Adapted cardiac rehabilitation for people with sub-acute, mild-to-moderate stroke: a mixed methods feasibility study

Objective To determine the recruitment strategy, acceptability, adherence, outcome measures, and adverse events for a definitive study that will explore adapted cardiac rehabilitation (CR) for people post-stroke with mild-to-moderate severity stroke in the sub-acute stage of recovery.Design Mixed methods feasibility study.Setting Acute hospital setting, neurology outpatients and community hospitals.Participants 32 participants with stroke (mean age: 64.4 years) of median National Institutes of Health Stroke Scale (NIHSS) score 2 (range: 0 to 6) within six months of stroke.Intervention All participants attended six weeks, adapted CR within one to six months after a stroke. A combined class with people post cardiac event.Main outcome measures Incremental shuttle walk test (ISWT), blood pressure, heart rate, weight, body mass index, quality of life, fatigue, anxiety and depression, tone, falls, stroke attitude and knowledge, physical activity (accelerometry) and functional ability.Qualitative Interviews with participants, non-participants and people post-cardiac event. Focus groups with Stroke and CR teams.Results 32 participants were recruited. The programme was acceptable to people with mild stroke (NIHSS < 3) and people post cardiac events; 80% of classes attended, a mean of 9.6 classes, with six drop-outs. The ISWT was an acceptable outcome measure (for NIHSS < 3) and most measures showed positive changes. There was one adverse event.Conclusion A definitive study to determine the effect of six weeks of adapted CR on cardiorespiratory fitness (CRf) in people who have had a mild severity stroke (NIHSS < 3) in the sub-acute phase of recovery, is feasible. Teams need specialist education and support. A more specialist service may be needed for people with a stroke severity defined by NIHSS > 2.Clinical Trial Registration Number ISRCTN14861846.Contribution of the paperAdds to current literature:center dot Results add to the evidence-base for CR with people with stroke particularly those with greater stroke severity i.e. >2 NIHSS center dot The study adds to the limited research in the UK related to stroke and CRAdds new knowledge:center dot Suggests positive effects of adapted CR on CRf, activity levels, psychological wellbeing, fatigue, quality of life and stroke knowledge. center dot It is feasible to conduct a larger study of adapted CR with people post stroke, however, people with a stroke severity >2 on the NIHSS need a more specialist service (c) 2022 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.