Effects of Adherence Enhanced Intervention on Home Program Exercise Adherence and Functional Recovery in Stroke Patients
Date Issued
2010
Date
2010
Author(s)
Lee, Ting-Chen
Abstract
Background and Purpose: Stroke is one of the main leading causes of physical disability in the elderly. The maintenance of home rehabilitation program, i.e., patient adherence, reduces side-effects from declined physical activity, improves fitness, prevents recurrent stroke and is an important strategy in response to gradually limited insurance coverage. The purpose of this study is to investigate the effects of an enhanced intervention program (based on Five A’s Behavior Intervention Protocol) on the adherence of home rehabilitation program in stroke patients. Method: This was a randomized, controlled, double-blind clinical trial. Neither the subjects nor the assessing therapist were informed of the assignment of groups. Sixteen subacute stroke in-patients were recruited. The subjects were randomly assigned into the Adherence Enhancement (AE) group or the Conventional Home Program (CHP) group. Both groups received home exercise instructions before discharge, however, only the AE group instructed based on the 5A’s (address the issue, address the patient, advise the patient, assist the patient, arrange follow-up and assess adherence) Behavior Intervention Protocol. At the baseline test, the subjects evaluated with 10-meter walking test, functional ambulation category, and the Berg Balance Scale. These data were recorded within the last two weeks prior to discharge from the hospital. The AE group subjects used self-reports of daily activity diary and pedometer throughout the 4 weeks after discharge from the hospital as enhancers. One telephone follow up was scheduled on the 2nd week to encourage exercise at home and evaluated the progression of home exercise for each AE group subject. The outcome measurements included the 10-meter walking test, the Functional Ambulation Category, the Berg Balance Scale, the daily activity diary, and the Specific Home Exercise Checklist between the two groups at the end of the 4th week post discharge. Follow up was scheduled during the 12th week post discharge. Results: There were no significant difference on the parameters of basic data, except the hemiplegic side. The AE group subjects exhibited better adherence in some of self-reported of daily activity diary such as flexibility exercise and balance exercise at 4th week, but not at 12th week after discharge. Both groups improved significantly on 10MWT and BBS (p <0.001) at both 4th and 12th weeks after discharge. The AE group subjects exhibited better performance in the 10MWT than the CHP group subjects ( p <0.05) at follow up. All subjects in the AE group reached FAC5 at 12th week, which was significantly better than the CHP group subjects ( p <0.05). However, the groups did not differ significantly on the BBS, PASIPD (Physical Activity Scale for Individuals with Physical Disability, and Specific Home Exercise Cheek list and perceptions of home program exercise. Conclusion: The Five A’s Behavior Intervention Protocol, along with other interventions such as pedometer and telephone follow up possibly reinforced the adherence of some of the home program exercises, particularly in the flexibility exercise and balance exercise. In the functional performance tests, stroke patients who received the adherence enhanced intervention program had better performance in gait speed and community walking ability than the patients who did not receive the intervention program. Though the AE group subjects did not demonstrate better balance performance nor on participation or perceptions of exercise than the CHP group, it is possible that the CHP group subjects might have received enough interventions for enhancing their adherence, thus minizing the between group difference. The CHP group received an exercise booklet with action picture to help remember the movement, one-to-one instructions by the same intervening physiotherapist on how to perform the home program exercise as well as some tips to prevent adverse events, a diary card to record the three test scores, and so on. These were all methods that may help enhancing adherence in the CHP group, thus reducing the differences between the two groups. In addition, the insufficient number of subjects and insufficient responsiveness of evaluating scales might have limited the findings of significance between groups. Thus far, the researches about the effects of the adherence enhanced intervention for functional recovery in stroke patients are limited. It is suggested that further studies in the field of adherence enhancement strategy interventions for functional recovery in stroke patients may help enhance and prolong the effects of physical therapy after the patients are dischaged.
Subjects
Home program exercise
Adherence
Stroke
Compliance
Functional recovery
Type
thesis
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