Effectiveness of adaptive physical activity combined with therapeutic patient education in stroke survivors at twelve months: a non-randomized parallel group study.

Background: Adaptive physical activity (APA) is a community-based exercise program for chronic stroke survivors that proved to be effective in improving physical functioning and psychological well-being in the short term.

Aim: The aim of the present paper is to determine the effectiveness at twelve months of an intervention of APA combined with therapeutic patient education (TPE) in stroke survivors.

Design: This study is a non-randomized parallel group study comparing APA-TPE intervention with treatment as usual (TAU).

Setting: Patients were recruited after discharge from two Physical Medicine and Rehabilitation Units, 3 to 18 months after the stroke event. The APA-TPE intervention was conducted in local gymnasiums.

Population: The study population includes consecutive adult stroke survivors with mild to moderate hemiparesis who were able to walk 25 m independently and had no need of physical therapy.

Methods: The experimental group (N.=126) underwent 16 biweekly sessions of APA and 3 TPE sessions and controls (N.=103) underwent TAU. Twelve-month outcomes included the Modified Barthel Index, the Caregiver Strain Index, SF-12 health-related quality of life, medical complications and health services use.

Results: At twelve months, the ability to perform daily living activities, assessed using Modified Barthel Index, was decreased in the TAU group and improved in the APA-TPE group. The physical and mental components of quality of life were significantly improved in both groups. The risk of fractures (OR=0.09, 95% CI 0.01-0.79) and recourse to rehabilitation treatments (OR=0.24, 95% CI 0.08-0.77) were lower in the APA-TPE compared with the TAU group. No difference was found between groups concerning the caregiver burden.

Conclusion: APA-TPE is an effective intervention to maintain and improve activities of daily living, reduce falls and recourse to rehabilitation treatments at twelve months.

Clinical Rehabilitation Impact: Structured physical activity programs that can be performed also at home, when combined with therapeutic education focused on benefits of physical activity, will encourage stroke survivors to continue exercising. Therefore, it fulfills an essential requirement to the maintenance of lasting health benefits and the prevention of physical and psychological deterioration.