Original research| Volume 98, ISSUE 3, P434-441, March 2017

Effects of a Self-Exercise Program on Activities of Daily Living in Patients After Acute Stroke

A Propensity Score Analysis Based on the Japan Association of Rehabilitation Database
Published:September 12, 2016DOI:



      To investigate whether self-exercise programs for patients after stroke contribute to improved activities of daily living (ADL) at hospital discharge.


      Retrospective, observational, propensity score (PS)–matched case-control study.


      General hospitals.


      Participants included patients after stroke (N=1560) hospitalized between January 3, 2006, and December 26, 2012, satisfying the following criteria: (1) data on age, sex, duration from stroke to hospital admission, length of stay, FIM score, modified Rankin Scale (mRS) score, Glasgow Coma Scale score, Japan Stroke Scale score, and self-exercise program participation were available; and (2) admitted within 7 days after stroke onset, length of stay was between 7 and 60 days, prestroke mRS score was ≤2, and not discharged because of FIM or mRS exacerbation. A total of 780 PS-matched pairs were selected for each of the self-exercise program and no–self-exercise program groups.


      Self-exercise program participation.

      Main Outcome Measures

      At discharge, FIM motor score, FIM cognitive score, FIM motor score gain (discharge value − admission value), FIM motor score gain rate (gain/length of stay), a binary variable divided by the median FIM motor score gain rate (high efficiency or no–high efficiency), and mRS score.


      Patients were classified into a self-exercise program (n=780) or a no–self-exercise program (n=780) group. After matching, there were no significant between-group differences, except motor system variables. The receiver operating characteristic curve for PS had an area under the curve value of .71 with a 95% confidence interval of .68 to .73, and the model was believed to have a relatively favorable fit. A logistic regression analysis of PS-matched pairs suggested that the self-exercise program was effective, with an overall odds ratio for ADL (high efficiency or no–high efficiency) of 2.2 (95% confidence ratio, 1.75–2.70).


      SEPs may contribute to improving ADL.


      List of abbreviations:

      ADL (activities of daily living), GCS (Glasgow Coma Scale), JSS (Japan Stroke Scale), mRS (modified Rankin Scale), PS (propensity score), RCT (randomized controlled trial)
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        • Langhorne P.
        • Bernhardt J.
        • Kwakkel G.
        Stroke rehabilitation.
        Lancet. 2011; 377: 1693-1702
        • Kawano T.
        • Hatakenaka M.
        • Mihara M.
        • Hattori N.
        • Hino T.
        • Yagura H.
        Neurorehabilitation after stroke.
        Sogo Rehabil. 2011; 39: 1151-1156
        • Dobkin B.H.
        Clinical practice: rehabilitation after stroke.
        N Engl J Med. 2005; 352: 1677-1684
        • Vogel C.H.
        Post-stroke rehabilitation.
        J Am Acad Nurse Pract. 1995; 7: 493-497
        • Kwakkel G.
        • van Peppen R.
        • Wagenaar R.C.
        • et al.
        Effects of augmented exercise therapy time after stroke: a meta-analysis.
        Stroke. 2004; 35: 2529-2539
        • Sugiyama M.
        • Kondo K.
        • Matsumoto D.
        • Tanaka H.
        The relation between walking ability and social support among stroke patients in acute hospital: a research using the data of the rehabilitation patient Databank-Registered from multi-institutions.
        Sogo Rehabil. 2013; 41: 161-169
        • Luker J.
        • Lynch E.
        • Bernhardsson S.
        • Bennett L.
        • Bernhardt J.
        Stroke survivors' experiences of physical rehabilitation: a systematic review of qualitative studies.
        Arch Phys Med Rehabil. 2015; 96: 1698-1708.e10
        • Maeshima S.
        • Ueyoshi A.
        • Osawa A.
        • et al.
        Mobility and muscle strength contralateral to hemiplegia from stroke: benefit from self-training with family support.
        Am J Phys Med Rehabil. 2003; 82: 456-462
        • Galvin R.
        • Cusack T.
        • O'Grady E.
        • Murphy T.B.
        • Stokes E.
        Family-mediated exercise intervention (FAME): evaluation of a novel form of exercise delivery after stroke.
        Stroke. 2011; 42: 681-686
        • Shiraishi N.
        • Suzuki Y.
        • Matsumoto D.
        • et al.
        The effect of additional training on motor outcomes at discharge from recovery phase rehabilitation wards: a survey from multi-center stroke data Bank in Japan.
        PLoS One. 2014; 9: e91738
        • Quinn T.J.
        • Paolucci S.
        • Sunnerhagen K.S.
        • et al.
        • European Stroke Organisation (ESO) Executive Committee
        • ESO Writing Committee
        Evidence-based stroke rehabilitation: an expanded guidance document from the European Stroke Organisation (ESO) guidelines for management of ischaemic stroke and transient ischaemic attack 2008.
        J Rehabil Med. 2009; 41: 99-111
        • Kondo K.
        • Yamaguchi A.
        The potential and challenges of large databanks toward EBM.
        Sogo Rehabil. 2005; 33: 1119-1124
        • Murray P.K.
        • Singer M.
        • Dawson N.V.
        • Thomas C.L.
        • Cebul R.D.
        Outcomes of rehabilitation services for nursing home residents.
        Arch Phys Med Rehabil. 2003; 84: 1129-1136
        • Momosaki R.
        • Abo M.
        • Watanabe S.
        • Kakuda W.
        • Yamada N.
        • Kinoshita S.
        Effects of ankle-foot orthoses on functional recovery after stroke: a propensity score analysis based on Japan rehabilitation database.
        PLoS One. 2015; 10: e0122688
        • Rosenbaum P.R.
        • Rubin D.B.
        The central role of the propensity score in observational studies for causal effects.
        Biometrika. 1983; 70: 41-55
        • Luk J.K.
        • Cheung R.T.
        • Ho S.L.
        • Li L.
        Does age predict outcome in stroke rehabilitation? A study of 878 Chinese subjects.
        Cerebrovasc Dis. 2006; 21: 229-234
        • Kwakkel G.
        • Wagenaar R.C.
        • Kollen B.J.
        • Lankhorst G.J.
        Predicting disability in stroke—a critical review of the literature.
        Age Ageing. 1996; 25: 479-489
        • Hendricks H.T.
        • van Limbeek J.
        • Geurts A.C.
        • Zwarts M.J.
        Motor recovery after stroke: a systematic review of the literature.
        Arch Phys Med Rehabil. 2002; 83: 1629-1637
        • Rabadi M.H.
        Review of the randomized clinical stroke rehabilitation trials in 2009.
        Med Sci Monit. 2011; 17: RA25-RA43
        • Indredavik B.
        • Bakke F.
        • Slørdahl S.A.
        • Rokseth R.
        • Håheim L.L.
        Stroke unit treatment: 10-year follow-up.
        Stroke. 1999; 30: 1524-1527