Walk with Ease to Improve Mobility and Quality of Life in Chronic Stroke Survivors
Carly Laper
I conducted to research study to examine the feasibility and preliminary effects of the Walk with Ease (WWE) program on chronic stroke survivors. I wanted to do this because there is currently not much research about interventions to improve quality of life (QoL) in chronic stroke survivors. Here are my two evidence table that highlight some concerns with QoL in this population and some potential factors impacting QoL:
The WWE program is a community-based exercise program that was developed for people with arthritis. It is a 6 week walking program that can be conducted in a group or self-guided manner. Groups meet 3 times per week and work up to walking for a total of 30 minutes each session. In the self-guided version, participants agree to the same schedule. It comes with a manual that includes topics ranging from physical activity to pain to depression. It also includes stretches, warm-up and cool-down activities and encourages readers to create goals, contracts and a walking diary to help identify motivators and barriers to physical activity.
The WWE program has shown to be beneficial for reducing pain, fatigue and some measures of mobility and quality of life in the arthritis population. I believe that many of these benefits would be attained by the chronic stroke population. Additionally, one main aim of this study was to look at the effects of a group program on quality of life, so the study was only offered in a group format. Unfortunately, that did not happen because of a lack of participants, so no conclusions can be drawn about that.
After completion of the IRB, I began recruiting participants from UNC’s stroke registry and through fliers posted at the Hillsborough PT Clinic and Seymour Center. I had 4 potential participants lined up. Two dropped out before pre-testing due to family or personal health concerns. Two completed the pre-test measures, but one of those dropped out due to time constraints and travel arrangements. I was left with one participant and no time left for more recruiting since I was working on a deadline.
The one participant and I met 3 times per week for 6 weeks at University Mall in Chapel Hill. We did warm-up exercises and stretches and then walked for 30 minutes. After that, we did cool-down exercises.
I then began to start writing a research journal article. Before I began working on the actual article, I did some research to learn how to write a journal article. I found it extremely helpful and referenced this throughout my writing process.
I wrote the WWE research paper, with much help from Dr. Mercer and Dr. Nyrop, and I will try to submit it to GeriNotes in the near future.
To highlight the results and conclusions from the research, no definitive conclusions can be drawn based on the results of this study. The participant made some personal improvements in a few of the mobility measures and demonstrated no change in health-related quality of life. Due to the lack of participants, the results are not generalizable and it is difficult to determine the feasibility of the program for the chronic stroke population. The article highlights problems that arose during the study and provides a few suggestions and alterations to the WWE program that may make it more applicable for the chronic stroke population.
Overall, the participant enjoyed the program and felt that she received some benefit from it. One of her main reasons for joining the study were to meet more people in a similar situation to form new relationships. I was disappointed that I could not do that for her. Other than than, I think the experience was great. We both learned a lot and enjoyed our time together.
5 Responses to “Walk with Ease to Improve Mobility and Quality of Life after Stroke”
Carly Laper
Brandon –
Thanks for you input. Currently the WWE program is being tested on women with breast cancer. A side effect of the medication is joint pain, similar to arthritis, so they are examining the impact. I don’t think anything has been published yet, but preliminary results suggest there may be some benefit.
I do think that the WWE program will have some benefit for the chronic stroke population. It is an alternative to some other community-based programs out there. Some require a longer or more involved time commitment, so this could work for some. This also partially addresses your last question, but the WWE program can also be self-guided. This is a benefit to a large proportion of people to do time constraints or transportation issues. I chose not to do the self-guided version because I wanted to examined the impact of a group on HRQoL.
Time and transportation were the two biggest issues I faced during recruitment. I would suggest making sure you have ample time to recruit and that you have more potential participants than you might need for the study.
Carly
Brandon Hall
Carly,
Great project. I think your efforts to apply programs such as Walk with Ease across populations will greatly benefit your patients in the future. It helped me realize a large part of being a good physical therapist is going beyond the clinic and providing patients with the tools they need to continue rehabilitation after the clinic; such as evidence based community exercise programs. Besides the post stroke population and arthritis population the program is intended for, did the research mention any other populations who may benefit from WWE?
Your paper seemed to stick straight to the facts in the discussion and results section. I feel like, although only one patient completed the study, patients who complete this program will see many benefits in their endurance, strength, emotional health, internal locus of control, and overall quality of life. Although the study could not justify improvements, due to the small sample size, do you think there are any likely benefits which will benefit the post stroke population?
Lastly, it’s unlucky that only one person completed the study. From your experience, do you have any recommendations for me or other therapists on how to recruit individuals for a study and/or not have them quit?
Brandon Hall
Carly Laper
Liz –
I have an extra copy of the book if you would like it.
When I met with participants the first time, we went over the different aspects of the book and I showed them where they could do the different aspects, such as the goal setting, walking diary, warm-up and cool-down exercises and the strengthening exercises. We practiced them just so the participants would have an idea of how to do them on their own.
I’m glad you enjoyed reading my project and I hoped that you learned something from it.
Carly
ewaddell
Carly,
I enjoyed reading about your walking program! Are the WWE books available anywhere? It sounds like a great resource and perhaps one that I could incorporate into a patient’s HEP. I could see it helping encourage a patient to exercise with friends or family members. I also like that it facilitates goal-setting.
What were the strengthening exercises? Did you go over them as part of the walking program or does the participant just try them on their own? I agree with your conclusion that the strength exercises likely contributed to the FTSTS improvement. However, even though the participant walked regularly prior to the intervention I’m sure just walking with you was motivating to walk faster and contributed to the improved gait speed.
Also, I appreciate that you included the description and rationale for the outcome measures. There were a few that I hadn’t used before that I’ll have to check out, especially some of the participation and QoL measures.
Thanks,
Liz
Vicki Mercer
Carly – Very nice job on this project and paper! This was definitely an opportunity to learn about the ups and downs of doing research with human subjects. Glad that you are interested in sharing some of what you’ve learned via an article in GeriNotes! – Vicki