Does Participation in a Group, Task-oriented Community-based Exercise Program Improve the Ability to do Everyday Activities Among People With Stroke?

Recruiting

Phase N/A Results N/A

Trial Description

After a stroke, people find it difficult to perform everyday activities independently, like getting dressed, preparing meals, and shopping. This can cause many problems. First, people with stroke can't do activities they enjoy, like walk outside, or make home repairs. Second, a family member or friend has to help and has less time to do important activities. If a family member or friend is not available, someone from homecare services has to help. Third, people who need help with everyday activities are more likely to visit the doctor, and enter a nursing home than those who do not need this help. Losing one's independence can decrease quality of life. Functional exercise classes run by physical therapists where people with stroke practice getting in and out of a chair, stepping, and walking, can improve the ability to balance, walk, and do everyday activities. These classes are not commonly available in community centres, mainly because fitness instructors do not receive training in how to run exercise classes for people with stroke. Therefore there is a need to make these functional exercise programs available in local community centres.
The objective of this project is to test procedures for running a large study to see whether people with stroke improve their ability to do everyday activities after participating in functional group exercise classes for 12 weeks in local community centres. If ability to do everyday activities improves, the investigators wish to see if the improvement is still present 3, 6 and 9 months later. Physical therapists at a nearby hospital will teach fitness instructors how to run the exercise class, help out during the classes, and answer questions by email or phone. Before conducting the larger study, it is important to see how many people with stroke are interested to participate, if they attend all of the exercise classes, and if they find the evaluations acceptable. It is also important to know whether the fitness instructors are able to run the program as planned, if managers at the hospital and recreation centre find the cost of running the exercise program acceptable, and if the improvements people make are large enough to support the decision to run a large study.
In Toronto, London and Pembroke, Canada, managers at a hospital and a nearby recreation centre have agreed to help run the exercise program. The physical therapist will ask people with stroke who can walk and are being discharged home from the hospital whether they can be called about the study. People with stroke and a family member who agree to participate in the study will complete four evaluations when they enter the study, and 3, 6, and 12 months later. At each evaluation, people with stroke will perform tests of balance and walking, and complete questionnaires about their mood, participation in valued activities, and quality of life. Family members will complete a questionnaire about the help they provide. After the first evaluation, the investigators will use a process like flipping a coin, to see if the person with stroke will begin the exercise program immediately or 12 months later. The investigators will call people each month to ask if a fall occurred, and obtain data on doctor and hospital visits. The investigators will interview exercise participants, family members and hospital/recreation staff at the end of the study to ask about the experiences.
This project is unique because the program combines the expert knowledge and skills of physical therapists and fitness instructors. Because a physical therapist is involved, people with stroke feel the program is credible and the exercises will be suitable. The exercise program involves practicing everyday movements, making the exercises easy for fitness instructors and people with stroke to learn. Each exercise has multiple levels of difficulty so the instructor can adapt exercises to how the person is feeling. The exercise program does not require expensive equipment (e.g. chairs, stepping stools) and therefore can be offered in most community centres. Finally, an extensive network of hospitals providing stroke care and community centres run by recreation organizations exists in Canada. Thus, if this program is beneficial, it could easily be made widely available.
The number of Canadians living with the effects of stroke will increase to between 654 000 and 726 000 over the next 18 years. Eighty percent of these individuals will live at home. This means that a large number of Canadians will be faced with challenges performing everyday activities that will affect their family members, threaten their ability to live on their own, and result in substantial healthcare costs. The investigators need functional exercise programs in local community centres now so that these people can have the opportunity to improve their ability to function and live independently in the community

Conditions

Interventions

  • Together in Movement and Exercise (TIME) Program Behavioral
    Intervention Desc: The TIME program is an evidence-based, standardized, progressive, licensed exercise program developed by physical therapists at the Toronto Rehabilitation Institute-University Health Network.
    ARM 1: Kind: Experimental
    Label: Experimental Group
    Description: The intervention is a group, task-oriented exercise program involving two 1-hour exercise classes per week for 12 weeks. The class involves a seated warm-up, repetitive, progressive practice of functional balance and mobility tasks, and a seated cool down. The warm-up consists of active range-of-motion exercises, aerobic exercise, leg loading, stretching, and sit-to-stand training. The cool-down involves exercises with an emphasis on stretching and relaxation. Tasks are organized in a 3-station circuit completed by participants grouped by overall ability: Superstation 1: walking, aerobic training, and wall work (standing and reaching, wall push-ups); Superstation 2: standing weight shifts, coordinated with stepping and lunging; and Superstation 3: tap-ups, step-ups, and heel/toe raises, hamstring curls, marching-on-the-spot, and mini-squats. Participants are instructed to be physically active by walking in their neighbourhood, practicing the program exercises, or using the stairs.

Outcomes

Type Measure Time Frame Safety Issue
Primary Subjective Index of Physical and Social Outcome (SIPSO) 3 minutes
Primary Nottingham Extended Activities of Daily Living (NEADL) 10 minutes
Secondary Barthel Index 5 minutes
Secondary EuroQol five dimensions questionnaire 2 minutes
Secondary Stroke Impact Scale 10 minutes
Secondary Berg Balance Test 12 minutes
Secondary Activities-specific Balance Confidence (ABC) Scale 4 minutes
Secondary 30-second Timed Sit-to-stand Test 2 minutes
Secondary 6-Minute Walk Test 8 minutes
Secondary 10-metre Walk Test 2 minutes
Secondary Life Space Assessment questionnaire 2 minutes
Secondary Canadian Study of Health and Aging-Clinical Frailty Scale 3 minutes
Secondary Trail Making Test 5 minutes
Secondary Geriatric Depression Scale-Short Version 3 minutes
Secondary Occurrence of injurious falls 1 minute
Secondary Number of healthcare services utilized 0.25 minutes
Secondary Type of healthcare services utilized 0.25 minutes
Secondary Number of homecare services 0.25 minutes
Secondary Type of homecare services 0.25 minutes
Secondary Blood Pressure 0.5 minutes
Secondary Heart Rate 0.5 minutes
Secondary Mobility aid 0.25 minutes
Secondary Stroke characteristic 0.25 minutes
Secondary Sociodemographic data 1 0.25 minutes
Secondary Sociodemographic data 2 0.25 minutes
Secondary Height 0.25 minutes
Secondary Weight 0.25 minutes
Secondary Sociodemographic data 3 0.25 minutes
Secondary Education level 0.25 minutes
Secondary Personal income 0.25 minutes
Secondary Charlson Comorbidity Index 2 minutes
Secondary Co-intervention 0.5 minutes
Secondary Caregiver Assistance Scale 5 minutes
Secondary Rand 2 minutes
Secondary Time per week spent caregiving 0.25 minutes
Secondary Costs report 5 minutes
Secondary Intervention fidelity-activity checklist 5 minutes
Secondary Intervention feasibility-attendance sheet 5 minutes
Secondary PT Evaluation form 5 minutes
Secondary Adverse events 5 minutes
Secondary Mobility aid type 0.25 minutes
Secondary Mobility aid number 0.25 minutes
Secondary Stroke characteristic date 0.25 minutes
Secondary Stroke side 0.25 minutes
Secondary Stroke type 0.25 minutes
Secondary Sociodemographic data-age 0.25 minutes
Secondary Sociodemographic data-sex 0.25 minutes
Secondary Sociodemographic data-employement 0.25 minutes
Secondary Co-intervention type 0.5 minutes
Secondary Co-intervention frequency 0.5 minutes

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