Romaguera Pereira dos Santos F1, Garzim Faria J1, Cardoso Rodrigues L1, Magalhães Demartino A1, Michaelsen SM1
1Santa Catarina State University, Physical Therapy, Florianópolis, Brazil
Background: Specificity, intensity, and training dosage are the main determinants of post-stroke motor and functional recovery. However, current doses of task-specific activity for those in subacute phase may be not adequate task-specific. Low-cost strategies to increase dose include home exercise program and circuit class, but little is known on how to combine both to promote additional practice.
Purpose: To verify the feasibility (on recruitment, intervention and outcome measures) of a physiotherapy protocol that adds a self-monitoring Home Exercise Program (HEP) to group Circuit Class Training (CCT), aiming the increase on the amount of task-specific activity for subacute post-stroke individuals.
Methods: This pilot study included seventeen post-stroke (110.3±45.4 days) subjects (62.1±11 years) which were allocated after randomization in the control (n=8) or intervention (n=9) groups. Both received educational guidelines about the disease and performed twelve one-hour meetings of group CCT (twice a week over six weeks). In addition, during CCT meetings the experimental group received two booklets of exercises on HEP (four tasks each, with a target of 135 repetitions by task) which should be performed daily without supervision and documented on a self-report logbook. They were also verbally encouraged during the meetings to clarify doubts about home practice and to verify the filling of the self-report logbook. Evaluations were performed at baseline, immediately after and four weeks after the end of the intervention (follow-up) by investigators blinded to the allocation group. Clinical outcomes were motor recovery and measures of balance, mobility and upper limb activities. The feasibility of recruitment, intervention, and selected evaluation measures were assessed.
Results: The recruitment rate was 59%. Six out nine of the participants on the intervention group completed the program (unsupervised HEP added to group CCT). For those subjects the intervention was feasible: 87,5% of frequency in the CCT group meetings; 91,5% of adherence to unsupervised HEP; target repetitions completed by 50% of them with at least 100 of 135 repetitions (74,1%); and participants perceived the self-management program to be useful. The time spent in the evaluations (clinical outcomes measures) was feasible.
Conclusion(s): When combined, HEP added to group CCT cost a feasible strategy with the potential to maximize adherence during unsupervised practice at home and also to promote a target number of repetitions. Self-management appears to be feasible and has the potential to increase dosage task-specific activity after stroke. An exercise program that includes their preferences may promote more interest in their activities. Phase II randomized trial is warranted to verify the related changes on clinical outcome measures.
Implications: This protocol is a low-cost intervention for individuals with mild to moderate motor impairment after stroke that seems to increase the amount of task-specific activity. As so, it can be an useful tool for functional recovery for post-stroke individuals.
Keywords: Stoke, Task-specific activity, Home exercise program
Funding acknowledgements: CAPES - Brazilian Federal Agency for Support and Evaluation of Graduate Education
Purpose: To verify the feasibility (on recruitment, intervention and outcome measures) of a physiotherapy protocol that adds a self-monitoring Home Exercise Program (HEP) to group Circuit Class Training (CCT), aiming the increase on the amount of task-specific activity for subacute post-stroke individuals.
Methods: This pilot study included seventeen post-stroke (110.3±45.4 days) subjects (62.1±11 years) which were allocated after randomization in the control (n=8) or intervention (n=9) groups. Both received educational guidelines about the disease and performed twelve one-hour meetings of group CCT (twice a week over six weeks). In addition, during CCT meetings the experimental group received two booklets of exercises on HEP (four tasks each, with a target of 135 repetitions by task) which should be performed daily without supervision and documented on a self-report logbook. They were also verbally encouraged during the meetings to clarify doubts about home practice and to verify the filling of the self-report logbook. Evaluations were performed at baseline, immediately after and four weeks after the end of the intervention (follow-up) by investigators blinded to the allocation group. Clinical outcomes were motor recovery and measures of balance, mobility and upper limb activities. The feasibility of recruitment, intervention, and selected evaluation measures were assessed.
Results: The recruitment rate was 59%. Six out nine of the participants on the intervention group completed the program (unsupervised HEP added to group CCT). For those subjects the intervention was feasible: 87,5% of frequency in the CCT group meetings; 91,5% of adherence to unsupervised HEP; target repetitions completed by 50% of them with at least 100 of 135 repetitions (74,1%); and participants perceived the self-management program to be useful. The time spent in the evaluations (clinical outcomes measures) was feasible.
Conclusion(s): When combined, HEP added to group CCT cost a feasible strategy with the potential to maximize adherence during unsupervised practice at home and also to promote a target number of repetitions. Self-management appears to be feasible and has the potential to increase dosage task-specific activity after stroke. An exercise program that includes their preferences may promote more interest in their activities. Phase II randomized trial is warranted to verify the related changes on clinical outcome measures.
Implications: This protocol is a low-cost intervention for individuals with mild to moderate motor impairment after stroke that seems to increase the amount of task-specific activity. As so, it can be an useful tool for functional recovery for post-stroke individuals.
Keywords: Stoke, Task-specific activity, Home exercise program
Funding acknowledgements: CAPES - Brazilian Federal Agency for Support and Evaluation of Graduate Education
Topic: Neurology: stroke; Disability & rehabilitation; Service delivery/emerging roles
Ethics approval required: Yes
Institution: Santa Catarina State University
Ethics committee: Committee of Human Research Ethics
Ethics number: 1.974.549/2017
All authors, affiliations and abstracts have been published as submitted.
