Stroke in Young Adults: The influence of an outdoor-walking rehabilitation programme on walking performance and quality of life

Clarke, Rebecca Jayne (2024) Stroke in Young Adults: The influence of an outdoor-walking rehabilitation programme on walking performance and quality of life. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

Stroke is a debilitating neurological condition, affecting twenty-six percent of adults under the age of 65 years. Most are unable to complete activities of daily living, return to work, participate in social, leisure and outdoor activities. There is very little research and limited clinical guidelines to support their care. A plethora of previous research has reported that exercising outdoors can improve psychological health, confidence and physical function for healthy populations and a paucity of research regarding other health conditions such as dementia. This gives premise for natural outdoor environments to be used as settings for an alternative form of stroke rehabilitation. The aim of this research project is to design, develop and deliver a rehabilitation programme, using the outdoor natural environment as an alternative setting, specific to the needs and requirements of young stroke survivors with mild to moderate physical impairments. As part of this research project, a three-week feasibility study was conducted, assessing whether an outdoor-based rehabilitation programme that included activities such as walking, canoeing and archery chosen by the stroke participants as part of a focus group, was feasible as a form of rehabilitation for young adults who have had a stroke (n=5). Walking speed and was measured during three minutes of walking in indoor at baseline. Quality of life was assessed using the EuroQoL EQ-5D-5L Quality of Life scale pre and post-intervention. A larger scale case controlled study examined the effects of a ten-week outdoor-walking rehabilitation programme and home exercise programme on walking performance and quality of life in young adults who have had a stroke (n=12). Walking speed and metabolic energy cost was measured during three minutes of walking in indoor and outdoor environments at baseline and post-rehabilitation. Quality of life was assessed using Stroke and Aphasia Quality of Life Scale. Walking performance parameters such as walking speed, walking efficiency, key joint kinematic and kinetic measures and quality of life were impaired as a result of stroke. Participants walked quicker indoors (pre: 0.82m/s, post: 0.91m/s post-intervention (p=0.01)), outdoors (pre: 0.79m/s, post: 0.89m/s (p=0.005)) and more efficiently (indoor, pre: 0.75 beats/m, post: 0.57 beats/m (p=0.56), outdoor, pre: 0.83 beats/m, post: 0.60 beats/m (p=0.168) post-intervention. Self-reported quality of life improved from 2.76 to 3.21 (p=0.024). The outdoor-walking rehabilitation programme was feasible and highly beneficial to walking performance, confidence and health-related quality of life. Therefore, outdoor-walking is an innovative approach to improving walking performance and managing the physical and mental challenges of stroke in young adults and in doing so motivate the young stroke population to better engage in their rehabilitation and maintain independence.