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

Abstract

ObjectiveTo 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. DesignMixed methods feasibility study. SettingAcute hospital setting, neurology outpatients and community hospitals. Participants32 participants with stroke (mean age: 64.4 years) of median National Institutes of Health Stroke Scale (NIHSS) score 2 (range: 0 to 6) within six months of stroke. InterventionAll participants attended six weeks, adapted CR within one to six months after a stroke. A combined class with people post cardiac event. Main outcome measuresIncremental 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. QualitativeInterviews with participants, non-participants and people post-cardiac event. Focus groups with Stroke and CR teams. Results32 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. ConclusionA 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 NumberISRCTN14861846.