Community-based exercise programs incorporating healthcare-community partnerships to improve function post-stroke: feasibility of a 2-group randomized controlled trial

Gayatri Aravind¹, Kainat Bashir¹, Jill I Cameron², Jo-Anne Howe^{1

3}, Susan B Jaglal^{1

4}, Mark T Bayley^{3

4

5}, Robert W Teasell⁶, Rahim Moineddin⁷, Joanne Zee⁸, Walter P Wodchis⁹, Alda Tee¹⁰, Susan Hunter¹¹, Nancy M Salbach^{12

13}

Affiliations

¹ Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.
² Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.
³ Toronto Rehabilitation Institute, University Health Network, University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
⁴ The KITE Research Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
⁵ Department of Medicine, University of Toronto, C. David Naylor Building, 6 Queen's Park Crescent West, Third Floor, London, ON, M5S 3H2, Canada.
⁶ Schulich School of Medicine and Dentistry, Western University, St Joseph's Health Care London - Parkwood Institute, 550 Wellington Rd, London, ON, N6C 0A7, Canada.
⁷ Department of Family and Community Medicine, University of Toronto, 160‑500 University Avenue, Toronto, ON, M5G 1V7, Canada.
⁸ Toronto General Hospital, University Health Network, 585 University Avenue, Toronto, ON, M5G 2N2, Canada.
⁹ Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T 3M6, Canada.
¹⁰ Central East Stroke Network, Royal Victoria Regional Health Centre, 201 Georgian Drive, Barrie, ON, L4M6M2, Canada.
¹¹ School of Physical Therapy, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada.
¹² Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada. nancy.salbach@utoronto.ca.
¹³ The KITE Research Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada. nancy.salbach@utoronto.ca.

PMID: 35459194
PMCID: PMC9028093
DOI: 10.1186/s40814-022-01037-9

Community-based exercise programs incorporating healthcare-community partnerships to improve function post-stroke: feasibility of a 2-group randomized controlled trial

Gayatri Aravind et al. Pilot Feasibility Stud. 2022.

. 2022 Apr 22;8(1):88.

doi: 10.1186/s40814-022-01037-9.

Authors

Affiliations

¹ Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.
² Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.
³ Toronto Rehabilitation Institute, University Health Network, University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
⁴ The KITE Research Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
⁵ Department of Medicine, University of Toronto, C. David Naylor Building, 6 Queen's Park Crescent West, Third Floor, London, ON, M5S 3H2, Canada.
⁶ Schulich School of Medicine and Dentistry, Western University, St Joseph's Health Care London - Parkwood Institute, 550 Wellington Rd, London, ON, N6C 0A7, Canada.
⁷ Department of Family and Community Medicine, University of Toronto, 160‑500 University Avenue, Toronto, ON, M5G 1V7, Canada.
⁸ Toronto General Hospital, University Health Network, 585 University Avenue, Toronto, ON, M5G 2N2, Canada.
⁹ Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T 3M6, Canada.
¹⁰ Central East Stroke Network, Royal Victoria Regional Health Centre, 201 Georgian Drive, Barrie, ON, L4M6M2, Canada.
¹¹ School of Physical Therapy, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada.
¹² Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada. nancy.salbach@utoronto.ca.
¹³ The KITE Research Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada. nancy.salbach@utoronto.ca.

PMID: 35459194
PMCID: PMC9028093
DOI: 10.1186/s40814-022-01037-9

Abstract

Background: Despite the potential for community-based exercise programs supported through healthcare-community partnerships (CBEP-HCPs) to improve function post-stroke, insufficient trial evidence limits widespread program implementation and funding. We evaluated the feasibility and acceptability of a CBEP-HCP compared to a waitlist control group to improve everyday function among people post-stroke.

Methods: We conducted a 3-site, pilot randomized trial with blinded follow-up evaluations at 3, 6, and 10 months. Community-dwelling adults able to walk 10 m were stratified by site and gait speed and randomized (1:1) to a CBEP-HCP or waitlist control group. The CBEP-HCP involved a 1-h, group exercise class, with repetitive and progressive practice of functional balance and mobility tasks, twice a week for 12 weeks. We offered the exercise program to the waitlist group at 10 months. We interviewed 13 participants and 9 caregivers post-intervention and triangulated quantitative and qualitative results. Study outcomes included feasibility of recruitment, interventions, retention, and data collection, and potential effect on everyday function.

Results: Thirty-three people with stroke were randomized to the intervention (n = 16) or waitlist group (n = 17). We recruited 1-2 participants/month at each site. Participants preferred being recruited by a familiar healthcare professional. Participants described a 10- or 12-month wait in the control group as too long. The exercise program was implemented per protocol across sites. Five participants (31%) in the intervention group attended fewer than 50% of classes for health reasons. In the intervention and waitlist group, retention was 88% and 82%, respectively, and attendance at 10-month evaluations was 63% and 71%, respectively. Participants described inclement weather, availability of transportation, and long commutes as barriers to attending exercise classes and evaluations. Among participants in the CBEP-HCP who attended ≥ 50% of classes, quantitative and qualitative results suggested an immediate effect of the intervention on balance, balance self-efficacy, lower limb strength, everyday function, and overall health.

Conclusion: The CBEP-HCP appears feasible and potentially beneficial. Findings will inform protocol revisions to optimize recruitment, and program and evaluation attendance in a future trial.

Trial registration: ClinicalTrials.gov , NCT03122626 . Registered April 21, 2017 - retrospectively registered.

Keywords: Balance; Community; Everyday function; Healthcare-community partnership; Mobility; Randomized controlled trial; Stroke; Task-oriented training.

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Conflict of interest statement

JH is one of the lead developers of the TIME^TM program but was not involved in data collection or data analysis.

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References

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Community-based exercise programs incorporating healthcare-community partnerships to improve function post-stroke: feasibility of a 2-group randomized controlled trial

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Community-based exercise programs incorporating healthcare-community partnerships to improve function post-stroke: feasibility of a 2-group randomized controlled trial

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Conflict of interest statement

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