This study aimed to investigate whether depressive symptoms are associated with reduced participation in unsupervised training among inpatients with subacute stroke. We hypothesized that participants with depressive symptoms would spend less time engaged in unsupervised training compared to those without depressive symptoms.
This study was a secondary analysis of an unpublished dataset from 34 inpatients with subacute stroke (19 males; median age 65 [interquartile range, 55–75] years). Depressive symptoms were defined as the Japanese version of the Geriatric Depression Scale Short Form score of ≥7 (Sugishita et al., 2017). To evaluate the unsupervised training participation, participants performed three leg cycle training sessions on separate days within one week. The leg cycle training consisted of an initial 5-minute supervised phase, followed by an unsupervised phase lasting up to 15 minutes. The workload was set at an intensity level that each participant perceived as somewhat hard. Primary outcome was the median time spent in unsupervised training across three leg cycle sessions. Secondary outcomes included the Functional Independence Measure motor scores at discharge and the length of stay.
Twelve participants (35.3%) had depressive symptoms. Participants with depressive symptoms spent significantly less time in unsupervised training (367 [249–799] sec) than those without depressive symptoms (888 [579–901] sec), with a medium effect size (U = 57, p = 0.006, Cohen's r = 0.46). No significant differences were found in the secondary outcomes (p > 0.05).
Depressive symptoms were associated with reduced participation in unsupervised training among inpatients after stroke. The findings highlight the importance of considering psychological factors in designing and implementing self-rehabilitation programs at the early stages of rehabilitation.
The present findings suggest that it is crucial for healthcare providers to prioritize the early identification of stroke patients with depressive symptoms and provide appropriate mental health support to optimize their engagement in self-rehabilitation. Thus, this study emphasizes the significance of a multidisciplinary-team approach in stroke rehabilitation, which should include not only physical and occupational therapists but also mental health professionals including psychologists and psychiatrists. In addition, it is important to implement psychological strategies, such as empathic and motivational communications, to enhance their adherence to unsupervised training and optimize the outcomes of self-rehabilitation programs in inpatients with depressive symptoms after stroke.
cerebrovascular disease
self-rehabilitation
