Date Presented 4/9/2016
Community reintegration and activity constraints significantly improved for people with chronic stroke after an 8-wk intervention combining yoga and group occupational therapy (OT) for fall risk management. Occupational therapists may wish to add yoga and group OT to community or hospital settings to improve similar outcomes.
Primary Author and Speaker: Ruby Bolster
Additional Authors and Speakers: Arlene A. Schmid
Contributing Authors: Katie M. Hinsey, Leslie A. Willis, Chloe E. Philips, Marieke Van Puymbroeck
PURPOSE: The purpose of this study was to assess the impact of an 8-wk yoga and group occupational therapy (OT) intervention (MY–OT) on perceived activity constraints and community reintegration among individuals with chronic stroke. We also assessed the correlation between activity constraints and community reintegration in the sample of people with chronic stroke.
RATIONALE: People with stroke commonly demonstrate increased activity constraints, or perceived constraints to engaging in activities, as well as decreased community integration. Both of these variables are important to poststroke quality of life and recovery.
DESIGN: The study was a noncontrolled pilot study with a traditional pretest–posttest design.
PARTICIPANTS: Fourteen people with stroke were included in the study. Inclusion criteria included stroke > 6 mo ago; >59 yr old; history of a fall or fear of falling; completion of stroke rehabilitation; ability to stand with or without assistive device; impaired balance with a score of <46 on the Berg Balance Scale; ability to speak English; score >4 out of 6 on the short Mini-Mental State Examination; ability to attend twice weekly sessions for 8 wk.
METHOD: The intervention occurred twice a week for 2 hr, with 1 hr of group OT and 1 hr of yoga. The OT sessions focused on fall risk factor management, and yoga sessions included yoga breathing, relaxation, and modified yoga postures in seated, standing, and supine positions. Assessments were completed at baseline and at the completion of the 8-wk intervention. The Reintegration to Normal Living Index (RNLI) was used to examine social reintegration, and an established activity constraints questionnaire was administered to assess perceived barriers to engaging in physical activity.
ANALYSIS: We used paired-samples t tests (or Wilcoxon for nonparametric analyses) to compare baseline and 8-wk data for each variable. We also calculated percentage of change for each variable. Correlations were examined between perceived activity constraints and community reintegration.
RESULTS: On average, participants were 72.6 yr old, were >5 yr poststroke (71.4%), and had some college education (86%). There was an equal number of female and male participants and they attended 13.2/15 MY–OT sessions on average. Activity constraint scores improved significantly (76.82 vs. 87.55, p = .001, 14% increase), as did average RNLI scores (79.25 vs. 97.92, p = .001, 24% increase). Additionally, activity constraints and RNLI showed excellent correlation (r = .812, p = .001).
DISCUSSION: Findings suggest that activity constraints and community reintegration significantly improved after 8 wk of merged yoga and group OT for individuals with chronic stroke. These changes may relate to participants engaging in yoga as a new leisure activity or occupation, finding new social roles with the group yoga, and developing self-efficacy related to engagement in new activities. Further research is warranted, because these findings are preliminary.
IMPACT STATEMENT: These findings should be of interest to occupational therapists who value occupation-based interventions. This intervention allowed participants to use yoga as a means to promote self-efficacy related to activity engagement and community integration and to also develop skills in a new occupation (yoga). Occupational therapists can integrate yoga and group OT to their practice to achieve similar outcomes.
