Impact of a Stroke Recovery Program Integrating Modified Cardiac Rehabilitation on All-Cause Mortality, Cardiovascular Performance and Functional Performance

Abstract

Objective Using a feasibility analysis and matched subgroup analysis, this study investigated the implementation/safety/outcomes of a stroke recovery program (SRP) integrating modified cardiac rehabilitation for stroke survivors. Design This prospective cohort study of 783 stroke survivors were discharged from an inpatient rehabilitation facility to an outpatient setting; 136 SRP-participants completed a feasibility study and received the SRP including modified cardiac rehabilitation, 473 chose standard of care rehabilitation (nonparticipants), and a group (n = 174) were excluded. The feasibility study assessed the following: safety/mortality/pre-post cardiovascular performance/pre-post function/patient/staff perspective. In addition to the feasibility study, a nonrandomized subgroup analysis compared SRP-participants (n = 76) to matched pairs of nonparticipants (n = 66, with 10 nonparticipants used more than once) for mortality/pre-post function. Results The feasibility study showed the SRP to have the following (a) excellent safety, (b) markedly low 1-yr poststroke mortality from hospital admission (1.47%) compared with national rate of 31%, (c) improved cardiovascular performance over 36 sessions (103% increase in metabolic equivalent of tasks times minutes), (d) improved function in Activity Measure of Post-Acute Care domains (P < 0.001), (e) positive reviews from SRP-participants/staff. Subgroup analysis showed the SRP to (a) positively impact mortality, nonparticipants had a 9.09 times higher hazard of mortality (P = 0.039), and (b) improve function in Activity Measure of Post-Acute Care domains (P < 0.001). Conclusions Stroke survivors receiving a SRP integrating modified cardiac rehabilitation may potentially benefit from reductions in all-cause mortality and improvements in cardiovascular performance and function.

Feasibility of integrating survivors of stroke into cardiac rehabilitation: A mixed methods pilot study

“…There are several studies and programs outside the U.S. that support the use of CR for stroke survivors, but they either lack the same dosage or create an entirely new program just for survivors [29]. While other research has examined modified CR in the U.S. and found it to be effective and feasible, these studies have not presented why programs separate from the standard CR programs are required or desired [46,47]. Utilizing existing CR programs, which are widely available in the U.S., has potential implementation advantages over creating new programs.…”

Usability and Acceptability of a Novel Secondary Prevention Initiative Targeting Physical Activity for Individuals after a Transient Ischaemic Attack or “Minor” Stroke: A Qualitative Study

“…Cardiac rehabilitation has been associated with reductions in biological markers linked to both cardiovascular and cerebrovascular mortality [13]. Given that cardiac and cerebrovascular disease share common underlying mechanisms and risk factors, adapted physical activity-based, cardiac rehabilitation interventions could potentially be beneficial in the acute and sub-acute period after a TIA [14,15], however, their effectiveness is uncertain. Existing evidence indicates that aerobic exercise can result in important reductions in systolic and diastolic blood pressure in patients following a TIA, with effects most pronounced when exercise is initiated within six months of an initial event, and when interventions incorporate educational components [16].…”

Application effect of the hospital-community integrated service model in home rehabilitation of stroke in disabled elderly: a randomised trial

“…The above scales all included 20 items, each item scored between 1 and 4 points, with the standard being the sum of all items scored multiplied by 1.25 to obtain an integer. The higher the score is, the more severe the anxiety and depression (8).…”