Date Presented 04/05/19
Stroke leads to high levels of sedentary behavior and may be associated with risk for recurrent stroke. The ABLE intervention was developed to reduce sedentary behavior by promoting engagement in meaningful occupations using a behavioral activation framework. This study examined the feasibility of the ABLE intervention among people with chronic stroke.
Primary Author and Speaker: Emily Kringle
Contributing Authors: Grace Campbell, Michael McCue, Bethany Barone Gibbs, Lauren Terhorst, Elizabeth Skidmore
PURPOSE: High levels of sedentary behavior (i.e., prolonged sitting time) and low levels of physical activity are prevalent among the 7.2 million Americans with stroke and contribute to elevated risk for recurrent stroke (Billinger, et al., 2014; Tieges, et al., 2015). Barriers to physical activity after stroke include transportation, stroke-related impairments (e.g., motor, cognition), and health concerns (Nicholson, et al., 2013). The ABLE intervention aims to reduce sedentary behavior using activity monitoring, activity scheduling, problem solving, and intrinsic sensing to promote engagement in stroke survivors’ meaningful occupations and activities. These activities may not require transportation and may be safely completed despite stroke-related impairments and health concerns. The purpose of this study was to assess feasibility of the ABLE intervention protocol (tolerability, acceptability, safety, reliability) in chronic stroke.
DESIGN: We used a descriptive case series (n=5) to test feasibility of the ABLE intervention protocol. We included participants 6 months to 2 years post-stroke who were ambulatory and reported at least 6 hours of sitting time per day. We excluded participants currently receiving occupational, physical, or speech therapy; cancer treatment; and those with neurodegenerative comorbidities.
METHODS: The ABLE intervention was conducted by an occupational therapist in participants’ homes (12 sessions in total). Tolerability (session attendance), acceptability (Client Satisfaction Questionnaire-8, CSQ), safety (adverse events), and reliability (fidelity checklist) were described and examined against benchmarks established a priori. We also assessed expectations for this intervention using the Healing Encounters and Attitudes Lists Treatment Expectancy Short Form (HEAL-TE). Acceptability, reliability, and expectations for treatment were assessed by an independent assessor.
RESULTS: The benchmark for tolerability (≥90% attendance) was met for 5 participants (range 92-100%) The benchmark for acceptability (CSQ score≥28.8) was met for 3 participants (CSQ range 25-32). The benchmark for safety was met for 5 participants (no intervention-related falls or adverse events were reported). The benchmark for reliability (activity monitoring, activity scheduling, problem solving, and intrinsic sensing present in ≥90% of sampled intervention sessions) was met for 3 participants (range 62.5-100.0%). Participants reported positive expectations for the intervention to be successful (HEAL-TE, T-score range 50.9 to 70.8).
CONCLUSIONS: The ABLE intervention was tolerable and safe for people with chronic stroke. Three participants met all feasibility benchmarks. The intervention structure was modified after the first participant completed intervention, to support satisfaction and reliability of the intervention. One additional participant did not meet satisfaction and reliability benchmarks, possibly due to low need for the intervention (low sedentary behavior on device-based assessment despite greater than 6 hours self-reported sedentary behavior on study admission). Future studies are required to establish efficacy of the ABLE intervention for sedentary behavior and physical activity outcomes.
IMPACT STATEMENT: Engaging in meaningful occupations post-stroke may play a role in reducing sedentary behavior and optimizing stroke survivors’ health (e.g., cardiometabolic health, Dunstan, et al., 2012). Establishing the feasibility of the ABLE intervention is an important step toward future intervention development to promote health among stroke survivors.
RESEARCH/GRANT SUPPORT: University of Pittsburgh School of Health and Rehabilitation Sciences PhD Student Award.
References
Billinger, S. A., Arena, R., Bernhardt, J., Eng, J. J., Franklin, B. A., Johnson, C. M., ... & Shaughnessy, M. (2014). Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 45(8), 2532-2553. DOI: 10.1161/STR.0000000000000022
Dunstan, D. W., Kingwell, B. A., Larsen, R., Healy, G. N., Cerin, E., Hamilton, M. T., ... & Owen, N. (2012). Breaking up prolonged sitting reduces postprandial glucose and insulin responses. Diabetes care, 35(5), 976-983. DOI: 10.2337/dc11-1931
Nicholson, S., Sniehotta, F. F., Wijck, F., Greig, C. A., Johnston, M., McMurdo, M. E., ... & Mead, G. E. (2013). A systematic review of perceived barriers and motivators to physical activity after stroke. International Journal of Stroke, 8(5), 357-364. DOI: 10.1111/j.1747-4949.2012.00880.x
Tieges, Z., Mead, G., Allerhand, M., Duncan, F., Van Wijck, F., Fitzsimons, C., ... & Chastin, S. (2015). Sedentary behavior in the first year after stroke: a longitudinal cohort study with objective measures. Archives of physical medicine and rehabilitation, 96(1), 15-23. DOI: 10.1016/j.apmr.2014.08.015
