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| The impact of a patient-directed activity program on functional outcomes and activity participation after stroke during inpatient rehabilitation -- a randomized controlled trial [with consumer summary] |
| Swank C, Trammell M, Callender L, Bennett M, Patterson K, Gillespie J, Kapoor P, Driver S |
| Clinical Rehabilitation 2020 Apr;34(4):504-514 |
| clinical trial |
| 7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
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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; 3,586.5 +/- 3,468.5 steps/day) compared to control (n = 10; 1,760.9 +/- 2,346.3 steps/day). CONCLUSION: Functional outcome improvement was comparable between groups; however, PDAP participants completed more steps and perceived greater recovery.
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