Adherence to home exercises and rehabilitation (ADHERE) after stroke in low-to-middle-income countries: A randomized controlled trial

ABSTRACT

Background

Adherence to prescribed exercises is essential for home-based programs to be effective, but evidence for strategies to enhance exercise adherence in people with stroke is lacking.

Objectives

To determine the effect of adherence strategies on the proportion of people with stroke who adhere to prescribed home-based exercises and their level of adherence at 6 and 12 weeks of intervention. Our secondary objective was to determine the effect of the combined intervention on mobility and quality of life post-stroke.

Methods

We conducted an RCT among people with stroke (Exp = 27, Con = 25) living in semi-urban India. Both groups received standard hospital care and a home exercise program. The experimental group also received adherence strategies delivered over five sessions. Adherence was measured using the Stroke-Specific Measure of Adherence to Home-based Exercises (SS-MAHE) , mobility using Mobility Disability Scale, and quality of life using the Stroke Impact Scale.

Results

The experimental group had better exercise adherence compared to the control group both at six (mean difference [MD] 45, 95% CI 40, 64, p < .001) and 12 weeks (MD 51, 95% CI 39, 63, p < .001). The experimental group also had better mobility at 12 weeks (median (IQR), experimental 42 (57), median (IQR), control 95 (50), p = .002). There was no difference in the quality of life scores between groups at six or 12 weeks.

Conclusion

The adherence strategies were effective in improving exercise adherence and mobility post-stroke but did not improve quality of life.

Trial registration

CTRI/2018/08/015212

KEYWORDS:

• Adherence
• Compliance
• Home-based exercises
• Rehabilitation
• Health behavior

Acknowledgments

We are thankful to Rohan Jonathan Silveira and Ruchira Kumaranayake, Manipal Academy of Higher Education, Manipal for their help in developing and editing exercise videos. We are grateful to Karly Zacharia, PhD candidate, School of Health Sciences, Priority Research Centre (PRC) for Stroke and Brain Injury and HMRI, University of Newcastle for proofreading the manuscript.

Author contributions

JMS, MN and CE first designed the study. The interventions were delivered by AM under the supervision of AD. AM and PN collected data. MN and SU analysed the data. AM prepared the first draft of the manuscript. All authors contributed in writing and revising the paper. JMS is the guarantor of the study.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.