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Adapted cardiac rehabilitation for people with sub-acute, mild-to-moderate stroke: a mixed methods feasibility study

Published:November 29, 2021DOI:https://doi.org/10.1016/j.physio.2021.11.002

      ABSTRACT

      Objective

      To determine the recruitment strategy, acceptability, adherence, outcome measures, and adverse events for a definitive study that will explore adapted cardiac rehabilitation (CR) for people post-stroke with mild-to-moderate severity stroke in the sub-acute stage of recovery.

      Design

      Mixed methods feasibility study.

      Setting

      Acute hospital setting, neurology outpatients and community hospitals

      Participants

      32 participants with stroke (mean age: 64.4 years) of median National Institutes of Health Stroke Scale (NIHSS) score 2 (range: 0-6) within six months of stroke.

      Intervention

      All participants attended six weeks, adapted CR within one to six months after a stroke. A combined class with people post cardiac event.

      Main outcome measures

      Incremental shuttle walk test (ISWT), blood pressure, heart rate, weight, body mass index, quality of life, fatigue, anxiety and depression, tone, falls, stroke attitude and knowledge, physical activity (accelerometry) and functional ability.

      Qualitative

      Interviews with participants, non-participants and people post-cardiac event. Focus groups with Stroke and CR teams.

      Results

      32 participants were recruited. The programme was acceptable to people with mild stroke (NIHSS < 3) and people post cardiac events; 80% of classes attended, a mean of 9.6 classes, with six drop-outs. The ISWT was an acceptable outcome measure (for NIHSS < 3) and most measures showed positive changes. There was one adverse event.

      Conclusion

      A definitive study to determine the effect of six weeks of adapted CR on cardiorespiratory fitness (CRf) in people who have had a mild severity stroke (NIHSS < 3) in the sub-acute phase of recovery, is feasible. Teams need specialist education and support. A more specialist service may be needed for people with a stroke severity defined by NIHSS > 2.

      Clinical Trial Registration Number

      ISRCTN14861846.

      Keywords

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