title: Impact of adapted physical activity and therapeutic patient education on functioning and quality of life in patients with postacute strokes.
abstract: OBJECTIVE
  The aim of this study was to assess whether the combination of Adapted Physical Activity (APA) and Therapeutic Patient Education (TPE) improves function and quality of life in survivors of strokes.
  
  
  METHODS
  This nonrandomized controlled study enrolled patients with mild to moderate hemiparesis referred to 2 physical medicine and rehabilitation units in Emilia-Romagna, Italy, 3 to 18 months after a single unilateral mild to moderate stroke. The experimental group (n = 126) received 16 APA sessions and 3 sessions of TPE, and the control group (n = 103) received usual care; 86.9% completed treatment. The main outcome measure was a 4-month change in gait endurance (that corresponds to 2 months after intervention in the experimental group), and secondary outcomes included the Short Physical Performance Battery, Berg Balance Scale, Barthel Index, Geriatric Depression Scale, 12-item Short-Form Health Survey, and Caregiver Strain Index. Changes in scores at 4 months were compared between groups using analysis of variance and controlling for group imbalance by means of the propensity score.
  
  
  RESULTS
  Gait endurance, physical performance, balance, and the physical component of the quality of life score increased significantly at 4 months in the APA group and remained stable in the control group. The propensity-adjusted between-group change was significant for these scores at P < .01.
  
  
  CONCLUSIONS
  Our results confirm that it is feasible and potentially effective to implement APA programs for elderly patients with complex clinical conditions as early as 3 months after a stroke and suggest that, when combined with TPE, the effects of a postrehabilitation APA program are relatively enduring.
authors.affiliation: University Hospital Policlinico Sant'Orsola Malpighi, Bologna, Italy.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Taricco
authors.affiliation: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy laura.dallolio@unibo.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Dallolio
authors.affiliation: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Calugi
authors.affiliation: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Rucci
authors.affiliation: Istituto di Ricerca e Cura a Carattere Scientifico - Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Fugazzaro
authors.affiliation: Health Administration and Policy Program, Baltimore County, Maryland, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Stuart
authors.affiliation: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pillastrini
authors.affiliation: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Fantini
mesh_terms: D000208:Acute Disease; D000368:Aged; D003131:Combined Modality Therapy; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D010291:Paresis / Q000534:rehabilitation; D010353:Patient Education as Topic; D011446:Prospective Studies; D011788:Quality of Life; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome
keywords: exercise; patient education; physical activity; rehabilitation; stroke