PROMISING EFFECTS OF THE RISE INTERVENTION TO SUPPORT PEOPLE WITH STROKE IMPROVE THEIR MOVEMENT BEHAVIOUR PATTERN

W. Hendrickx^1,2, R. Wondergem^3,1, C. English^4,5, C. Veenhof^2,6, J.M.A. Visser-Meilij⁷, M.F. Pisters^1,2,8

¹Fontys University of Applied Sciences, Department of Health Innovations and Technology, Eindhoven, Netherlands, ²University Medical Center Utrecht, Utrecht University, Department of Rehabilitation, Physiotherapy Science & Sport, UMC Utrecht Brain Center, Utrecht, Netherlands, ³Fontys University of Applied Sciences, School of Sport Studies, Eindhoven, Netherlands, ⁴University of Newcastle, School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, Newcastle, Australia, ⁵Florey Institute of Neuroscience and Hunter Medical Research Institute, Centre for Research Excellence in Stroke Recovery and Rehabilitation, Newcastle, Australia, ⁶University of Applied Sciences Utrecht, Research Group Innovation of Human Movement Care, Utrecht, Netherlands, ⁷University Medical Center Utrecht and De Hoogstraat Rehabilitation, Center of Excellence for Rehabilitation Medicine, Brain Center, Utrecht, Netherlands, ⁸Julius Health Care Centers, Center for Physical Therapy Research and Innovation in Primary Care, Utrecht, Netherlands

Background: Due to the high risk of recurrent stroke, secondary prevention is highly important to people who have suffered a stroke.High amounts of sedentary behaviour and low levels of physical activity increase the risk of cardiovascular disease, including stroke, and 77% of people with stroke have such a high-risk movement behaviour pattern. Therefore, effective interventions are needed to support people with stroke improve their movement behaviour patterns.

Purpose: The objective was to determine the preliminary effectiveness and feasibility of the RISE intervention. The RISE intervention primarily aims to reduce and interrupt sedentary behaviour in people with a stroke living in the community.

Methods: A randomised multiple baseline study was conducted, including community dwelling people with stroke, up to six months after stroke who are highly sedentary. This design entails a baseline phase with repeated measurement of varying lengths, from 4 to 14 days, randomly allocated. The RISE intervention was developed in a comprehensive co-design process. It is a blended behavioural intervention combining 10 coaching sessions in the home setting with a physiotherapist with e-coaching using an activity monitor and m-health application to support real-time feedback, among other aspects. Seven randomly allocated participants were joint in the intervention by someone from their immediate social environment to provide participatory support. Appropriate analyses for this design were applied, including visual analyses methods, randomisation test and parametric effect size estimations. Feasibility of the intervention was objectified using adherence and satisfaction outcomes, including interviews.

Results: Of the fourteen participants, all but one, finished the intervention and did not miss any sessions. Analyses indicate that 71% of the participants have improved at least one sedentary behaviour outcome, either total sedentary time and/ or interrupting sedentary time, and at least one physical activity outcome. The remaining 29% of the participants showed no improvements. Looking at the group receiving additional participatory support we saw that 86% improved on at least one sedentary behaviour outcome, compared to 56% in the group without. For the most part, participants were satisfied with the intervention and believed it supported them in improving their movement behaviour pattern. The participatory support was indicated as great added value. Some suggestion were made how to improve the intervention even further. The coaching role of the physiotherapist was highly appreciated by the participants. However, some of the physiotherapists have stated they need a higher skill level in supporting movement behaviour change.

Conclusions: The results of this study indicate that the RISE intervention is promising to support people who have had a stroke to improve their movement behaviour pattern. Therefore, final development steps and a larger effectiveness trial are validated.

Implications: The promising results of this study indicate that the RISE intervention might be of great added value to secondary prevention after stroke. It also shows that the innovative combination of coaching by a physiotherapist and the use of an activity monitor and m-health application might have value when it comes to movement behaviour change.

Funding acknowledgements: SIA-RAAK, The Dutch Organisation for Scientific Research (NWO), number RAAK.PUB05.021

Keywords:
Stroke
Sedentary behaviour
Behaviour change intervention

Topics:
Neurology: stroke
Health promotion & wellbeing/healthy ageing/physical activity

Did this work require ethics approval? Yes

Institution: University Medical Centre Utrecht

Committee: Medical Ethics Research Committee of the University Medical Centre Utrecht

Ethics number: 20-250