The impact of a patient-directed activity program on functional outcomes and activity participation after stroke during inpatient rehabilitation—a randomized controlled trial

Abstract

Objective: Individuals post stroke are inactive, even during rehabilitation, contributing to ongoing disability and risk of secondary health conditions. Our aims were to (1) conduct a randomized controlled trial to examine the efficacy of a “Patient-Directed Activity Program” on functional outcomes in people post stroke during inpatient rehabilitation and (2) examine differences three months post inpatient rehabilitation discharge. Design: Randomized control trial. Setting: Inpatient rehabilitation facility. Subjects: Patients admitted to inpatient rehabilitation post stroke. Interventions: Patient-Directed Activity Program (PDAP) or control (usual care only). Both groups underwent control (three hours of therapy/day), while PDAP participants were prescribed two additional 30-minute activity sessions/day. Main measures: Outcomes (Stroke Rehabilitation Assessment of Movement Measure, Functional Independence Measure, balance, physical activity, Stroke Impact Scale) were collected at admission and discharge from inpatient rehabilitation and three-month follow-up. Results: Seventy-three patients (PDAP ( n = 37); control ( n = 36)) were included in the primary analysis. Patients in PDAP completed a total of 23.1 ± 16.5 sessions (10.7 ± 8.5 upper extremity; 12.4 ± 8.6 lower extremity) during inpatient rehabilitation. No differences were observed between groups at discharge in functional measures. PDAP completed significantly more steps/day (PDAP = 657.70 ± 655.82, control = 396.17 ± 419.65; P = 0.022). The Stroke Impact Scale showed significantly better memory and thinking (PDAP = 86.2 ± 11.4, control = 80.8 ± 16.7; P = 0.049), communication (PDAP = 93.6 ± 8.3, control = 89.6 ± 12.4; P = 0.042), mobility (PDAP = 62.2 ± 22.5, control = 53.8 ± 21.8; P = 0.038), and overall recovery from stroke (PDAP = 62.1 ± 19.1, control = 52.2 ± 18.7; P = 0.038) for PDAP compared to control. At three months post discharge, PDAP ( n = 11) completed significantly greater physical activity ( P = 0.014; 3586.5 ± 3468.5 steps/day) compared to control ( n = 10; 1760.9 ± 2346.3 steps/day). Conclusion: Functional outcome improvement was comparable between groups; however, PDAP participants completed more steps and perceived greater recovery.

Behaviour change interventions to increase physical activity in hospitalised patients: a systematic review, meta-analysis and meta-regression

“…Reapplication of eligibility to full texts resulted in 20 selected trials for review [ 7 , 40–58 ]. One of the 20 selected trials [ 52 ] was identified by checking reference lists or citation tracking ( Figure 1 ). Agreement between reviewers was fair for initial screening of titles and abstracts ( κ = 0.336, 95%CI 0.261–0.411) and substantial for screening full texts ( κ = 0.704, 95%CI 0.534–0.874).…”

“…The most common primary diagnosis was stroke ( n = 4 trials). Fourteen trials were in acute wards ( n = 10 surgical, n = 3 medical, n = 1 mixed medical/surgical) [ 41–43 , 45–48 , 50 , 51 , 53–57 ] and six trials in rehabilitation wards [ 7 , 40 , 44 , 49 , 52 , 58 ].…”

“…Five trials were assessed as having a low risk of bias for all items [ 7 , 47 , 49 , 50 , 58 ] and a further nine trials were rated to have ‘some concerns’ on one or two items but did not have any items assessed as being of high risk of bias [ 40 , 41 , 43–46 , 48 , 52 , 57 ]. Six trials were assessed as high risk of bias [ 42 , 51 , 53–56 ].…”

“…Other patient-level outcomes, including health-related quality of life outcomes, that could not be included in meta-analyses due to clinical heterogeneity, were characterised by non-significant between-group differences in individual trials. The only between-group differences in other patient-level outcomes in a single study were in four of eight domains of the Stroke Impact Scale at discharge favouring the experimental group [ 52 ].…”

Fatores facilitadores e barreiras ao trabalho em equipe para atendimento hospitalar de acidente vascular cerebral

“…Dessa forma e apesar da escassez de literatura acerca do tema sobre como funciona o trabalho das equipes inter e multidisciplinares, é notória a possibilidade de realização do trabalho em equipe no atendimento a vítimas de AVC. Também é evidente a importância do entendimento das possíveis formas de trabalho desses grupos e quem são os profissionais envolvidos, pois, as equipes são sistemas ativos de aprendizagem, nos quais os indivíduos desenvolvem relacionamentos e aplicam o conhecimento para resolver problemas relacionados aos pacientes internados, entre eles, os que são acometidos por um AVC (Schiavi et al, 2018;Amatangelo et al, 2020;Schwarzbach et al, 2020;Swank, 2020).…”