H-GRASP: the feasibility of an upper limb home exercise program monitored by phone for individuals post stroke

Lisa A Simpson,Janice J Eng,May Chan

doi:10.3109/09638288.2016.1162853

Abstract

Purpose: To investigate the feasibility of a phone-monitored home exercise program for the upper limb following stroke. Methods: A pre-post double baseline repeated measures design was used. Participants completed an 8-week home exercise program that included behavioural strategies to promote greater use of the affected upper limb. Participants were monitored weekly by therapists over the phone. The following feasibility outcomes were collected: Process (e.g. recruitment rate); Resources (e.g. exercise adherence rate); Management (e.g. therapist monitoring) and Scientific (e.g. safety, effect sizes). Clinical outcomes included: The Chedoke Arm and Hand Inventory, Motor Activity Log, grip strength and the Canadian Occupational Performance Measure. Results: Eight individuals with stroke were recruited and six participants completed the exercise program. All but one of the six participants met the exercise target of 60 minutes/day, 6 days/week. Participants were stable across the baseline period. The following post-treatment effect sizes were observed: CAHAI (0.944, p = 0.046); MALQ (0.789, p = 0.03) grip strength (0.947, p = 0.046); COPM (0.789, p = 0.03). Improvements were maintained at three and six month follow ups. Conclusions: Community dwelling individuals with stroke may benefit from a phone-monitored upper limb home exercise program that includes behavioural strategies that promote transfer of exercise gains into daily upper limb use.Implications for RehabilitationA repetitive, task-oriented home exercise program that utilizes telephone supervision may be an effective method for the treatment of the upper limb following strokeThis program is best suited for individuals with mild to moderate level impairment and experience a sufficient level of challenge from the exercisesAn exercise program that includes behavioural strategies may promote transfer of exercise gains into greater use of the affected upper limb during daily activities

Highlights

Following a stroke, up to three quarters of survivors will experience upper limb impairments that may impact their ability to participate in life activities.[1]
A repetitive, task-oriented home exercise program that utilizes telephone supervision may be an effective method for the treatment of the upper limb following stroke
We developed a novel program called the H-Graded Repetitive Arm Supplementary Program (GRASP) (HomeGRASP) with the following attributes: (1) graded self-administered exercises adapted from GRASP; (2) use of behavioural strategies to promote incorporation of the paretic limb into daily activities; (3) support and monitoring provided by phone

Summary

Introduction

Up to three quarters of survivors will experience upper limb impairments that may impact their ability to participate in life activities.[1] At six months post stroke, less than half of these individuals will regain independent functioning of their upper extremity.[2] The discrepancy between what a patient can do and actual use of the paretic limb in the patients’ own environment, referred to as learned non-use, is a major concern.[3] Despite gains made during rehabilitation, many individuals do not go on to use their paretic upper limbs.[4,5] Reduced arm use has been associated with decreased strength, bone density and reduced quality of life.[6,7] maximizing lasting rehabilitation gains is important for the patients’ long-term health and for a sustainable healthcare system

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Conclusion