BackgroundStroke rehabilitation is vital in improving mobility, achieving functional independence, and enhancing psychological health. However, sticking to rehabilitation programs is a significant hurdle, especially in low- and middle-income nations like India. Poor adherence is associated with delayed recovery, more significant disability, and an increased likelihood of secondary issues. Although a growing body of evidence highlights the significance of rehabilitation adherence, research on its effects in the Indian context remains limited. This study aims to assess the connection between adherence to rehabilitation and functional recovery outcomes in stroke survivors. It specifically investigates how adherence influences mobility enhancements (Functional Mobility Scale, Timed Up, and Go Test), independence in daily activities (Barthel Index), and psychological well-being (PHQ-9 Depression Scale). MethodsA prospective cohort study was conducted at Index Medical College, Hospital & Research Center, involving 200 individuals who had survived a stroke. The participants were categorized into two groups: High-Adherence Group (80% or more adherence, n = 100). Low-Adherence Group (adherence below 80%, n = 100). Adherence to rehabilitation was monitored through digital attendance records, patient rehabilitation journals, and weekly follow-ups by nurses. Functional mobility, independence in activities of daily living (ADL), and psychological well-being were assessed at baseline (Week 0), Week 12, and Week 24. ResultsFunctional Mobility: Higher adherence levels were significantly associated with enhanced mobility improvements (FMS: 4.38 ± 0.45 compared to 3.10 ± 0.51, p < 0.001; TUG: 11.9 ± 2.1 seconds versus 16.5 ± 2.8 seconds, p < 0.001). ADL Independence: By the 24th week, individuals with high adherence exhibited a 24% increase in Barthel Index scores (84.1 ± 10.2 as opposed to 67.5 ± 9.4, p < 0.001). Psychological Well-Being: Greater adherence correlated with a 48% more substantial reduction in PHQ-9 depression scores (4.8 ± 1.9 compared to 9.2 ± 2.7, p < 0.001). Multivariate Regression Analysis: Adherence to rehabilitation emerged as the most significant predictor of functional recovery (β = +4.5, p < 0.001). ConclusionStroke survivors who closely follow rehabilitation nursing interventions tend to experience enhanced mobility, increased independence in activities of daily living (ADL), and better psychological health. Since adherence is the most significant factor in recovery, hospitals are encouraged to implement nursing-led adherence initiatives and utilize digital tools for tracking adherence to boost patient involvement. Future studies should investigate the long-term impacts, explore telerehabilitation approaches, and consider gender-specific adherence methods to improve stroke recovery results further.

Keywords Stroke Rehabilitation, Adherence, Nursing Interventions, Functional Mobility, Barthel Index, Depression, India

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1. WHO Stroke Fact Sheet. Global burden of stroke and rehabilitation challenges. WHO Report.
2. Winstein CJ, Stein J, Arena R, et al. Guidelines for adult stroke rehabilitation and recovery: AHA/ASA scientific statement. 2016;47(6):e98-169.
3. Kwakkel G, Kollen BJ, Wagenaar RC. Long-term effects of intensity of arm training in stroke rehabilitation: A randomized trial. 2002;33(2):599-606.
4. Hakkennes S, Brock K, Hill K, et al. Adherence to stroke rehabilitation: A systematic review. J Rehabil Med.2020;52(4):361-368.
5. Bernhardt J, Hayward KS, Kwakkel G, et al. A new definition for stroke recovery and adherence: Findings from the Stroke Recovery and Rehabilitation Roundtable. Int J Stroke. 2017;12(5):444-450.
6. Hackett ML, Pickles K. Psychological barriers to rehabilitation adherence after stroke: Systematic review and meta-analysis. Int J Stroke. 2014;9(8):1017-1025.
7. Cramer SC, Nudo RJ. Rehabilitation adherence and brain plasticity after stroke. Neurorehabil Neural Repair.2010;24(6):506-514.
8. Barker-Collo S, Feigin VL, Parag V, Lawes CM, Senior H. Barriers to stroke rehabilitation adherence in low-resource settings: A qualitative study. 2015;41(10):2317-2323.
9. Langhorne P, Stott DJ, Robertson L, MacDonald J, Jones L, McAlpine C, et al. Predictors of stroke rehabilitation adherence and long-term functional outcomes. 2017;31(6):1223-1229.
10. Cumming TB, Thrift AG, Collier JM, Churilov L, Dewey HM, Donnan GA. The relationship between rehabilitation adherence and functional mobility recovery in stroke survivors. 2020;51(7):1843-1850.
11. Mehrholz J, Pohl M, Platz T, Kugler J, Elsner B. Strategies to improve stroke rehabilitation adherence: A Cochrane systematic review. Cochrane Database Syst Rev. 2018;7(7):CD002840.
12. Winstein CJ, Wolf SL, Dromerick AW, et al. Effect of rehabilitation adherence programs on upper extremity recovery following stroke: The ICARE randomized clinical trial. JAMA Neurol. 2016;76(6):930-939.
13. Pandian JD, William AG, Kate MP, et al. Stroke rehabilitation adherence programs: Strategies to improve compliance. Neurorehabil Neural Repair. 2020;53(1):55-68.
14. Prabhakaran S, Ruff I, Bernstein RA. Stroke rehabilitation and adherence in underserved populations: A systematic review. JAMA Neurol. 2015;72(2):202-208.
15. Indian Council of Medical Research (ICMR). National stroke rehabilitation guidelines for India: Adherence framework. ICMR Report.
16. Wang Y, Xie CL, Lu L, et al. Factors influencing rehabilitation adherence among stroke survivors: A prospective cohort study. BMC Neurol. 2019;19(1):67-75.
17. Jones F, Riazi A. Self-management of stroke rehabilitation: Adherence trends and impact on outcomes. Neurorehabil Neural Repair. 2011;25(1):20-26.
18. Bernhardt J, Godecke E, Johnson L, et al. Early rehabilitation adherence in stroke: An update on research gaps and future directions. Neurorehabil Neural Repair. 2019;33(11):899-912.
19. Zheng C, Xia R, Zhou X. Barriers to rehabilitation adherence in post-stroke patients: A mixed-methods study. Arch Phys Med Rehabil. 2021;102(5):859-868.
20. Johnston MV, Graves DE. Stroke rehabilitation adherence models: A systematic review. Am J Phys Med Rehabil. 2006;85(10):852-860.

BackgroundStroke rehabilitation is vital in improving mobility, achieving functional independence, and enhancing psychological health. However, sticking to rehabilitation programs is a significant hurdle, especially in low- and middle-income nations like India. Poor adherence is associated with delayed recovery, more significant disability, and an increased likelihood of secondary issues. Although a growing body of evidence highlights the significance of rehabilitation adherence, research on its effects in the Indian context remains limited. This study aims to assess the connection between adherence to rehabilitation and functional recovery outcomes in stroke survivors. It specifically investigates how adherence influences mobility enhancements (Functional Mobility Scale, Timed Up, and Go Test), independence in daily activities (Barthel Index), and psychological well-being (PHQ-9 Depression Scale). MethodsA prospective cohort study was conducted at Index Medical College, Hospital & Research Center, involving 200 individuals who had survived a stroke. The participants were categorized into two groups: High-Adherence Group (80% or more adherence, n = 100). Low-Adherence Group (adherence below 80%, n = 100). Adherence to rehabilitation was monitored through digital attendance records, patient rehabilitation journals, and weekly follow-ups by nurses. Functional mobility, independence in activities of daily living (ADL), and psychological well-being were assessed at baseline (Week 0), Week 12, and Week 24. ResultsFunctional Mobility: Higher adherence levels were significantly associated with enhanced mobility improvements (FMS: 4.38 ± 0.45 compared to 3.10 ± 0.51, p < 0.001; TUG: 11.9 ± 2.1 seconds versus 16.5 ± 2.8 seconds, p < 0.001). ADL Independence: By the 24th week, individuals with high adherence exhibited a 24% increase in Barthel Index scores (84.1 ± 10.2 as opposed to 67.5 ± 9.4, p < 0.001). Psychological Well-Being: Greater adherence correlated with a 48% more substantial reduction in PHQ-9 depression scores (4.8 ± 1.9 compared to 9.2 ± 2.7, p < 0.001). Multivariate Regression Analysis: Adherence to rehabilitation emerged as the most significant predictor of functional recovery (β = +4.5, p < 0.001). ConclusionStroke survivors who closely follow rehabilitation nursing interventions tend to experience enhanced mobility, increased independence in activities of daily living (ADL), and better psychological health. Since adherence is the most significant factor in recovery, hospitals are encouraged to implement nursing-led adherence initiatives and utilize digital tools for tracking adherence to boost patient involvement. Future studies should investigate the long-term impacts, explore telerehabilitation approaches, and consider gender-specific adherence methods to improve stroke recovery results further.

Keywords Stroke Rehabilitation, Adherence, Nursing Interventions, Functional Mobility, Barthel Index, Depression, India

🔒 This is a subscription article

Full text is available to subscribers and institutional members. Please choose an option below to access it.

1. WHO Stroke Fact Sheet. Global burden of stroke and rehabilitation challenges. WHO Report.
2. Winstein CJ, Stein J, Arena R, et al. Guidelines for adult stroke rehabilitation and recovery: AHA/ASA scientific statement. 2016;47(6):e98-169.
3. Kwakkel G, Kollen BJ, Wagenaar RC. Long-term effects of intensity of arm training in stroke rehabilitation: A randomized trial. 2002;33(2):599-606.
4. Hakkennes S, Brock K, Hill K, et al. Adherence to stroke rehabilitation: A systematic review. J Rehabil Med.2020;52(4):361-368.
5. Bernhardt J, Hayward KS, Kwakkel G, et al. A new definition for stroke recovery and adherence: Findings from the Stroke Recovery and Rehabilitation Roundtable. Int J Stroke. 2017;12(5):444-450.
6. Hackett ML, Pickles K. Psychological barriers to rehabilitation adherence after stroke: Systematic review and meta-analysis. Int J Stroke. 2014;9(8):1017-1025.
7. Cramer SC, Nudo RJ. Rehabilitation adherence and brain plasticity after stroke. Neurorehabil Neural Repair.2010;24(6):506-514.
8. Barker-Collo S, Feigin VL, Parag V, Lawes CM, Senior H. Barriers to stroke rehabilitation adherence in low-resource settings: A qualitative study. 2015;41(10):2317-2323.
9. Langhorne P, Stott DJ, Robertson L, MacDonald J, Jones L, McAlpine C, et al. Predictors of stroke rehabilitation adherence and long-term functional outcomes. 2017;31(6):1223-1229.
10. Cumming TB, Thrift AG, Collier JM, Churilov L, Dewey HM, Donnan GA. The relationship between rehabilitation adherence and functional mobility recovery in stroke survivors. 2020;51(7):1843-1850.
11. Mehrholz J, Pohl M, Platz T, Kugler J, Elsner B. Strategies to improve stroke rehabilitation adherence: A Cochrane systematic review. Cochrane Database Syst Rev. 2018;7(7):CD002840.
12. Winstein CJ, Wolf SL, Dromerick AW, et al. Effect of rehabilitation adherence programs on upper extremity recovery following stroke: The ICARE randomized clinical trial. JAMA Neurol. 2016;76(6):930-939.
13. Pandian JD, William AG, Kate MP, et al. Stroke rehabilitation adherence programs: Strategies to improve compliance. Neurorehabil Neural Repair. 2020;53(1):55-68.
14. Prabhakaran S, Ruff I, Bernstein RA. Stroke rehabilitation and adherence in underserved populations: A systematic review. JAMA Neurol. 2015;72(2):202-208.
15. Indian Council of Medical Research (ICMR). National stroke rehabilitation guidelines for India: Adherence framework. ICMR Report.
16. Wang Y, Xie CL, Lu L, et al. Factors influencing rehabilitation adherence among stroke survivors: A prospective cohort study. BMC Neurol. 2019;19(1):67-75.
17. Jones F, Riazi A. Self-management of stroke rehabilitation: Adherence trends and impact on outcomes. Neurorehabil Neural Repair. 2011;25(1):20-26.
18. Bernhardt J, Godecke E, Johnson L, et al. Early rehabilitation adherence in stroke: An update on research gaps and future directions. Neurorehabil Neural Repair. 2019;33(11):899-912.
19. Zheng C, Xia R, Zhou X. Barriers to rehabilitation adherence in post-stroke patients: A mixed-methods study. Arch Phys Med Rehabil. 2021;102(5):859-868.
20. Johnston MV, Graves DE. Stroke rehabilitation adherence models: A systematic review. Am J Phys Med Rehabil. 2006;85(10):852-860.