Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Stroke Unit, Department of Internal Medicine, Trondheim University Hospital, Trondheim, Norway.
Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Stroke Unit, Department of Internal Medicine, Trondheim University Hospital, Trondheim, Norway.
Arch Phys Med Rehabil. 2019 Dec;100(12):2251-2259. doi: 10.1016/j.apmr.2019.04.023. Epub 2019 Jul 30.
To investigate the associations between participants' adherence to a physical activity and exercise program after stroke and functional recovery 18 months after inclusion.
Secondary analyses of the intervention arm in the multisite randomized controlled trial Life After Stroke (LAST).
Primary health care services in 3 Norwegian municipalities.
Of the participants enrolled (N=380), 186 (48.9%) were randomized to the intervention. The study sample comprised community dwelling individuals included 3 months after stroke, with mean age of 71.7 ± 11.9 years and 82 (44.1%) women. According to the National Institutes of Health Stroke Scale, 97.3% were diagnosed as having mild (National Institutes of Health Stroke Scale<8) and 2.7% with moderate (8-16 on the National Institutes of Health Stroke Scale) stroke.
Monthly coaching by physiotherapists encouraging participants to adhere to 30 minutes of daily physical activity and 45-60 minutes of weekly exercise.
The primary outcome was Motor Assessment Scale (MAS). Secondary outcome measures were 6-minute walk test, Timed Up and Go (TUG), Berg Balance Scale (BBS), and the physical domains of the Stroke Impact Scale (SIS). Adherence was assessed by combining participants' training diaries and physiotherapists' reports.
The relationship between adherence and functional recovery was analyzed with simple and multiple linear regression models. Adjusted for age, sex, dependency, and cognition, results showed statistically significant associations between adherence and functional outcomes after 18 months, as measured by MAS, TUG, BBS, and SIS (P≤.026).
Increased adherence to physical activity and exercise was associated with improved functional recovery after mild to moderate stroke. This emphasizes the importance of developing adherence-enhancing interventions. Dose-response studies are recommended for future research.
探究卒中后参与者对体育活动和锻炼计划的坚持情况与 18 个月后功能恢复的相关性。
多中心随机对照试验 Life After Stroke（LAST）干预组的二次分析。
挪威 3 个市的初级卫生保健服务。
纳入的参与者（n=380）中，186 人（48.9%）被随机分配到干预组。研究样本包括卒中后 3 个月内居住在社区的个体，平均年龄为 71.7±11.9 岁，82 人（44.1%）为女性。根据国立卫生研究院卒中量表（National Institutes of Health Stroke Scale），97.3%被诊断为轻度卒中（国立卫生研究院卒中量表评分<8），2.7%为中度卒中（国立卫生研究院卒中量表评分 8-16）。
每月由物理治疗师提供辅导，鼓励参与者每天坚持 30 分钟的身体活动和每周 45-60 分钟的锻炼。
主要结局测量指标为运动评估量表（Motor Assessment Scale，MAS）。次要结局测量指标为 6 分钟步行试验、起立行走计时测试（Timed Up and Go，TUG）、伯格平衡量表（Berg Balance Scale，BBS）和卒中影响量表（Stroke Impact Scale，SIS）的身体领域。通过合并参与者的训练日记和物理治疗师的报告来评估依从性。
采用简单和多元线性回归模型分析了依从性与功能恢复之间的关系。调整年龄、性别、依赖程度和认知能力后，结果显示，在 18 个月时，依从性与 MAS、TUG、BBS 和 SIS 等功能结局呈显著正相关（P≤.026）。
增加对体育活动和锻炼的依从性与轻度至中度卒中后功能恢复改善相关。这强调了开发增强依从性的干预措施的重要性。建议进行剂量-反应研究以进行未来的研究。
