The Effect of a Written and Pictorial Home Exercise Prescription on Adherence for People with Stroke

Abstract

Background/Objective: Functional recovery for stroke survivors begins with rehabilitation. It may not be feasible for therapists to supervise all rehabilitation, especially in the home environment. Therefore, adherence to prescribed exercise programmes is important. The objective of this study was to determine the effect of a written and pictorial home exercise prescription on adherence to a home exercise programme in patients with stroke. Methods: This was a randomised controlled trial with a blinded assessor. The control group received a home exercise programme with verbal instructions, while the intervention group received the same home exercise programme with verbal instructions but with additional written and pictorial instructions for the exercises. An exercise logbook was used to monitor adherence. The Modified Rivermead Mobility Index (MRMI) and Barthel Index (BI) were used to establish mobility and activities of daily living. Results: There were a total of 42 participants, with 21 in each group; mean age was 60.8 AE 15.5 years. Forty (95%) of the participants had suffered a stroke less than 4 months prior to the study. Both control and intervention groups had similar outcomes: there was no significant difference between groups with regard to functional ability (MRMI, p Z .40; BI, p Z .65) and adherence (p Z .53). The relationship between functional ability (MRMI and BI) and the level of adherence for both the control and intervention groups was not statistically significant. Conclusion: The addition of a written and pictorial home exercise prescription does not lead to better adherence to a home exercise programme compared to having no written and pictorial instructions. Possible reasons may be that patients had caregivers as a support system, and the exercise logbook served as a reminder and motivational track record for patients. There also Funding/support: This study was partially funded by the

Current stroke rehabilitation services and physiotherapy research in South Africa

“…South African physiotherapy stroke rehabilitation research is undertaken to establish interventions that are context-specific, taking into consideration available resources (human and material), geographical and political factors that are unique to the country or even specific provinces, and we report this research below (Comley-White, Mudzi & Musenge 2018; Kara & Ntsiea 2015; Knox, Stewart & Richards 2018; Mudzi, Stewart & Musenge 2012b; Ntsiea et al 2015; Puckree & Naidoo 2014; Van Wyk 2016; Van Wyk, Eksteen & Rheeder 2014). We also have included intervention evidence from studies conducted outside South Africa whose findings we consider are relevant to the SA context.…”

A comprehensive design of a structured technology-based therapy to prevent post intensive care syndrome (CogGYM platform)

“…The entire CogGym platform interface is in Arabic language. CogGym contains ten sub-games that are used to enhance the ten different perceptions capabilities for each person as addressed in literature (Lin et al, 2012;Malinowsky et al, 2015;Kara and Ntsiea, 2015;Rubrics and Fun, 2018) that are defined in Table 1. Visual discrimination is defined as the capability to recognise differences and similarities between size, shapes, colours, patterns and objects.…”

“…Yearly, millions of critically ill patients experience newly acquired long-term cognitive impairment and major physical, mental and functional disabilities (Jackson et al, 2012;Kara and Ntsiea, 2015). Those patients are given the diagnosis of post-intensive care syndrome (PICS).…”

Pilot study on comparisons between the effectiveness of mobile video-guided and paper-based home exercise programs on improving exercise adherence, self-efficacy for exercise and functional outcomes of patients with stroke with 3-month follow-up: A single-blind randomized controlled trial

“…Traditionally, for continuation of exercise training program, physiotherapists would prescribe home exercises programs in paper-based format. 9,10 However, evidence showed that home exercise prescription in paper-based format does not lead to better adherence to a home exercise program compared to having no written and pictorial instructions for patients with stroke less than four months. 10 The recent increasing accessibility of smart technology 11 o®ers an opportunity to advance the mode of delivery of home exercise program by mobile devices such as video-guided exercise on electronic tablets 12 and video-guided exercise on mobile apps.…”

“…12 In contrast, another study showed that people with musculoskeletal conditions who adhere better to their home exercise programs in video-based format are provided with an app with remote support compared to paper handouts; although the clinical importance of this added adherence is unclear. 13 Since one of the major outcomes to evaluate the e®ectiveness of the mode of delivery of home exercise program is adherence, 10,12,13 it is worthwhile to study the factor a®ecting adherence of mode of delivery of home exercise program. It was suggested that one of the barriers to adherence of home exercise is low self-e±cacy.…”