Physical activity can have beneficial effects on post-stroke recovery, but only if it is maintained. Current evidence shows that physical activity levels of individuals with stroke do not meet recommended guidelines. This thesis investigated current programs and proposed a novel trial design to aid stroke survivors with maintaining their activity levels in free-living environments. The first study was a systematic review of the effects of current interventions in post-stroke recovery. The review reported no differences between intervention and control groups for steps walked/day at 3-month (standardized mean difference (SMD) 0.19; 95% CI -0.30 to 0.69; I2 = 47%; GRADE rating: Very Low), time spent in moderate-vigorous physical activity at 3-month (SMD -0.03; 95% CI -0.73 to 0.68; I2 = 52%; GRADE rating: Very Low), or self-reported physical activity at the 6-month follow-up (SMD 0.40; 95% CI -0.02 to 0.82; I2 = 0%; GRADE rating: Very Low). However, the pooled estimate of the self-reported physical activity at the 3-month follow-up was above the line of no-effect (SMD 0.22; 95% confidence intervals, 0.01 to 0.42; I2 = 0%; GRADE rating: Very Low). Intervention characteristics associated with physical activity maintenance could not be explored due to the low number of trials. Insights from this review were used to design an Adaptive Treatment Strategy where high-intensity interventions are sequentially tailored to participants following the identification of increased needs. A protocol of a proof-of-concept pilot Sequential Multiple Assignment Randomized Trial was outlined to assess trial feasibility, participants’ acceptability with changes in interventions, participants’ and staffs’ satisfaction with the treatment strategy, and to provide preliminary estimates of effect of physical activity and self-efficacy for physical activity. Together, these two studies provide direction about intervention design, physical activity maintenance assessment, and proposes the design of a novel pilot SMART trial. / Thesis / Master of Science Rehabilitation Science (MSc) / Physical activity can help with recovery after stroke if it is maintained. This thesis examined ways to support stroke survivors with remaining active in their daily lives. The first study was a review of existing programs to investigate their effects on the physical activity levels of individuals with stroke. Findings from this study showed that current programs produced a small improvement in physical activity that was short-lived, and no program component was better than others at promoting activity maintenance. Insights from this review were used to design a new study that provides increased support to stroke survivors in steps to cater to individual needs. This study will investigate whether this program is practical, acceptable by stroke survivors and people delivering it, and helps to improve and maintain physical activity. Together, these studies provide directions for designing future programs, assessing activity maintenance, and propose the design for a novel study.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/26151 |
| Date | January 2021 |
| Creators | Masrur, Muhib |
| Contributors | Richardson, Julie, Rehabilitation Science |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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