Adherence to home exercises and rehabilitation (ADHERE) after stroke in low-to-middle-income countries: a randomized controlled trial

Mahmood, A ORCID: https://orcid.org/0000-0002-2803-3598, Nayak, P ORCID: https://orcid.org/0000-0001-8872-6858, English, C ORCID: https://orcid.org/0000-0001-5910-7927, Deshmukh, A ORCID: https://orcid.org/0000-0002-8744-9331, Shashikiran, U ORCID: https://orcid.org/0000-0001-5210-7457, Manikandan, N ORCID: https://orcid.org/0000-0002-4329-5748 and Solomon, JM ORCID: https://orcid.org/0000-0002-0828-6977 (2022) Adherence to home exercises and rehabilitation (ADHERE) after stroke in low-to-middle-income countries: a randomized controlled trial. Topics in Stroke Rehabilitation, 29 (6). pp. 438-448. ISSN 1074-9357

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Abstract

Background: Adherence to prescribed exercises is essential for home-based programs to be effective, but evidence for strategies to enhance exercise adherence in people with stroke is lacking. Objectives: To determine the effect of adherence strategies on the proportion of people with stroke who adhere to prescribed home-based exercises and their level of adherence at 6 and 12 weeks of intervention. Our secondary objective was to determine the effect of the combined intervention on mobility and quality of life post-stroke. Methods: We conducted an RCT among people with stroke (Exp = 27, Con = 25) living in semi-urban India. Both groups received standard hospital care and a home exercise program. The experimental group also received adherence strategies delivered over five sessions. Adherence was measured using the Stroke-Specific Measure of Adherence to Home-based Exercises (SS-MAHE), mobility using Mobility Disability Scale, and quality of life using the Stroke Impact Scale. Results: The experimental group had better exercise adherence compared to the control group both at six (mean difference [MD] 45, 95% CI 40, 64, p < .001) and 12 weeks (MD 51, 95% CI 39, 63, p < .001). The experimental group also had better mobility at 12 weeks (median (IQR), experimental 42 (57), median (IQR), control 95 (50), p = .002). There was no difference in the quality of life scores between groups at six or 12 weeks. Conclusion: The adherence strategies were effective in improving exercise adherence and mobility post-stroke but did not improve quality of life. Trial registration: CTRI/2018/08/015212.