise rehabilitation appeared to be mediated by inter-related factors, including: seeing progress, sourcing motivation, working hard, the people involved and the fit with the person and their life. Participants directly related the intensity of their effort to the gains that they made. CONCLUSIONS In this study, people with stroke viewed training at higher intensities as a facilitator, not a barrier, to engagement in exercise rehabilitation. The findings may challenge assumptions about the influence of exercise intensity on engagement.
Collapse
Affiliation(s)
- Nada Signal
- Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand
| | - Kathryn McPherson
- Health Research Council of New Zealand, Auckland, New Zealand.,Centre for Person Centered Research, AUT University, Auckland, New Zealand
| | - Gwyn Lewis
- Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand
| | - Nicola Kayes
- Centre for Person Centered Research, AUT University, Auckland, New Zealand
| | - Nicola Saywell
- Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand
| | - Suzie Mudge
- Centre for Person Centered Research, AUT University, Auckland, New Zealand
| | - Denise Taylor
- Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand
| |
Collapse
|
44
|
Stephenson A, Stephens J. An exploration of physiotherapists’ experiences of robotic therapy in upper limb rehabilitation within a stroke rehabilitation centre. Disabil Rehabil Assist Technol 2017; 13:245-252. [DOI: 10.1080/17483107.2017.1306593] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Andrew Stephenson
- Northumbria Healthcare NHS Foundation Trust, Northumbria Specialist Emergency Care Hospital, Cramlington, UK
| | - John Stephens
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| |
Collapse
|
45
|
Jackson S, Mercer C, Singer BJ. An exploration of factors influencing physical activity levels amongst a cohort of people living in the community after stroke in the south of England. Disabil Rehabil 2016; 40:414-424. [PMID: 28029070 DOI: 10.1080/09638288.2016.1258437] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To explore factors influencing physical activity (PA) reported by people living in rural/semi-rural communities in the south of England post-stroke, and to understand relationships between personal, interpersonal and environmental barriers and self-reported levels of PA. METHOD A survey was mailed to patients of NHS Trusts who were identified as potential participants. Self-reported PA levels, type, and frequency of reported barriers were tabulated. Spearman's rank correlation coefficient was used to explore associations between self-reported PA level and: age, gender, level of physical function, fear of falling, beliefs regarding PA, available supports, and socioeconomic status. RESULTS Seventy-six of 322 questionnaires distributed were returned (24%). Only 55.2% of respondents reported undertaking PA of sufficient intensity to meet current guidelines. Personal barriers included fear of falling, stroke-related disability, pain, and fatigue. Interpersonal and environmental barriers included lack of social support, transport, and inclement weather. Significant relationships existed between self-reported PA and fear of falling, functional mobility, and beliefs relating to PA. CONCLUSIONS Almost half of the survey cohort reported PA levels insufficient to meet current guidelines. Similar to barriers reported in previous studies in USA and other parts of the UK, numerous interlinking and overlapping personal, interpersonal, and environmental barriers to undertaking PA were identified. Implications for Rehabilitation This study found that although more than 60% of the survey population were able to ambulate >200 m, only 55.2% reported undertaking sufficient PA to meet current guidelines, putting them at increased risk of further stroke and other co-morbidities. Participants reported a number of interlinking and overlapping personal, interpersonal, and environmental barriers to undertaking PA, which may explain this discrepancy between mobility status and self reported activity levels. Rehabilitation professionals and primary care providers are well positioned to address the barriers identified in this survey, such as providing interventions to reduce fear of falling, pain, and fatigue, providing support and education about safely increasing physical activity and addressing unhelpful beliefs about PA. Behaviour change strategies, such as increasing self-efficacy, and partnering with the person with stroke to problem solve strategies to address the barriers identified by this, and related research, are likely to be more successful in increasing PA than providing information alone.
Collapse
Affiliation(s)
- Sharon Jackson
- a School of Surgery, FMDHS , The Centre for Musculoskeletal Studies, The University of Western Australia , Perth , Australia.,b Portsmouth Hospitals NHS Foundation Trust , Portsmouth , UK
| | | | - Barbara Jennifer Singer
- a School of Surgery, FMDHS , The Centre for Musculoskeletal Studies, The University of Western Australia , Perth , Australia
| |
Collapse
|
46
|
Anderson C, Grant RL, Hurley MV. Exercise facilities for neurologically disabled populations - Perceptions from the fitness industry. Disabil Health J 2016; 10:157-162. [PMID: 27687636 DOI: 10.1016/j.dhjo.2016.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 09/04/2016] [Accepted: 09/07/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND People with neurological disabilities (pwND) face many barriers to undertaking physical activity. One option for exercise alongside formal physiotherapy is local fitness facilities but accessibility is often found wanting and gyms are seen as unwelcoming to pwND. OBJECTIVE The objective of this exploratory study was to investigate the perceptions of fitness facility managers with respect to exercise for pwND in a gym environment. The aim was to identify potential barriers to provision by the fitness industry for pwND. METHODS The participants included those who were in a position to influence provision at a policy level and those working at management level within fitness providers. A mixed methods approach was used: a quantitative questionnaire and 4 qualitative interviews. Descriptive and correlational analysis, thematic content analysis and concurrent triangulation analysis was undertaken. RESULTS Specially trained staff is perceived to be necessary to make fitness facilities accessible for pwND. CONCLUSIONS Ensuring the provision of specially trained staff to support pwND to exercise in gyms may be the main barrier to provision for this population. Investigation into the standard training of fitness professionals combining the expertise of neurological physiotherapists with that of fitness professionals to meet the needs of pwND would be advantageous.
Collapse
Affiliation(s)
- Cheryl Anderson
- Faculty of Health, Social Care and Education, St George's University of London and Kingston University, Cranmer Terrace, London, SW17 0RE, UK.
| | - Robert L Grant
- Faculty of Health, Social Care and Education, St George's University of London and Kingston University, Cranmer Terrace, London, SW17 0RE, UK.
| | - Michael V Hurley
- Faculty of Health, Social Care and Education, St George's University of London and Kingston University, Cranmer Terrace, London, SW17 0RE, UK.
| |
Collapse
|
47
|
Adie K, Schofield C, Berrow M, Wingham J, Humfryes J, Pritchard C, James M, Allison R. Does the use of Nintendo Wii Sports TM improve arm function? Trial of Wii TM in Stroke: a randomized controlled trial and economics analysis. Clin Rehabil 2016; 31:173-185. [PMID: 26975313 DOI: 10.1177/0269215516637893] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The Trial of Wii™ in Stroke investigated the efficacy of using the Nintendo Wii Sports™ (WiiTM) to improve affected arm function after stroke. DESIGN Multicentre, pragmatic, parallel group, randomized controlled trial. SETTING Home-based rehabilitation. SUBJECTS A total of 240 participants aged 24-90 years with arm weakness following a stroke within the previous six months. INTERVENTION Participants were randomly assigned to exercise daily for six weeks using the WiiTM or arm exercises at home. MAIN MEASURES Primary outcome was change in the affected arm function at six weeks follow-up using the Action Research Arm Test. Secondary outcomes included occupational performance, quality of life, arm function at six months and a cost effectiveness analysis. RESULTS The study was completed by 209 participants (87.1%). There was no significant difference in the primary outcome of affected arm function at six weeks follow-up (mean difference -1.7, 95% CI -3.9 to 0.5, p = 0.12) and no significant difference in secondary outcomes, including occupational performance, quality of life or arm function at six months, between the two groups. No serious adverse events related to the study treatment were reported. The cost effectiveness analysis showed that the WiiTM was more expensive than arm exercises £1106 (SD 1656) vs. £730 (SD 829) (probability 0.866). CONCLUSION The trial showed that the WiiTM was not superior to arm exercises in home-based rehabilitation for stroke survivors with arm weakness. The WiiTM was well tolerated but more expensive than arm exercises.
Collapse
Affiliation(s)
- Katja Adie
- 1 Stroke and Eldercare, Royal Cornwall Hospital Trust, Cornwall, UK
| | - Christine Schofield
- 2 Research, Development and Innovation, Royal Cornwall Hospital Trust, Truro, UK
| | - Margie Berrow
- 3 Peninsula Clinical Trials Unit, Plymouth University Schools of Medicine and Dentistry, Plymouth, UK
| | - Jennifer Wingham
- 2 Research, Development and Innovation, Royal Cornwall Hospital Trust, Truro, UK.,4 University of Exeter Medical School (Primary Care), St Luke's Campus, Exeter, UK
| | | | - Colin Pritchard
- 2 Research, Development and Innovation, Royal Cornwall Hospital Trust, Truro, UK
| | - Martin James
- 6 Royal Devon & Exeter Hospital/University of Exeter Medical School, Exeter, UK
| | - Rhoda Allison
- 7 Torbay and South Devon NHS Foundation Trust, Newton Abbott Hospital, Devon, UK
| |
Collapse
|
48
|
Saywell N, Taylor N, Rodgers E, Skinner L, Boocock M. Play-based interventions improve physical function for people with adult-acquired brain injury: a systematic review and meta-analysis of randomised controlled trials. Clin Rehabil 2016; 31:145-157. [DOI: 10.1177/0269215516631384] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective: To undertake a systematic review and meta-analysis of the effectiveness of play-based interventions compared to traditional therapy in rehabilitation of adults with adult-acquired brain injury. Data sources: The search was performed using Medline; Cinahl Plus; Health Source (Nursing/Academic Edition); Psychology and behavioural sciences collection; Biomedical reference collection (basic). Review methods: Studies included were randomised controlled trials that investigated the effect of play-based interventions on physical function of adults with adult acquired brain injury. Two independent reviewers identified eligible studies and assessed methodological quality using a modified Downs and Black. Meta-analysis compared standardised differences in means, to determine effect sizes for grouped functional outcome measures. The GRADE scoring system was used to determine the level of clinical evidence. Results: Thirty studies met the inclusion criteria, 13 were considered high quality and 17 moderate quality. Studies predominantly involved post-stroke participants, with only three studies including participants with traumatic brain injury. When compared to traditional therapy, dose-matched studies of play-based interventions showed a significant effect on independence (Effect size (ES) = 0.6) and physical performance (ES = 0.43), as measured using the Fugl –Meyer. For non-dose matched studies, play-based interventions showed a significant improvement for balance (ES = 0.76) compared with traditional therapy. In all studies that measured participant enjoyment, play-based therapy was rated as more enjoyable than traditional therapy. Conclusion: Play-based interventions for people with adult acquired brain injury are more effective in improving balance and independence, which may be due to them being more enjoyable than traditional therapy.
Collapse
Affiliation(s)
- Nicola Saywell
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | | | | | - Luke Skinner
- Waitemata District Health Board, Auckland, New Zealand
| | - Mark Boocock
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
49
|
Clanchy KM, Tweedy SM, Trost SG. Evaluation of a Physical Activity Intervention for Adults With Brain Impairment. Neurorehabil Neural Repair 2016; 30:854-65. [DOI: 10.1177/1545968316632059] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Individuals with brain impairment (BI) are less active than the general population and have increased risk of chronic disease. Objective. This controlled trial evaluated the efficacy of a physical activity (PA) intervention for community-dwelling adults with BI. Methods. A total of 43 adults with BI (27 male, 16 female; age 38.1 ± 11.9 years; stage of change 1-3) who walked as their primary means of locomotion were allocated to an intervention (n = 23) or control (n = 20) condition. The intervention comprised 10 face-to-face home visits over 12 weeks, including a tailored combination of stage-matched behavior change activities, exercise prescription, community access facilitation, and relapse prevention strategies. The control group received 10 face-to-face visits over 12 weeks to promote sun safety, healthy sleep, and oral health. Primary outcomes were daily activity counts and minutes of moderate-to-vigorous-intensity PA (MVPA) measured with the ActiGraph GT1M at baseline (0 weeks), postintervention (12 weeks) and follow-up (24 weeks). Between-group differences were evaluated for statistical significance using repeated-measures ANOVA. Results. MVPA for the intervention group increased significantly from baseline to 12 weeks (20.8 ± 3.1 to 31.2 ± 3.1 min/d; P = .01), but differences between baseline and 24 weeks were nonsignificant (20.8 ± 3.1 to 25.3 ± 3.2 min/d; P = .28). MVPA changes for the control group were negligible and nonsignificant. Between-group differences for change in MVPA were significant at 12 weeks ( P = .03) but not at 24 weeks ( P = .49). Conclusion. The 12-week intervention effectively increased adoption of PA in a sample of community-dwelling adults with BI immediately after the intervention but not at follow-up. Future studies should explore strategies to foster maintenance of PA participation.
Collapse
Affiliation(s)
- Kelly M. Clanchy
- Griffith University, Southport, QLD, Australia
- The University of New England, Armidale, NSW, Australia
| | | | - Stewart G. Trost
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, QLD, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology - Centre for Children’s Health Research South Brisbane QLD, Australia
| |
Collapse
|
50
|
Pomeroy SH. Commentary by Pomeroy. West J Nurs Res 2016. [DOI: 10.1177/0193945906289496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|