Post-rehabilitation home exercises after stroke and hip fracture: results of a pilot study in Palermo

Abstract

Although most patients having sustained a stroke or hip fracture (PSHF) attend a period of therapy and rehabilitation program, it usually only last a few months and they may not continue an exercise program when the rehabilitation treatment has ended. Many Authors suggests that PSHF can improve or maintain the rehabilitation outcomes through an exercise program. At the geriatric assessment and integrated home-care Unit, Health-District 10, ASP6-Palermo, we enrolled 51 PSHF who were able to collaborate and follow the home exercise program and compared them with 50 PSHF who had been discharged from the same Unit in the period preceding the beginning of the study. The home exercise program was prescribed to the “exercise group” during the last week of the rehabilitation treatment. After a brief training, PSHF carried out their exercise program at home for 3 months without a regular supervision. At the beginning (T1) and the discharge (T2) of the rehabilitative treatment and at the end of the experimentation or after three months (T3), Barthel-Activities-Daily-Living (ADLs) and Barthel-Mobility-Indices were assessed and compared. The outcome was defined as the percent difference between Barthel ADLs and mobility scores at T1 vs. T2, T2 vs. T3 and T1 vs. T3. The differences were assessed by one-way ANOVA. Results showed statistically significant differences between T1 and T2 in the two patient’s groups, but no significant differences between T2 and T3 regardless of the allocation of the patients in the exercise group or not. The home exercise program apparently failed to improve or maintain rehabilitative treatment outcomes. Inconsistencies, poor adherence to the program and poor compliance were among the most likely causative factors. In this field there is much room for a more successful management of the post-rehabilitative period by entrusting planning, customizing and supervising home exercises to sport sciences specialists.