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Abstract
Stroke remains a major cause of disability. Intensive rehabilitation therapy can improve outcomes, but most patients receive limited doses. Telehealth methods can overcome obstacles to delivering intensive therapy and thereby address this unmet need. A specific example is reviewed in detail, focused on a telerehabilitation system that targets upper extremity motor deficits after stroke. Strengths of this system include provision of daily therapy associated with very high patient compliance, safety and feasibility in the inpatient or home setting, comparable efficacy to dose-matched therapy provided in-clinic, and a holistic approach that includes assessment, education, prevention, and activity-based therapy.
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Affiliation(s)
- Steven C Cramer
- Department of Neurology, UCLA, Los Angeles, CA, USA; California Rehabilitation Institute, 2070 Century Park East, Los Angeles, CA 90067-1907, USA.
| | - Brittany M Young
- Department of Neurology, UCLA, Los Angeles, CA, USA; California Rehabilitation Institute, 2070 Century Park East, Los Angeles, CA 90067-1907, USA
| | - Anne Schwarz
- Department of Neurology, UCLA, Los Angeles, CA, USA; California Rehabilitation Institute, 2070 Century Park East, Los Angeles, CA 90067-1907, USA
| | - Tracy Y Chang
- Department of Neurology, UCLA, Los Angeles, CA, USA; California Rehabilitation Institute, 2070 Century Park East, Los Angeles, CA 90067-1907, USA
| | - Michael Su
- Department of Neurology, UCLA, Los Angeles, CA, USA; California Rehabilitation Institute, 2070 Century Park East, Los Angeles, CA 90067-1907, USA
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2
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Oliveira SG, Ribeiro JAM, Silva ÉSM, Uliam NR, Silveira AF, Araújo PN, Camargo AI, Urruchia VRR, Nogueira SL, Russo TL. Interventions to Change Movement Behaviors After Stroke: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024; 105:381-410. [PMID: 37541356 DOI: 10.1016/j.apmr.2023.07.011] [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: 08/26/2022] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVE This systematic review aimed to determine which interventions increase physical activity (PA) and decrease sedentary behavior (SB) based on objective measures of movement behavior in individuals with stroke. DATA SOURCES The PubMed (Medline), EMBASE, Scopus, CINAHL (EBSCO), and Web of Science databases were searched for articles published up to January 3, 2023. STUDY SELECTION The StArt 3.0.3 BETA software was used to screen titles, abstracts, and full texts for studies with randomized controlled trial designs; individuals with stroke (≥18 years of age); interventions aimed at increasing PA or decreasing SB; and objective measurement instruments. DATA EXTRACTION Data extraction was standardized, considering participants and assessments of interest. The risk of bias and quality of evidence of the included studies were assessed. DATA SYNTHESIS Twenty-eight studies involving 1855 patients were included. Meta-analyses revealed that in the post-stroke acute/subacute phase, exercise interventions combined with behavior change techniques (BCTs) increased both daily steps (standardized mean difference [SMD]=0.65, P=.0002) and time spent on moderate-to-vigorous intensity physical activities (MVPAs) duration of PA (SMD=0.68, P=.0004) with moderate-quality evidence. In addition, interventions based only on BCTs increased PA levels with very low-quality evidence (SMD (low-intensity physical activity)=0.36, P=.02; SMD (MVPA)=0.56, P=.0004) and decreased SB with low-quality evidence (SMD=0.48, P=.03). In the post-stroke chronic phase, there is statistical significance in favor of exercise-only interventions in PA frequency (steps/day) with moderate-quality evidence (SMD=0.68, P=.002). In general, the risk of bias in the included studies was low. CONCLUSIONS In the acute/subacute phase after stroke, the use of BCTs combined with exercise can increase the number of daily steps and time spent on MVPA. In contrast, in the post-stroke chronic phase, exercise-only interventions resulted in a significant increase in daily steps.
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Affiliation(s)
| | | | | | - Nicoly Ribeiro Uliam
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Ana Flávia Silveira
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | | | - Ana Isabela Camargo
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | | | | | - Thiago Luiz Russo
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.
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Westlake K, Akinlosotu R, Udo J, Goldstein Shipper A, Waller SM, Whitall J. Some home-based self-managed rehabilitation interventions can improve arm activity after stroke: A systematic review and narrative synthesis. Front Neurol 2023; 14:1035256. [PMID: 36816549 PMCID: PMC9932529 DOI: 10.3389/fneur.2023.1035256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/06/2023] [Indexed: 02/05/2023] Open
Abstract
Background There is an increased need for home-based, self-managed, and low maintenance stroke rehabilitation as well as interest in targeting the arm, which often lags behind leg recovery. Previous reviews have not controlled for concurrent standard of care and the ratio of self-managed care to therapist input. Objectives To determine the effectiveness of home-based, self-managed and low maintenance programs for upper-limb motor recovery in individuals after stroke. A secondary objective explored the adherence to home-based self-managed programs. Data sources We searched PubMed (1809-present), Embase (embase.com, 1974-present), Cochrane CENTRAL Register of Controlled Trials (Wiley), CINAHL (EBSCOhost, 1937-present), Physiotherapy Evidence Database (pedro.org.au), OTseeker (otseeker.com), and REHABDATA (National Rehabilitation Information Center). All searches were completed on June 9, 2022. Bibliographic references of included articles also were searched. Eligibility criteria Randomized controlled trials (RCT) in adults after stroke, where both intervention and control were home-based, at least 75% self-managed and did not involve concurrent therapy as a confounding factor. Primary outcome was performance in functional motor activities after training. Secondary outcome was sensorimotor impairment. All outcomes after a retention period were also considered secondary outcomes. Data collection and analysis Two review authors independently screened titles/abstracts, three review authors screened full papers and extracted data, and two review authors undertook assessment of risk of bias (i.e., allocation bias, measurement bias, confounding factors) using the NHLBI Study Quality Assessment Tool. Main results We identified seven heterogenous studies, including five with fair to good quality. All studies had an alternative treatment, dose-equivalent control. Only one trial reported a positive, sustained, between-group effect on activity for the experimental group. The remaining studies reported seven interventions having a within-group training effect with three interventions having sustained effects at follow up. One study reported a between group effect on an impairment measure with no follow-up. Overall adherence rates were high, but three studies reported differential group rates. Compliance with daily logs was higher when the logs were collected on a weekly basis. Limitations By excluding studies that allowed concurrent therapy, we likely minimized the number of studies that included participants in the early sub-acute post-stroke stage. By focusing on RCTs, we are unable to comment on other potentially promising home-based, self-managed single cohort programs. By including only published and English language studies, we may have included publication bias. Conclusions and implications There is some evidence that a variety of home-based, self-managed training program can be beneficial after stroke. Future research could compare such programs with natural history controls. Clinicians might utilize home exercise programs with explicit directions and some form of weekly contact to aid compliance.
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Affiliation(s)
- Kelly Westlake
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
| | - Ruth Akinlosotu
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
| | - Jean Udo
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
| | - Andrea Goldstein Shipper
- Health Sciences and Human Services Library, University of Maryland, Baltimore, MD, United States
| | - Sandy McCombe Waller
- Division of Health, Business, Technology, and Science, Frederick Community College, Frederick, MD, United States
| | - Jill Whitall
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
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4
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Yau L, Soutter K, Ekegren C, Hill KD, Ashe M, Soh SE. Adherence to Exercise Programs in Community-Dwelling Older Adults Postdischarge for Hip Fracture: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2022; 103:1827-1838.e2. [PMID: 35143745 DOI: 10.1016/j.apmr.2022.01.145] [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: 09/30/2021] [Revised: 12/14/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether older adults adhere to exercise programs after discharge for hip fracture and how adherence relates to exercise program characteristics and intervention efficacy. DATA SOURCES Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health, Embase, Physiotherapy Evidence Database, Web of Science, SPORTDiscus, PsycINFO, PubMed, and Ovid MEDLINE were searched from inception to August 2020. STUDY SELECTION Randomized controlled trials of exercise interventions in adults older than 60 years with a surgically managed hip fracture that provided a measure of adherence were selected by 2 independent reviewers. DATA EXTRACTION Data were extracted independently by 1 reviewer and cross-checked by a second reviewer for accuracy. Risk of bias was assessed with 2 tools: a customized checklist was used to examine sources of bias and ambiguity for adherence data, and the Cochrane Risk of Bias tool was used to assess the interval validity of studies. DATA SYNTHESIS Seventeen trials with 1850 participants (mean age, 78.8 years) were included in the review. The pooled estimate of adherence to exercise programs post hip fracture was 0.88 (95% CI, 0.78-0.95). Programs that were more than 6 months in duration were associated with a decrease in adherence (odds ratio, 0.29; 95% CI, 0.11-0.77). However, increased adherence was not associated with improvements in functional outcomes. None of the other program characteristics were associated with improvements in functional outcomes. CONCLUSIONS Adherence to exercise programs after hip fracture appears to be high and may be related to program duration. However, there is a need for a standardized approach to measure and report adherence data in future studies to determine whether exercise adherence is associated with improvements in function for this population.
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Affiliation(s)
- Lucinda Yau
- Physiotherapy Department, Alfred Health, Melbourne, Australia
| | - Kate Soutter
- Physiotherapy Department, Alfred Health, Melbourne, Australia
| | - Christina Ekegren
- Rehabilitation, Ageing, and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Keith D Hill
- Rehabilitation, Ageing, and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia
| | - Maureen Ashe
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Sze-Ee Soh
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Physiotherapy, Monash University, Melbourne, Australia.
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Turk R, Whitall J, Meagher C, Stokes M, Roberts S, Woodham S, Clatworthy P, Burridge J. Task selection for a sensor-based, wearable, upper limb training device for stroke survivors: a multi-stage approach. Disabil Rehabil 2022; 45:1480-1487. [PMID: 35476616 DOI: 10.1080/09638288.2022.2065542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Post-stroke survivors report that feedback helps to increase training motivation. A wearable system (M-MARK), comprising movement and muscle sensors and providing feedback when performing everyday tasks was developed. The objective reported here was to create an evidence-based set of upper-limb tasks for use with the system. MATERIALS AND METHODS Data from two focus groups with rehabilitation professionals, ten interviews with stroke survivors and a review of assessment tests were synthesized. In a two-stage process, suggested tasks were screened to exclude non-tasks and complex activities. Remaining tasks were screened for suitability and entered into a categorization matrix. RESULTS Of 83 suggestions, eight non-tasks, and 42 complex activities were rejected. Of the remaining 33 tasks, 15 were rejected: five required fine motor control; eight were too complex to standardize; one because the role of hemiplegic hand was not defined and one involved water. The review of clinical assessment tests found no additional tasks. Eleven were ultimately selected for testing with M-Mark. CONCLUSIONS Using a task categorization matrix, a set of training tasks was systematically identified. There was strong agreement between data from the professionals, survivors and literature. The matrix populated by tasks has potential for wider use in upper-limb stroke rehabilitation. IMPLICATIONS FOR REHABILITATIONRehabilitation technologies that provide feedback on quantity and quality of movements can support independent home-based upper limb rehabilitation.Rehabilitation technology systems require a library of upper limb tasks at different levels for people with stroke and therapists to choose from.A user-defined and evidence-based set of upper limb tasks for use within a wearable sensor device system have been developed.
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Affiliation(s)
- Ruth Turk
- School of Health Sciences, Faculty of Environmental Sciences, University of Southampton, Southampton, UK
| | - Jill Whitall
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Claire Meagher
- School of Health Sciences, Faculty of Environmental Sciences, University of Southampton, Southampton, UK
| | - Maria Stokes
- School of Health Sciences, Faculty of Environmental Sciences, University of Southampton, Southampton, UK.,Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nottingham, UK
| | - Sue Roberts
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | | | | | - Jane Burridge
- School of Health Sciences, Faculty of Environmental Sciences, University of Southampton, Southampton, UK
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Amorese AJ, Ryan AS. Home-Based Tele-Exercise in Musculoskeletal Conditions and Chronic Disease: A Literature Review. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:811465. [PMID: 36188988 PMCID: PMC9397976 DOI: 10.3389/fresc.2022.811465] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/28/2022] [Indexed: 01/28/2023]
Abstract
Exercise training is an essential component in the treatment or rehabilitation of various diseases and conditions. However, barriers to exercise such as the burdens of travel or time may hinder individuals' ability to participate in such training programs. Advancements in technology have allowed for remote, home-based exercise training to be utilized as a supplement or replacement to conventional exercise training programs. Individuals in these home-based exercise programs are able to do so under varying levels of supervision from trained professionals, with some programs having direct supervision, and others having little to no supervision at all. The purpose of this review is to examine the use of home-based, tele-exercise training programs for the treatment of different disease states and conditions, and how these programs compare to conventional clinic-based exercise training programs.
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Affiliation(s)
- Adam J Amorese
- Baltimore Veterans Affairs (VA) Medical Center, Geriatric Research, Education and Clinical Center (GRECC), VA Maryland Health Care System, Baltimore, MD, United States
| | - Alice S Ryan
- Baltimore Veterans Affairs (VA) Medical Center, Geriatric Research, Education and Clinical Center (GRECC), VA Maryland Health Care System, Baltimore, MD, United States.,VA Research Service, Baltimore GRECC, Department of Medicine, Division of Geriatrics and Palliative Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
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Cramer SC, Dodakian L, Le V, McKenzie A, See J, Augsburger R, Zhou RJ, Raefsky SM, Nguyen T, Vanderschelden B, Wong G, Bandak D, Nazarzai L, Dhand A, Scacchi W, Heckhausen J. A Feasibility Study of Expanded Home-Based Telerehabilitation After Stroke. Front Neurol 2021; 11:611453. [PMID: 33613417 PMCID: PMC7888185 DOI: 10.3389/fneur.2020.611453] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/04/2020] [Indexed: 01/17/2023] Open
Abstract
Introduction: High doses of activity-based rehabilitation therapy improve outcomes after stroke, but many patients do not receive this for various reasons such as poor access, transportation difficulties, and low compliance. Home-based telerehabilitation (TR) can address these issues. The current study evaluated the feasibility of an expanded TR program. Methods: Under the supervision of a licensed therapist, adults with stroke and limb weakness received home-based TR (1 h/day, 6 days/week) delivered using games and exercises. New features examined include extending therapy to 12 weeks duration, treating both arm and leg motor deficits, patient assessments performed with no therapist supervision, adding sensors to real objects, ingesting a daily experimental (placebo) pill, and generating automated actionable reports. Results: Enrollees (n = 13) were median age 61 (IQR 52-65.5), and 129 (52-486) days post-stroke. Patients initiated therapy on 79.9% of assigned days and completed therapy on 65.7% of days; median therapy dose was 50.4 (33.3-56.7) h. Non-compliance doubled during weeks 7-12. Modified Rankin scores improved in 6/13 patients, 3 of whom were >3 months post-stroke. Fugl-Meyer motor scores increased by 6 (2.5-12.5) points in the arm and 1 (-0.5 to 5) point in the leg. Assessments spanning numerous dimensions of stroke outcomes were successfully implemented; some, including a weekly measure that documented a decline in fatigue (p = 0.004), were successfully scored without therapist supervision. Using data from an attached sensor, real objects could be used to drive game play. The experimental pill was taken on 90.9% of therapy days. Automatic actionable reports reliably notified study personnel when critical values were reached. Conclusions: Several new features performed well, and useful insights were obtained for those that did not. A home-based telehealth system supports a holistic approach to rehabilitation care, including intensive rehabilitation therapy, secondary stroke prevention, screening for complications of stroke, and daily ingestion of a pill. This feasibility study informs future efforts to expand stroke TR. Clinical Trial Registration: Clinicaltrials.gov, # NCT03460587.
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Affiliation(s)
- Steven C. Cramer
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
- California Rehabilitation Institute, Los Angeles, CA, United States
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Lucy Dodakian
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Vu Le
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Alison McKenzie
- Department of Physical Therapy, Chapman University, Orange, CA, United States
| | - Jill See
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Renee Augsburger
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Robert J. Zhou
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Sophia M. Raefsky
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Thalia Nguyen
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | | | - Gene Wong
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Daniel Bandak
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Laila Nazarzai
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Amar Dhand
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States
| | - Walt Scacchi
- Institute for Software Research, University of California, Irvine, Irvine, CA, United States
| | - Jutta Heckhausen
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
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Donoso Brown EV, Nolfi D, Wallace SE, Eskander J, Hoffman JM. Home program practices for supporting and measuring adherence in post-stroke rehabilitation: a scoping review. Top Stroke Rehabil 2019; 27:377-400. [PMID: 31891554 DOI: 10.1080/10749357.2019.1707950] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND After stroke, individuals face a variety of impairments that impact function. Increasingly, rehabilitation for these impairments has moved into the community and home settings through the use of home programs. However, adherence to these programs is often low, limiting effectiveness. OBJECTIVE This scoping review investigated home program implementation and measurement of adherence with persons post-stroke to identify commonly reported practices and determine areas for further research. METHODS The electronic databases of PubMed, CINAHL, Scopus, Cochrane Database of Systematic Reviews, and PEDro were searched. Studies focused on post-stroke rehabilitation with an independent home program were selected. Qualitative studies, commentaries, and single-case studies were excluded. Title and abstract screenings were completed by two reviewers with a third for tie-breaking. The full-text review was completed by two reviewers using consensus to resolve any differences. Of the 1,197 articles initially found only 6% (n = 70) met criteria for data extraction. Elements for data extraction included: type of study, area of intervention, description of home program, presence of strategies to support adherence, methods to measure adherence and reported adherence. RESULTS Most commonly reported strategies to support home practice were the use of technology, personalization, and written directions. Only 20 studies reported achieving adherence at or greater than 75% and 18 studies did not report adherence outcomes. CONCLUSIONS Future investigations that directly compare and identify the most effective strategies to support adherence to home programs for this population are warranted. The implementation of guidelines for reporting adherence to home programs is recommended.
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Affiliation(s)
| | - David Nolfi
- Gumberg Library, Duquesne University , Pittsburgh, USA
| | - Sarah E Wallace
- Department of Speech Language Pathology, Duquesne University , Pittsburgh, PA, USA
| | - Joanna Eskander
- Department of Occupational Therapy, Duquesne University , Pittsburgh, PA, USA
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington , Seattle, WA, USA
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Kringle EA, Barone Gibbs B, Campbell G, McCue M, Terhorst L, Kersey J, Skidmore ER. Influence of Interventions on Daily Physical Activity and Sedentary Behavior after Stroke: A Systematic Review. PM R 2019; 12:186-201. [DOI: 10.1002/pmrj.12222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 07/11/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Emily A. Kringle
- Department of Occupational Therapy, School of Health and Rehabilitation SciencesUniversity of Pittsburgh Pittsburgh PA
| | - Bethany Barone Gibbs
- Department of Health and Physical Activity, School of EducationUniversity of Pittsburgh Pittsburgh PA
- Department of Clinical and Translational ScienceUniversity of Pittsburgh Pittsburgh PA
| | - Grace Campbell
- Department of Acute and Tertiary Care, School of NursingUniversity of Pittsburgh Pittsburgh PA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation SciencesUniversity of Pittsburgh Pittsburgh PA
| | - Lauren Terhorst
- Department of Occupational Therapy, School of Health and Rehabilitation SciencesUniversity of Pittsburgh Pittsburgh PA
| | - Jessica Kersey
- Department of Occupational Therapy, School of Health and Rehabilitation SciencesUniversity of Pittsburgh Pittsburgh PA
| | - Elizabeth R. Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation SciencesUniversity of Pittsburgh Pittsburgh PA
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Lacroix J, Daviet JC, Salle JY, Borel B, Compagnat M, Mandigout S. Effort Assessment of Stroke Patients in Physiotherapy Session by Accelerometry and Perceived Exertion Score: Preliminary Study. Ann Rehabil Med 2019; 43:262-268. [PMID: 31311247 PMCID: PMC6637063 DOI: 10.5535/arm.2019.43.3.262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/18/2018] [Indexed: 11/13/2022] Open
Abstract
Objective To determine whether post-stroke patient’s perceived exertion correlates with effort intensity score as measured by a wearable sensor and to assess whether estimates of perceived exertion are correlated to the cerebral hemisphere involved in the stroke. Methods We evaluated the effort intensity score during physiotherapy sessions using a wearable sensor and subjects assessed their perceived exertion using the modified Borg CR10 Scale. Results Fifty-seven subacute stroke patients participated in the study. The correlation between perceived exertion rating and measured effort intensity was insignificant—mean (r=-0.04, p=0.78) and peak (r=-0.05, p=0.70). However, there was a significant difference (p<0.02) in the perceived exertion ratings depending on the cerebral hemisphere where the stroke occurred. Patients with left-hand side lesions rated their perceived exertion as 4.5 (min–max, 0.5–8), whereas patients with right-hand side lesions rated their perceived exertion as 5.0 (2–8). Conclusion While there was an insignificant correlation between perceived exertion and effort intensity measured by a wearable sensor, a consistent variations in perceived exertion estimates according to the side of the cerebral lesion was identified and established.
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Affiliation(s)
- Justine Lacroix
- HAVAE EA6310, Institut GEIST, University of Limoges, Limoges, France
| | - Jean-Christophe Daviet
- HAVAE EA6310, Institut GEIST, University of Limoges, Limoges, France.,Department of Physical Medicine and Rehabilitation, Jean Rebeyrol Hospital, CHU Limoges, Limoges, France
| | - Jean-Yves Salle
- HAVAE EA6310, Institut GEIST, University of Limoges, Limoges, France.,Department of Physical Medicine and Rehabilitation, Jean Rebeyrol Hospital, CHU Limoges, Limoges, France
| | - Benoit Borel
- HAVAE EA6310, Institut GEIST, University of Limoges, Limoges, France
| | - Maxence Compagnat
- HAVAE EA6310, Institut GEIST, University of Limoges, Limoges, France.,Department of Physical Medicine and Rehabilitation, Jean Rebeyrol Hospital, CHU Limoges, Limoges, France
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de Oliveira DC, Ferreira PRC, Silveira Fernandes ABG, Pacheco TBF, Avelino MML, Cavalcanti FADC, Vieira ER, Campos TF. Circadian activity rhythm and fragmentation are associated with sleep-wake patterns and sleep quality in patients with stroke. NeuroRehabilitation 2019; 44:353-360. [PMID: 31177246 DOI: 10.3233/nre-182665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Activity levels and disturbances of the sleep-wake pattern affect health and quality of life and need to be further explored in patients with stroke. OBJECTIVE To evaluate activity levels and their association with sleep-wake patterns in patients with stroke. METHODS Ten adults with (51±6 years) and 10 without stroke (52±7 years) participated in the study; they were matched on age, sex and educational level. Neurological status, motor function, sleep quality, and activity levels were measured. The groups were compared using Student t-tests and the association between the measures was assessed using Pearson's correlation. RESULTS Compared to people without stroke, those with stroke had worse sleep quality (p = 0.044), twice lower 24h-activity levels (p < 0.0001), higher interdaily stability and intradaily variability, lower activity during the most active 10 h and during the least active 5 h. Sleep quality was associated with activity level (r= -0.72) and with within-day activity variability (r= 0.53). CONCLUSIONS Activity level and fragmentation are associated with sleep-wake patterns and sleep quality in patients with stroke.
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Affiliation(s)
| | | | | | | | | | | | - Edgar Ramos Vieira
- Department of Physical Therapy, Florida International University, Miami, FL, USA
| | - Tania Fernandes Campos
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
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12
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Levy T, Laver K, Killington M, Lannin N, Crotty M. A systematic review of measures of adherence to physical exercise recommendations in people with stroke. Clin Rehabil 2018; 33:535-545. [PMID: 30458647 PMCID: PMC6416703 DOI: 10.1177/0269215518811903] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE: To review methods for measuring adherence to exercise or physical activity practice recommendations in the stroke population and evaluate measurement properties of identified tools. DATA SOURCES: Two systematic searches were conducted in eight databases (MEDLINE, CINAHL, PsycINFO, Cochrane Library of Systematic Reviews, Sports Discus, PEDro, PubMed and EMBASE). Phase 1 was conducted to identify measures. Phase 2 was conducted to identify studies investigating properties of these measures. REVIEW METHODS: Phase 1 articles were selected if they were published in English, included participants with stroke, quantified adherence to exercise or physical activity recommendations, were patient or clinician reported, were defined and reproducible measures and included patients >18 years old. In phase 2, articles were included if they explored psychometric properties of the identified tools. Included articles were screened based on title/abstract and full-text review by two independent reviewers. RESULTS: In phase 1, seven methods of adherence measurement were identified, including logbooks ( n = 16), diaries ( n = 18), 'record of practice' ( n = 3), journals ( n = 1), surveys ( n = 2) and questionnaires ( n = 4). One measurement tool was identified, the Physical Activity Scale for Individuals with Physical Disabilities ( n = 4). In phase 2, no eligible studies were identified. CONCLUSION: There is not a consistent measure of adherence that is currently utilized. Diaries and logbooks are the most frequently utilized tools.
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Affiliation(s)
- Tamina Levy
- 1 Flinders University, Adelaide, SA, Australia
| | - Kate Laver
- 1 Flinders University, Adelaide, SA, Australia
| | | | - Natasha Lannin
- 2 School of Allied Health, La Trobe University, Melbourne, VIC, Australia.,3 Alfred Health, Melbourne, VIC, Australia
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Home-based physical activity incentive and education program in subacute phase of stroke recovery (Ticaa'dom): study protocol for a randomized controlled trial. Trials 2018; 19:68. [PMID: 29370824 PMCID: PMC5785899 DOI: 10.1186/s13063-017-2410-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 12/14/2017] [Indexed: 12/16/2022] Open
Abstract
Background Stroke causes functional decline, psychological disorders and cognitive impairments that affect activities of daily living and quality of life. Although physical activity (PA) is beneficial in stroke recovery, PA recommendations are rarely met after hospital discharge. There is presently no standard strategy for monitoring and inciting PA at home during the subacute phase of stroke recovery. The main aim of this study is to evaluate the effects of a home-based physical activity incentive and education program (Ticaa’dom) on functional capacity in subacute stroke patients. Methods This study is a comparative prospective, observer-blinded, monocentric, parallel, randomized controlled clinical trial. This study will include 84 patients: 42 patients in the home-based physical activity incentive group (HB-PAI) and 42 in the control group (CG). The intervention group will follow the HB-PAI program over 6 months: their PA will be monitored with an accelerometer during the day at home while they record their subjective perception of PA on a chart; they will observe a weekly telephone call and a home visit every three weeks. The CG will receive traditional medical care over 12 months. The main study outcome will be the distance on a 6-minute walk test. Secondary outcomes will include measurements of lower limb strength, independence level, body composition, cardiac analysis, fatigue and depression state. Discussion The results of this trial will demonstrate the value of implementing the Ticaa’dom program during the subacute phase of stroke recovery. Trial registration ClinicalTrials.gov, NCT01822938. Registered on 25 March 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2410-9) contains supplementary material, which is available to authorized users.
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Vanroy C, Vanlandewijck Y, Cras P, Truijen S, Vissers D, Swinnen A, Bosmans M, Wouters K, Feys H. Does a cycling program combined with education and followed by coaching promote physical activity in subacute stroke patients? A randomized controlled trial. Disabil Rehabil 2017; 41:413-421. [PMID: 29105516 DOI: 10.1080/09638288.2017.1395084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND To investigate the effects of a three month active cycling program followed by coaching on physical activity in subacute stroke patients. METHODS Patients (n = 59; mean age =65.4 ± 10.3) aged ≤80 years with first stroke and able to cycle at 50 revolutions/minute enrolled 3-10 weeks post stroke. Patients were randomly allocated to three month active cycling group (n = 33) or to a control group (n = 26), 3 x 30 minutes training/week. Afterwards, the active cycling group was randomized into a coaching (n = 15) versus non-coaching group (n = 16) for nine months. Physical activity was measured by objective and self-reported measures, which were taken before/after the active cycling program and during six and 12 months, except the Baecke-questionnaire, which was used at baseline and 12 months. RESULTS A significant difference was found in Baecke/sport (95% confidence interval: 0.06, 2.24; p = 0.039) between the active cycling group and the control group, in patients with severe motor function deficits at baseline. Patients in the control group performed significant less sports at 12 months (mean Baecke/sportbaseline =3.07 ± 1.21, mean Baecke/sport12months = 1.43 ± 0.98; p = 0.01). Furthermore, all groups showed significant changes over time in all measures at three months (except: Physical Activity Scale for Individuals with Physical Disabilities, diary/Mets*minutes-moderate) and 12 month and additionally in a subgroup with severe motor function deficits (except diary Mets*minutes-sedentary). CONCLUSION When active cycling combined with education is used in subacute patients with severe motor function deficits, more sport participation might be observed after one year. No other significant group differences were found over time. In all groups, however, patients showed significant improvement over time in physical activity measures. Future work is needed to explore the most effective coaching approach after an aerobic training program. Implications for Rehabilitation The active cycling program combined with education is applicable in subacute stroke patients as it required little stand-by assistance due to chip cards, the intensity was gradually built and the involvement of caregivers in the educational sessions. This training approach also revealed applicable in severely impaired stroke patients and might facilitate sport participation on the long-term. This randomized controlled study aims to quantify physical activity after stroke by using a combination of objective and self-report measures, which revealed detailed information about different aspects of physical activity levels. There is a need for coaching approaches that facilitate aerobic exercise after ending a supervised program. A coaching approach needs to guide patients in adopting aerobic exercise as a part of a lifestyle change and needs to be less time consuming.
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Affiliation(s)
- Christel Vanroy
- a Department of Rehabilitation Sciences and Physiotherapy , University of Antwerp (Faculty of Medicine and Health Sciences) , Wilrijk , Belgium.,b Department of Rehabilitation Sciences , KU Leuven - University of Leuven , Leuven , Belgium
| | - Yves Vanlandewijck
- b Department of Rehabilitation Sciences , KU Leuven - University of Leuven , Leuven , Belgium
| | - Patrick Cras
- c Department of Neurology, Translational Neurosciences , University of Antwerp (Faculty of Medicine and Health Sciences) , Wilrijk , Belgium.,d Born-Bunge Institute , Wilrijk , Belgium.,e Department of Neurology , University Hospital Antwerp , Edegem , Belgium
| | - Steven Truijen
- a Department of Rehabilitation Sciences and Physiotherapy , University of Antwerp (Faculty of Medicine and Health Sciences) , Wilrijk , Belgium
| | - Dirk Vissers
- a Department of Rehabilitation Sciences and Physiotherapy , University of Antwerp (Faculty of Medicine and Health Sciences) , Wilrijk , Belgium
| | - Anke Swinnen
- f Rehabilitation Campus Sint-Ursula , Jessa Hospital , Herk-de-Stad , Belgium
| | - Matthieu Bosmans
- a Department of Rehabilitation Sciences and Physiotherapy , University of Antwerp (Faculty of Medicine and Health Sciences) , Wilrijk , Belgium
| | - Kristien Wouters
- g Department of Scientific Coordination and Biostatistics , University Hospital Antwerp , Edegem , Belgium
| | - Hilde Feys
- b Department of Rehabilitation Sciences , KU Leuven - University of Leuven , Leuven , Belgium
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Fini NA, Holland AE, Keating J, Simek J, Bernhardt J. How Physically Active Are People Following Stroke? Systematic Review and Quantitative Synthesis. Phys Ther 2017; 97:707-717. [PMID: 28444348 DOI: 10.1093/ptj/pzx038] [Citation(s) in RCA: 186] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 04/05/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Mobility limitations are common following stroke and frequently lead to poor participation in physical activity (PA). PURPOSE The purpose of this study was to describe PA across the various stages following stroke (acute, subacute, and chronic). DATA SOURCES Searches were conducted in 5 databases. STUDY SELECTION Eligible studies included participants with stroke whose PA was quantitatively measured for at least 4 hours in a single session. Two reviewers independently reviewed titles and abstracts. DATA EXTRACTION One reviewer extracted data and assessed quality using the Downs and Black checklist. Weighted means were calculated for PA outcomes. DATA SYNTHESIS Searches yielded 103 eligible papers including 5306 participants aged 21 to 96 years. Devices (eg, activity monitors) were used in 73 papers, and behavioral mapping (observational monitoring) in 30. Devices show that people with stroke took on average 5535 steps per day (n = 406, 10 studies) in the subacute phase and 4078 steps (n = 1280, 32 studies) in the chronic phase. Average daily walking duration (% measured time) was higher in the chronic phase (9.0%, n = 100) than subacute (1.8%, n = 172), and sedentary time was >78% regardless of time post stroke. Acute data were lacking for these variables. Matched healthy individuals took an average of 8338 steps per day (n = 129). Behavioral mapping showed time in bed was higher in the acute than subacute phase (mean 45.1% versus 23.8%), with similar time spent sitting (mean 37.6% versus 32.6%). LIMITATIONS Limitations of this review include not pooling data reported as medians. CONCLUSIONS Physical activity levels do not meet guidelines following stroke. Time spent inactive and sedentary is high at all times. Increasing PA and developing standardized activity targets may be important across all stages of stroke recovery.
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Affiliation(s)
- Natalie A Fini
- Physiotherapy Department, Caulfield Hospital, Alfred Health, 260 Kooyong Rd, Caulfield, Victoria, 3162 Australia; Department of Physiotherapy, La Trobe University, Bundoora, Victoria, Australia; and Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Anne E Holland
- Department of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia, and Alfred Health, Melbourne, Victoria, Australia
| | - Jenny Keating
- Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia
| | - Jacinta Simek
- Physiotherapy Department, Eastern Health, Melbourne, Victoria, Australia
| | - Julie Bernhardt
- Department of Physiotherapy, La Trobe University, and Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne
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Preston E, Dean CM, Ada L, Stanton R, Brauer S, Kuys S, Waddington G. Promoting physical activity after stroke via self-management: a feasibility study. Top Stroke Rehabil 2017; 24:353-360. [PMID: 28335690 DOI: 10.1080/10749357.2017.1304876] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Many people with mild disability after stroke are physically inactive despite the risk of recurrent stroke. A self-management program may be one strategy to increase physical activity in stroke survivors. OBJECTIVES To investigate the feasibility of a self-management program, and determine whether self-management can increase daily physical activity levels and self-efficacy for exercise, decrease cardiovascular risk, and improve walking ability, participation, and quality of life in people with mild disability after stroke. METHOD A Phase I, single-group, pre-post intervention study was carried out with twenty stroke survivors who had mild disability and were discharged directly home from acute stroke units. A self-management program was delivered via five home-based sessions over 3 months, incorporating: education, goal setting, barrier identification, self-monitoring, and feedback. Feasibility of the intervention was determined by examining adherence, duration, usefulness, and safety. Clinical outcomes were amount of physical activity (duration of moderate physical activity in min/day and counts of physical activity in steps/day), self-efficacy, cardiovascular risk, walking ability, participation, and quality of life. RESULTS The intervention was feasible with 96% of sessions being delivered, each taking less than an hour (41 min, SD 12). Participants perceived the self-management program to be useful and there were few adverse events. At 3 months, participants completed 27 min/day (95% CI 4-49) more moderate physical activity than at baseline and 16 min/day (95% CI -10 to 42) at 6 months. CONCLUSION Self-management appears to be feasible and has the potential to increase physical activity in people with mild disability after stroke. A Phase II randomized trial is warranted.
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Affiliation(s)
- Elisabeth Preston
- a Discipline of Physiotherapy , University of Canberra , Canberra , Australia
| | - Catherine M Dean
- b Discipline of Physiotherapy , Macquarie University , Sydney , Australia
| | - Louise Ada
- c Discipline of Physiotherapy , The University of Sydney , Sydney , Australia
| | - Rosalyn Stanton
- c Discipline of Physiotherapy , The University of Sydney , Sydney , Australia
| | - Sandy Brauer
- d Discipline of Physiotherapy , University of Queensland , Brisbane , Australia
| | - Suzanne Kuys
- e School of Physiotherapy , Australian Catholic University , Brisbane , Australia
| | - Gordon Waddington
- a Discipline of Physiotherapy , University of Canberra , Canberra , Australia
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Bonner NS, O’Halloran PD, Bernhardt J, Cumming TB. Developing the Stroke Exercise Preference Inventory (SEPI). PLoS One 2016; 11:e0164120. [PMID: 27711242 PMCID: PMC5053595 DOI: 10.1371/journal.pone.0164120] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/20/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Physical inactivity is highly prevalent after stroke, increasing the risk of poor health outcomes including recurrent stroke. Tailoring of exercise programs to individual preferences can improve adherence, but no tools exist for this purpose in stroke. METHODS We identified potential questionnaire items for establishing exercise preferences via: (i) our preliminary Exercise Preference Questionnaire in stroke, (ii) similar tools used in other conditions, and (iii) expert panel consultations. The resulting 35-item questionnaire (SEPI-35) was administered to stroke survivors, along with measures of disability, depression, anxiety, fatigue and self-reported physical activity. Exploratory factor analysis was used to identify a factor structure in exercise preferences, providing a framework for item reduction. Associations between exercise preferences and personal characteristics were analysed using multivariable regression. RESULTS A group of 134 community-dwelling stroke survivors (mean age 64.0, SD 13.3) participated. Analysis of the SEPI-35 identified 7 exercise preference factors (Supervision-support, Confidence-challenge, Health-wellbeing, Exercise context, Home-alone, Similar others, Music-TV). Item reduction processes yielded a 13-item version (SEPI-13); in analysis of this version, the original factor structure was maintained. Lower scores on Confidence-challenge were significantly associated with disability (p = 0.002), depression (p = 0.001) and fatigue (p = 0.001). Self-reported barriers to exercise were particularly prevalent in those experiencing fatigue and anxiety. CONCLUSIONS The SEPI-13 is a brief instrument that allows assessment of exercise preferences and barriers in the stroke population. This new tool can be employed by health professionals to inform the development of individually tailored exercise interventions.
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Affiliation(s)
- Nicholas S. Bonner
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Paul D. O’Halloran
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Toby B. Cumming
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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Sandberg K, Kleist M, Falk L, Enthoven P. Effects of Twice-Weekly Intense Aerobic Exercise in Early Subacute Stroke: A Randomized Controlled Trial. Arch Phys Med Rehabil 2016; 97:1244-53. [DOI: 10.1016/j.apmr.2016.01.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 01/14/2016] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
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Kim KJ, Kim HY, Chun IA. Correlations between the sequelae of stroke and physical activity in Korean adult stroke patients. J Phys Ther Sci 2016; 28:1916-21. [PMID: 27390446 PMCID: PMC4932087 DOI: 10.1589/jpts.27.1916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/12/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The present study investigated a wide range of stroke patients living in South Korea using the Korean Community Health Survey raw data to determine the correlation between stroke and physical activity. [Subjects and Methods] This study used raw data from the 2012 Korean Community Health Survey. The total number of participants was 228,921; of the 4,475 stroke patients who had been diagnosed by a medical doctor or an oriental medical doctor, the data for 4,460 patients, excluding 15 whose amount of physical activity was unclear, were used in the analysis. [Results] The amount of physical activity performed by patients who had sequelae was significantly lower than that performed by patients who no longer had sequelae. Similarly, for the type of sequelae, palsy in the arms and legs, facial palsy, communication disability, swallowing or eating disability, and visual disability were associated with lower physical activity. Furthermore, as the number of sequelae increased, patients performed significantly less physical activity. [Conclusion] The findings suggest that when decisions on national policies and budgets are made, methods for increasing the physical activity of patients with a history of stroke should be considered.
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Affiliation(s)
- Ki-Jong Kim
- Department of Physical Therapy, Cheongam College, Republic of Korea
| | - Hwang-Yong Kim
- Department of Occupational Therapy, Gwangju University: 277 Hyodeok-ro, Nam-gu, Gwangju, Republic of Korea
| | - In-Ae Chun
- Department of Nutritional Service Team, Chosun University Hospital, Republic of Korea
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Lacroix J, Daviet JC, Borel B, Kammoun B, Salle JY, Mandigout S. Physical Activity Level Among Stroke Patients Hospitalized in a Rehabilitation Unit. PM R 2016; 8:97-104. [DOI: 10.1016/j.pmrj.2015.06.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 06/12/2015] [Accepted: 06/13/2015] [Indexed: 01/04/2023]
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Kara S, Ntsiea MV. The Effect of a Written and Pictorial Home Exercise Prescription on Adherence for People with Stroke. Hong Kong J Occup Ther 2015. [DOI: 10.1016/j.hkjot.2015.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Background/Objective Functional recovery for stroke survivors begins with rehabilitation. It may not be feasible for therapists to supervise all rehabilitation, especially in the home environment. Therefore, adherence to prescribed exercise programmes is important. The objective of this study was to determine the effect of a written and pictorial home exercise prescription on adherence to a home exercise programme in patients with stroke. Methods This was a randomised controlled trial with a blinded assessor. The control group received a home exercise programme with verbal instructions, while the intervention group received the same home exercise programme with verbal instructions but with additional written and pictorial instructions for the exercises. An exercise logbook was used to monitor adherence. The Modified Rivermead Mobility Index (MRMI) and Barthel Index (BI) were used to establish mobility and activities of daily living. Results There were a total of 42 participants, with 21 in each group; mean age was 60.8 ± 15.5 years. Forty (95%) of the participants had suffered a stroke less than 4 months prior to the study. Both control and intervention groups had similar outcomes: there was no significant difference between groups with regard to functional ability (MRMI, p = .40; Bl, p = .65) and adherence (p = .53). The relationship between functional ability (MRMI and Bl) and the level of adherence for both the control and intervention groups was not statistically significant. Conclusion The addition of a written and pictorial home exercise prescription does not lead to better adherence to a home exercise programme compared to having no written and pictorial instructions. Possible reasons may be that patients had caregivers as a support system, and the exercise logbook served as a reminder and motivational track record for patients. There also does not appear to be a relationship between functional ability and level of adherence, which may be due to most of the study participants being within the optimal time frame for spontaneous functional recovery. Further study at different time frames in stroke rehabilitation in different contexts is recommended.
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Affiliation(s)
- Sheetal Kara
- School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Mokgobadibe Veronica Ntsiea
- School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
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English C, Healy GN, Olds T, Parfitt G, Borkoles E, Coates A, Kramer S, Bernhardt J. Reducing Sitting Time After Stroke: A Phase II Safety and Feasibility Randomized Controlled Trial. Arch Phys Med Rehabil 2015; 97:273-80. [PMID: 26529471 DOI: 10.1016/j.apmr.2015.10.094] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To test the safety, feasibility, and effectiveness of reducing sitting time in stroke survivors. DESIGN Randomized controlled trial with attention-matched controls and blinded assessments. SETTING Community. PARTICIPANTS Stroke survivors (N=35; 22 men; mean age, 66.9±12.7y). INTERVENTIONS Four counseling sessions over 7 weeks with a message of sit less and move more (intervention group) or calcium for bone health (attention-matched control group). MAIN OUTCOME MEASURES Measures included safety (adverse events, increases in pain, spasticity, or fatigue) and feasibility (adherence to trial protocol). Secondary measures included time spent sitting (including in prolonged bouts ≥30min), standing, and stepping as measured by the thigh-worn inclinometer (7d, 24h/d protocol) and time spent in physical activity of at least moderate intensity as measured by a triaxial accelerometer. The Multimedia Activity Recall for Children and Adults was used to describe changes in use of time. RESULTS Thirty-three participants completed the full protocol. Four participants reported falls during the intervention period with no other adverse events. From a baseline average of 640.7±99.6min/d, daily sitting time reduced on average by 30±50.6min/d (95% confidence interval [CI], 5.8-54.6) in the intervention group and 40.4±92.5min/d in the control group (95% CI, 13.0-93.8). Participants in both groups also reduced their time spent in prolonged sitting bouts (≥30min) and increased time spent standing and stepping. CONCLUSIONS Our protocol was both safe and feasible. Participants in both groups spent less time sitting and more time standing and stepping postintervention, but outcomes were not superior for intervention participants. Attention matching is desirable in clinical trials and may have contributed to the positive outcomes for control participants.
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Affiliation(s)
- Coralie English
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute of Health Research, University of South Australia, Adelaide, SA, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia.
| | - Genevieve N Healy
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia; Baker International Diabetes Institute Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Physiotherapy, Curtin University, Perth, WA, Australia
| | - Tim Olds
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute of Health Research, University of South Australia, Adelaide, SA, Australia
| | - Gaynor Parfitt
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute of Health Research, University of South Australia, Adelaide, SA, Australia
| | - Erika Borkoles
- Faculty of Management, Bournemouth University, Poole, Dorset, United Kingdom; College of Sport and Exercise, Victoria University, Melbourne, VIC, Australia
| | - Alison Coates
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute of Health Research, University of South Australia, Adelaide, SA, Australia
| | - Sharon Kramer
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Julie Bernhardt
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
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Donoso Brown EV, Dudgeon BJ, Gutman K, Moritz CT, McCoy SW. Understanding upper extremity home programs and the use of gaming technology for persons after stroke. Disabil Health J 2015; 8:507-13. [PMID: 25953349 DOI: 10.1016/j.dhjo.2015.03.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 02/01/2015] [Accepted: 03/13/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Many persons post-stroke continue to have difficulty using their more involved upper extremity and home programs may be poorly adhered to limiting the amount of practice an individual receives. More information on the experience of traditional home program and the acceptability of a novel home intervention was sought. OBJECTIVE To qualitatively describe 1) upper extremity use at home, 2) previous home exercise or activity programs, and 3) the acceptability of a novel upper extremity home program, NeuroGame Therapy (NGT), that combines surface electromyography (sEMG) biofeedback and a commercial computer game. METHODS A purposeful sample of ten persons with moderate to severe upper extremity motor impairment used the NGT intervention in their home for four weeks and completed nested (pre and post) one-on-one interviews. Written transcripts from the interviews were coded and themes were identified to address stated objectives. RESULTS Participants reported that while use of their upper extremity in daily activities was recommended it occurred infrequently. Most participants described previous home programs as being non-specific, were often not carried out as recommended or were self-modified. Participants found NGT to be engaging and motivating, but reported minimal changes in the functional uses of their upper extremity. CONCLUSION These findings suggest that after stroke upper extremity use may be infrequent and home program approaches could be re-examined. NGT was reported to be an acceptable home intervention, but it will require further development and study to understand its value and role in post-stroke rehabilitation.
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Affiliation(s)
- Elena V Donoso Brown
- University of Washington, School of Medicine, Department of Rehabilitation Medicine, 1959 N.E. Pacific St., Seattle, WA 98195, USA; Duquesne University, Department of Occupational Therapy, Rangos School of Health Sciences, 600 Forbes Ave, Pittsburgh, PA 15282, USA.
| | - Brian J Dudgeon
- University of Washington, School of Medicine, Department of Rehabilitation Medicine, 1959 N.E. Pacific St., Seattle, WA 98195, USA; University of Alabama at Birmingham, Department of Occupational Therapy, School of Health Professions, SHPB 353, 1720 2nd Ave South, Birmingham, AL 35294-1212, USA
| | - Karli Gutman
- University of Washington, School of Medicine, Department of Rehabilitation Medicine, 1959 N.E. Pacific St., Seattle, WA 98195, USA
| | - Chet T Moritz
- University of Washington, School of Medicine, Department of Rehabilitation Medicine, 1959 N.E. Pacific St., Seattle, WA 98195, USA; University of Washington, School of Medicine, Department of Physiology & Biophysics, 1959 N.E. Pacific St., Seattle, WA 98195, USA
| | - Sarah Westcott McCoy
- University of Washington, School of Medicine, Department of Rehabilitation Medicine, 1959 N.E. Pacific St., Seattle, WA 98195, USA
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Cleveland S, Driver S, Swank C, Macklin S. Classifying physical activity research following stroke using the behavioral epidemiologic framework. Top Stroke Rehabil 2015; 22:289-98. [PMID: 26258454 DOI: 10.1179/1074935714z.0000000043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Stroke is a significant public health issue in the USA and a need emerges to better understand how to reduce an individual's co-morbidity risk. Physical activity is one approach to improving the health of individuals and comprehensive literature supports increased activity as a means to reduce risk of morbidity and mortality. One approach to examining whether research in a field is addressing a public health issue is through application of the behavioral epidemiological framework. OBJECTIVE To classify physical activity research for individuals following stroke into distinct phases so that efforts can be made to systematically address gaps and disseminate evidence-based practice. METHODS Specific key words were identified and then searched through EBSCO host, PubMed, and Google Scholar. Physical activity and stroke literature from 2000-2014 was categorized into one of five discrete phases. Research in Phase 1 identified associations between activity and health; Phase 2 established valid measures of activity; Phase 3 examined determinants of behavior; Phase 4 evaluated activity interventions; and Phase 5 disseminated evidence-based practice. RESULTS A comprehensive review of literature identified 202 articles with 70% categorized in Phase 1 (n = 141), 11% in Phase 2 (n = 23), 10% in Phase 3 (n = 20), 8% in Phase 4 (n = 15), and 1% in Phase 5 (n = 3). CONCLUSION Findings suggest that physical activity research for individuals following stroke is in the early stages of development with less than 10% of research evaluating or disseminating interventions.
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Walter T, Hale L, Smith C. Blue Prescription: A single-subject design intervention to enable physical activity for people with stroke. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2015. [DOI: 10.12968/ijtr.2015.22.2.87] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: Adherence to long-term physical activity is low in stroke survivors despite evidence supporting the benefits of regular physical activity on health and wellbeing. The aims of this single-subject design study were to: i) determine whether Blue Prescription, a physiotherapy approach to increase physical activity, enabled adults with chronic stroke living in the community to engage in a physical activity of their choice for three months; ii) explore the benefits of the Blue Prescription intervention on self-reported quality of life, physical function and self-efficacy. Methods: A multiple-participant, two-phase (baseline followed by treatment) single-subject design study was repeated with adults (n=5) with chronic stroke. The time of baseline testing, follow-up outcome measurement and Blue Prescription visits were randomly assigned to each participant. Due to randomisation, the baseline phase spanned four to six weeks. The intervention phase had a duration of three months. Engagement in physical activity was recorded in a physical activity diary. Secondary outcome measures used included the European Quality of Life Scale, Stroke Impact Scale and Stroke Self-Efficacy Questionnaire, which were completed at 15 random intervals over four and a half months. Results: All five participants maintained engagement in their chosen activity for three months. Participant 2 mostly showed significant improvements in the secondary outcome measures (p<0.05), while participant 4 showed a significant decline in the European Quality of Life Scale (p<0.05). No other significant results were found, although observable trends in secondary outcome measure scores were present. Conclusions: Blue Prescription appears feasible for engaging chronic stroke survivors in physical activity, although its effects on quality of life, physical function and self-efficacy are variable.
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Affiliation(s)
- Tayler Walter
- Project investigator, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Leigh Hale
- Associate professor and deputy dean, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Cath Smith
- Associate dean of graduate research studies, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Deutsch JE, Guarrera-Bowlby P, Myslinski MJ, Kafri M. Is There Evidence That Active Videogames Increase Energy Expenditure and Exercise Intensity for People Poststroke and with Cerebral Palsy? Games Health J 2014; 4:31-7. [PMID: 26181678 DOI: 10.1089/g4h.2014.0082] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This article asked and answered the question of whether there was evidence to support the use of videogames for promotion of wellness and fitness for people poststroke and those with cerebral palsy (CP). A literature search of PubMed, CINAHL, and PEDro using a population, intervention, and outcome (PIO) approach and the key words "stroke (or CP) AND video games (and synonyms) AND energy expenditure (EE) (and synonyms)" was conducted. It yielded two relevant references for people poststroke and five references for people with CP. The literature extraction and synthesis by the categories of the PIO indicated that most studies used only the population of interest, except two that compared the EE with that of healthy controls. The main finding is that both people poststroke (moderate severity) and people with CP (mild severity) can achieve moderate EE playing Wii(™) (Nintendo, Kyoto, Japan), PlayStation(®) (Sony, Tokyo, Japan), and Kinect(™) (Microsoft, Redmond, WA) games. Adults with CP of mild severity played the videogames at vigorous levels, whereas those with severe CP played them at low levels. There appears to be an interaction between development and severity that influences the exercise intensity measured by EE. The findings suggests that videogames are a gateway for wellness promotion.
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Affiliation(s)
- Judith E Deutsch
- 1 Rivers Lab, Rutgers University , Newark, New Jersey, USA.,2 Department of Rehabilitation and Movement Sciences, Rutgers University , Newark, New Jersey, USA
| | - Phyllis Guarrera-Bowlby
- 1 Rivers Lab, Rutgers University , Newark, New Jersey, USA.,2 Department of Rehabilitation and Movement Sciences, Rutgers University , Newark, New Jersey, USA
| | - Mary Jane Myslinski
- 2 Department of Rehabilitation and Movement Sciences, Rutgers University , Newark, New Jersey, USA
| | - Michal Kafri
- 3 Program in Physical Therapy, University of Haifa , Haifa, Israel
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Fini NA, Holland AE, Keating J, Simek J, Bernhardt J. How is physical activity monitored in people following stroke? Disabil Rehabil 2014; 37:1717-31. [DOI: 10.3109/09638288.2014.978508] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Ekbia HR, Lee J, Wiley S. Rehab Games as Components of Workflow: A Case Study. Games Health J 2014; 3:215-26. [PMID: 26192370 DOI: 10.1089/g4h.2014.0039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study explored and evaluated the integration of rehabilitation games into therapy workflow. MATERIALS AND METHODS A multistage and multimethod study was followed: (1) A formative study involving observations and interviews with a total of approximately 90 therapists across the rehabilitation continuum was conducted for the design and development of an interactive therapy platform using Microsoft(®) (Redmond, WA) Kinect(®) for Windows. (2) A pilot study was carried out in an inpatient facility, involving patients and therapists. (3) Heuristic evaluation was performed on the basis of the principles of universal design. RESULTS The findings from the study show the overall appeal of the system to patients and therapists, but also the challenges of integrating the system into the workflow. CONCLUSIONS The findings from the study are in line with other similar studies in terms of the appeal and potential impact of games for rehabilitation and the applicability of the principles of universal design, as well as the need for institutional and public policy changes in the field of medical rehabilitation.
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Affiliation(s)
- Hamid R Ekbia
- 1 School of Informatics & Computing, Indiana University , Bloomington, Indiana
| | - Joomi Lee
- 2 Department of Telecommunication, Indiana University , Bloomington, Indiana
| | - Steve Wiley
- 3 Krannert School of Physical Therapy, University of Indianapolis , Indianapolis, Indiana
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Kunkel D, Fitton C, Burnett M, Ashburn A. Physical inactivity post-stroke: a 3-year longitudinal study. Disabil Rehabil 2014; 37:304-10. [DOI: 10.3109/09638288.2014.918190] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Dorit Kunkel
- Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Carolyn Fitton
- Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Malcolm Burnett
- Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Ann Ashburn
- Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Southampton, UK
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Donoso Brown EV, McCoy SW, Fechko AS, Price R, Gilbertson T, Moritz CT. Preliminary investigation of an electromyography-controlled video game as a home program for persons in the chronic phase of stroke recovery. Arch Phys Med Rehabil 2014; 95:1461-9. [PMID: 24657112 DOI: 10.1016/j.apmr.2014.02.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/23/2014] [Accepted: 02/21/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the preliminary effectiveness of surface electromyography (sEMG) biofeedback delivered via interaction with a commercial computer game to improve motor control in chronic stroke survivors. DESIGN Single-blinded, 1-group, repeated-measures design: A1, A2, B, A3 (A, assessment; B, intervention). SETTING Laboratory and participants' homes. PARTICIPANTS A convenience sample of persons (N=9) between 40 and 75 years of age with moderate to severe upper extremity motor impairment and at least 6 months poststroke completed the study. INTERVENTION The electromyography-controlled video game system targeted the wrist muscle activation with the goal of increasing selective muscle activation. Participants received several laboratory training sessions with the system and then were instructed to use the system at home for 45 minutes, 5 times per week for the following 4 weeks. MAIN OUTCOME MEASURES Primary outcome measures included duration of system use, sEMG during home play, and pre/post sEMG measures during active wrist motion. Secondary outcomes included kinematic analysis of movement and functional outcomes, including the Wolf Motor Function Test and the Chedoke Arm and Hand Activity Inventory-9. RESULTS One third of participants completed or exceeded the recommended amount of system use. Statistically significant changes were observed on both game play and pre/post sEMG outcomes. Limited carryover, however, was observed on kinematic or functional outcomes. CONCLUSIONS This preliminary investigation indicates that use of the electromyography-controlled video game impacts muscle activation. Limited changes in kinematic and activity level outcomes, however, suggest that the intervention may benefit from the inclusion of a functional activity component.
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Affiliation(s)
- Elena V Donoso Brown
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA.
| | - Sarah Westcott McCoy
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA
| | - Amber S Fechko
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA
| | - Robert Price
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA
| | - Torey Gilbertson
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA
| | - Chet T Moritz
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA
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Physical activity and sedentary behaviors in people with stroke living in the community: a systematic review. Phys Ther 2014; 94:185-96. [PMID: 24029302 DOI: 10.2522/ptj.20130175] [Citation(s) in RCA: 170] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Regular physical activity is vital for cardiovascular health. Time spent in sedentary behaviors (eg, sitting, lying down) also is an independent risk factor for cardiovascular disease. The pattern in which sedentary time is accumulated is important-with prolonged periods of sitting time being particularly deleterious. People with stroke are at high risk for cardiovascular disease, including recurrent stroke. PURPOSE This systematic review aimed to update current knowledge of physical activity and sedentary behaviors among people with stroke living in the community. A secondary aim was to investigate factors associated with physical activity levels. DATA SOURCES The data sources used were MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complimentary Medicine Database (AMED), EMBASE, and the Cochrane Library. STUDY SELECTION Studies involving people with stroke living in the community and utilizing objective measures of physical activity or sedentary behaviors were included. DATA EXTRACTION Data were extracted by one reviewer and checked for accuracy by a second person. DATA SYNTHESIS Twenty-six studies, involving 983 participants, were included. The most common measure of activity was steps per day (22 studies), which was consistently reported as less than half of age-matched normative values. Only 4 studies reported on sedentary time specifically. No studies described the pattern by which sedentary behaviors were accumulated across the day. Walking ability, balance, and degree of physical fitness were positively associated with higher levels of physical activity. LIMITATIONS This review included only studies of people living in the community after stroke who were able to walk, and the majority of included participants were aged between 65 and 75 years of age. CONCLUSIONS Little is known about the time people with stroke spend being sedentary each day or the pattern in which sedentary time is accumulated. Studies using objective, reliable, and valid measures of sedentary time are needed to further investigate the effects of sedentary time on the health of people with stroke.
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Kafri M, Myslinski MJ, Gade VK, Deutsch JE. Energy expenditure and exercise intensity of interactive video gaming in individuals poststroke. Neurorehabil Neural Repair 2013; 28:56-65. [PMID: 23897906 DOI: 10.1177/1545968313497100] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Off-the-shelf activity-promoting video games (AVGs) are proposed as a tool for promoting regular physical activity among individuals poststroke. OBJECTIVE To characterize the energy expenditure (EE), exercise intensity, and energy metabolism of individuals poststroke, while playing AVGs in different positions, from different consoles, and to compare the performance with comfortable walking and with able-bodied individuals. METHODS Eleven poststroke and 8 able-bodied participants played in standing Wii-Boxing Xbox-Boxing, Wii-Run and Penguin, and also Wii-Boxing in sitting. EE (expressed as metabolic equivalents [METs]); exercise intensity (expressed as %predicted maximal heart rate [HR]), rate of perceived exertion (RPE), and respiratory exchange ratio (RER) were used to characterize the games. RESULTS Participants' poststroke EE ranged from 1.81 ± 0.74 to 3.46 ± 1.3 METs and was lower compared with able-bodied participants for Xbox-Boxing (P = .001), Wii-Boxing in standing (P = .01), Run (P < .001), and Penguin (P = .001). Participants' poststroke exercise intensity ranged from 49.8 ± 9.3 to 64.7 ± 9.3 %predicted maximal HR and was lower compared with able-bodied participants for Xbox-Boxing (P = .007) and Run (P = .005). For participants poststroke, EE of walking at a comfortable did not differ from boxing games in standing or Run. For able-bodied participants only, the EE for Xbox-Boxing was higher than Wii-Boxing (6.5 ± 2.6 vs 4.4 ± 1.1, P = .02). EE was higher in standing versus sitting for poststroke (P = .04) and able-bodied (P = .03) participants. There were no significant group differences for RPEs. RER of playing in sitting approached anaerobic metabolism. CONCLUSIONS Playing upper extremity (ie, Boxing) or mobility (ie, Run) AVGs in standing resulted in moderate EE and intensity for participants poststroke. EE was lower for poststroke than for able-bodied participants.
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Affiliation(s)
- Michal Kafri
- 1University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
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Taukobong NP, Myezwa H, Pengpid S, Van Geertruyden JP. The degree to which physiotherapy literature includes physical activity as a component of health promotion in practice and entry level education: a scoping systematic review. Physiother Theory Pract 2013; 30:12-9. [DOI: 10.3109/09593985.2013.783896] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Neurologic rehabilitation aims to reduce impairments and disabilities so that persons with serious stroke can return to participation in usual self-care and daily activities as independently as feasible. New strategies to enhance recovery draw from a growing understanding of how types of training, progressive task-related practice of skills, exercise for strengthening and fitness, neurostimulation, and drug and biological manipulations can induce adaptations at multiple levels of the nervous system. Recent clinical trials provide evidence for a range of new interventions to manage walking, reach and grasp, aphasia, visual field loss, and hemi-inattention.
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Affiliation(s)
- Bruce H Dobkin
- Department of Neurology, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
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Daviet JC, Bonan I, Caire J, Colle F, Damamme L, Froger J, Leblond C, Leger A, Muller F, Simon O, Thiebaut M, Yelnik A. Therapeutic patient education for stroke survivors: Non-pharmacological management. A literature review. Ann Phys Rehabil Med 2012; 55:641-56. [DOI: 10.1016/j.rehab.2012.08.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 08/20/2012] [Accepted: 08/22/2012] [Indexed: 11/17/2022]
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Sharma H, Bulley C, van Wijck FM. Experiences of an exercise referral scheme from the perspective of people with chronic stroke: a qualitative study. Physiotherapy 2012; 98:336-43. [DOI: 10.1016/j.physio.2011.05.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 05/29/2011] [Indexed: 11/29/2022]
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The importance of psychological and social factors in influencing the uptake and maintenance of physical activity after stroke: a structured review of the empirical literature. Stroke Res Treat 2011; 2012:195249. [PMID: 21918730 PMCID: PMC3170904 DOI: 10.1155/2012/195249] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 07/12/2011] [Indexed: 11/18/2022] Open
Abstract
Background. People with stroke are not maintaining adequate engagement in physical activity (PA) for health and functional benefit. This paper sought to describe any psychological and social factors that may influence physical activity engagement after stroke. Methods. A structured literature review of studies indexed in MEDLINE, CinAHL, P&BSC, and PsycINFO using search terms relevant to stroke, physical disabilities, and PA. Publications reporting empirical findings (quantitative or qualitative) regarding psychological and/or social factors were included. Results. Twenty studies from 19 publications (9 surveys, 1 RCT, and 10 qualitative studies) were included. Seventeen studies reported findings pertinent to psychological factors and fourteen findings pertinent to social factors. Conclusion. Self-efficacy, physical activity beliefs, and social support appear particularly relevant to physical activity behaviour after stroke and should be included in theoretically based physical interventions. The Transtheoretical Model and the Theory of Planned Behaviour are candidate behavioural models that may support intervention development.
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