Journal Article

A community-based exercise and education scheme for stroke survivors: a randomized controlled trial and economic evaluation

Reed, Mary, Harrington, Rachel, Wood, Victorine A, Kay, Hazel, Taylor, Gordon, Hollinghurst, Sandra

2010

Overview

Objective: The evaluation of a community-based exercise and education scheme for stroke survivors. Design: A single blind parallel group randomized controlled trial. Setting: Leisure and community centres in the south-west of England. Subjects: Stroke survivors (median (IQR) time post stroke 10.3 (5.4—17.1) months). 243 participants were randomized to standard care (124) or the intervention (119). Intervention: Exercise and education schemes held twice weekly for eight weeks, facilitated by volunteers and qualified exercise instructors (supported by a physiotherapist), each with nine participants plus carers or family members. Method: Participants were assessed by a blinded independent assessor at two weeks before the start of the scheme, nine weeks and six months. One-year follow-up was by postal assessment. Main measures: Primary outcomes: Subjective Index of Physical and Social Outcome (SIPSO); Frenchay Activities Index; Rivermead Mobility Index. NHS, social care and personal costs. Secondary outcomes included WHOQoL-Bref. Analysis: Intention-to-treat basis, using non-parametric analysis to investigate change from baseline. Economic costs were compared in a cost-consequences analysis. Results: There were significant between-group changes in SIPSO physical at nine weeks (median (95% confidence interval (CI)), 1 (0, 2): P = 0.022) and at one year (0 (—1, 2): P = 0.024). (WHOQol-Bref psychological (6.2 (—0.1, 9.1): P = 0.011) at six months. Mean cost per patient was higher in the intervention group. The difference, excluding inpatient care, was £296 (95% CI: —£321 to £913). Conclusion: The community scheme for stroke survivors was a low-cost intervention successful in improving physical integration, maintained at one year, when compared with standard care.

• Publisher: SAGE Publications,Sage Publications Ltd
• Subject: Aged / Assessors / Caregivers / Caregivers - economics / Caregivers - psychology / Clinical trials / Community based / Community centers / Community Health Centers - economics / Community Networks - economics / Community organizations / Community support / Cost analysis / Cost-Benefit Analysis / Costs / Design / Economic change / Education / Educational activities / Exercise / Exercise Therapy - economics / Exercise Therapy - methods / Female / Health care expenditures / Humans / Indexes / Inpatient care / Integrated care / Integrated services / Interpersonal Relations / Intervention / Leisure / Male / Medical personnel / Mobility / Patient Education as Topic - economics / Patient Education as Topic - methods / Patient Satisfaction / Peer tutoring / Physical therapists / Professional ethics / Quality of Life / Randomized controlled trials / Rehabilitation / Relatives / Social services / Social Support / State Medicine - economics / Statistics, Nonparametric / Stroke / Stroke - economics / Stroke Rehabilitation / Strokes / Subjectivity / Survivor / Survivors / Treatment Outcome / United Kingdom / Volunteers