Defining the rehabilitation adherence curve and adherence phases of stroke patients: an observational study

Abstract

Background

Patient adherence is a crucial determinant of rehabilitation in the long term after stroke. However, adherence is inconstant and fluctuates along a time course, and the underlying regular pattern of adherence variation remains to be clarified.

Objective

We aimed to describe the longitudinal pattern of adherence to rehabilitation exercises in stroke patients and to determine different adherence phases based on formulated rehabilitation adherence curve.

Patients and methods

Rehabilitation adherence levels were prospectively collected using the Questionnaire of Exercise Adherence (EAQ) among patients diagnosed with first-onset stroke since the second week of stroke onset, with a follow-up of 24 weeks. SPSS19.0 was used to formulate a fitting curve based on a scatter diagram. Possible causal factors for the different adherence phases are also discussed from the psychological, socioeconomic, and behavioral aspects.

Results

A total of 98 patients were included in this study. General adherence of the included subjects was classified as low to medium during follow-up. The adherence fitting curve was an “S” curve, with the fitting function y =0.005x³−0.211x²+1.963x+52.345. Three phases, namely, rapid increase phase, slow decrease phase, and stable phase, were identified based on the adherence curve, and relevant theories are explored.

Conclusion

Rehabilitation adherence of stroke patients is a dynamic behavioral process that continuously changes along a time course, with a regular pattern of an “S” curve and includes a rapid increase phase, a slow decrease phase, and a stable phase.

Keywords:

• cerebrovascular disease
• rehabilitation pattern
• early rehabilitation

Supplementary material

Questionnaire of Exercise Adherence (EAQ)

Questionnaire instructions: please tick in the box if you agree to the terms. The term “never” means you are unable to complete the corresponding guidance; “sometimes” means that you adhere to the guidance on <50% occasions; “often” means you adhere to the guidance on >50% occasions, but have not yet reached 100%; and “always” means you can complete the guidance or training requirements if there is no special situation. Thanks for your cooperation!

1. Follow the instructions given by the medical staff during admission and after discharge.

   □➀ never □➁ sometimes □➂ often □➃ always

2. Follow the guidance strictly and insisting on exercising 2–3 times every day at least.

   □➀ never □➁ sometimes □➂ often □➃ always

3. Strictly follow the requirement that each exercise duration be for at least 30–45 minutes.

   □➀ never □➁ sometimes □➂ often □➃ always

4. Insist on walking up and down the stairs every day (or other forms of exercise that can be done).

   □➀ never □➁ sometimes □➂ often □➃ always

5. Insist on practicing dressing, eating, washing face, and brushing teeth by yourself (especially practicing the function of the paralyzed side).

   □➀ never □➁ sometimes □➂ often □➃ always

6. Adhere to exercise every day to the paralyzed side of the body.

   □➀ never □➁ sometimes □➂ often □➃ always

7. Stretch the affected extremity to keep it in antispasmodic condition.

   □➀ never □➁ sometimes □➂ often □➃ always

8. Care about your own functional recovery of the affected extremity and push yourself to exercise daily.

   □➀ never □➁ sometimes □➂ often □➃ always

9. You take the initiative to observe and evaluate the effect of limb functional exercise.

   □➀ never □➁ sometimes □➂ often □➃ always

10. You adhere to the learning of healthy exercises regularly.

    □➀ never □➁ sometimes □➂ often □➃ always

11. During the functional exercise, you accept the family/friends’ advice.

    □➀ never □➁ sometimes □➂ often □➃ always

12. In the process of functional exercise, you like to talk with the medical staff when you encounter problems.

    □➀ never □➁ sometimes □➂ often □➃ always

13. You communicate with your wardmates who are just like you.

    □➀ never □➁ sometimes □➂ often □➃ always

14. When you notice that there is no positive effect of functional exercise, you’re eager to seek suggestions from others to improve the effectiveness of functional exercise.

    □➀ never □➁ sometimes □➂ often □➃ always

Acknowledgments

This study was financially supported by the Health Science and Technology Special Fund of Zhejiang Province (2015KYA106). We thank Ms Lin from the Zhengzhou University for permitting the use of the Questionnaire of Exercise Adherence in the current study. There were no financial benefits to the authors. This research work has not been previously presented anywhere in manuscript or abstract form.

Disclosure

The authors report no conflicts of interest in this work.