Effect of the Rehabilitation Setting on Motivation and Clinical Outcomes Post Stroke – a Pilot Study

ii Background Previous research suggests that the rehabilitation setting can influence both motivation for rehabilitation and adherence to the rehabilitation programme. These two factors are considered important determinants of rehabilitation outcomes. Community rehabilitation is delivered at home or in a clinic, with clinic-based rehabilitation being provided either individually or in a group. Although research has shown that group exercise programmes can positively influence mobility outcomes following stroke, no community-based study has directly compared group and individual rehabilitation programmes using a similar content, to determine the effect on motivation and mobility outcomes. Purpose The purpose of this non-experimental pilot study was to undertake the feasibility work for a future randomised controlled trial (RCT) that would investigate whether the rehabilitation setting influences motivation for rehabilitation and clinical outcomes in patients with stroke. The motivation levels of two groups of participants undergoing community-based rehabilitation following stroke (group clinic-based and individual home-based rehabilitation) were evaluated to provide information about the required sample size for a future RCT. In addition, walking ability and adherence to the rehabilitation programme were compared in the two rehabilitation settings. Methods Sixteen participants, with a primary diagnosis of stroke, and who were referred for rehabilitation to the Community Rehabilitation Team in Wellington, were recruited. Participants completed rehabilitation in either a group clinic-based or individual home-based setting for up to eight weeks. Two motivation questionnaires, the Apathy Evaluation Scale (AES) and the Intrinsic Motivation Inventory (IMI), were administered and the Six Minute Walk Test (6MWT) was measured. Participants completed an exercise adherence diary to measure adherence to the prescribed home exercise programme (HEP), and the treating physiotherapist documented adherence to the rehabilitation sessions. ii