Daily functioning and quality of life in a randomized controlled trial of therapeutic exercise for subacute stroke survivors

Background and Purpose - The ability of therapeutic exercise after stroke to improve daily functioning and quality of life (QOL) remains controversial. We examined treatment effects on these outcomes in a randomized controlled trial (RCT) of exercise in subacute stroke survivors. Methods - This is a secondary analysis of a single-blind RCT of a 12-week program versus usual care. Baseline, post-treatment and 6-month post-treatment daily functioning and QOL were assessed by Barthel index, Functional Independence Measure, instrumental activities of daily living, Medical Outcomes Study short-form 36-item questionnaire (SF-36), and Stroke Impact Scale (SIS). Results - Of 100 randomized subjects, 93 completed the postintervention assessment, ( mean age 70; 54% male; 81% white; mean Orpington Prognostic Score 3.4), and 80 had 6-month post-treatment assessment. Immediately after intervention, the intervention group improved more than usual care in SF-36 social function ( 14.0 points; P = 0.0051) and in SIS ( strength [9.2 points; P = 0.0003], emotion [5.6 points; P = 0.0240], social participation [6.6 points; P = 0.0488], and physical function [5.0 points; P = 0.0145]). Treatment was marginally more effective on Barthel score (3.3 points; P = 0.0510), SF-36 ( physical function [6.8 points; P = 0.0586], physical role function [14.4 points; P = 0.0708]), and SIS upper extremity function (7.2 points; P = 0.0790). Effects were diluted 6 months after treatment ended. Conclusion - This rehabilitation exercise program led to more rapid improvement in aspects of physical, social, and role function than usual care in persons with subacute stroke. Adherence interventions to promote continued exercise after treatment might be needed to continue benefit.