Stroke in Young Adults Outdoor Rehabilitation
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      This research project aims to improve and promote physical activity participation in the
      outdoors and use outdoor walking as a form of long-term rehabilitation for young adults who
      have had a stroke.

      This research is specifically focused on adults of working age (e.g. 18 to 65 years classed
      as young adults) as there is little to no research or rehabilitation programmes for young
      adults who have had a stroke on how best to regain function and independence to return to
      social/leisure activities, employment and education. During this study, The investigators
      will measure how fast a young adult who has had a stroke walks, how much energy they use to
      walk and how their joints move when walking. The investigators will also use questionnaires
      to measure how confident a young adult who has had a stroke is and how they feel when
      outdoors.

      This project could highlight the positive role of exercising in outdoor natural environments
      to promote recovery following stroke in young adults. The investigators predict that an
      outdoor-walking rehabilitation programme could motivate the young stroke population to better
      engage in their rehabilitation, as walking in more challenging environments could facilitate
      an increase in the desire to walk outdoors and confidence.
    

Detailed description: 
      This study is a randomised controlled trial, which will investigate whether an
      outdoor-walking rehabilitation programme can improve walking performance (how efficiently and
      how fast or slow an individual is able to walk) and quality of life of young adults who have
      had a stroke, compared to controls who have had a stroke, who will not be provided with the
      outdoor-walking programme. Forty-six individuals aged between 18 and 65 years, who have had a
      stroke in the last three years, will be recruited to participate in this study. Participants
      will be recruited from 3 health boards in Wales, United Kingdom: Aneurin Bevan University
      Health Board, Swansea Bay University Health Board and Cwm Taf University Health Board.

      For the development of the outdoor-walking rehabilitation programme, the Consensus for
      Exercise Reporting Template (CERT) was followed. The outdoor-walking rehabilitation programme
      will run over 3 months and take place in Wales, United Kingdom. Each week will include
      once-per-week, outdoor-walking instructor-led sessions. The walking routes planned for the
      rehabilitation programme will be detailed in an exercise diary provided to the participant.
      This will include information such as distance, terrain (e.g gravel, tarmac, grass),
      environment (e.g woodland, lowland, moorland), gradient (e.g uphill to downhill ratio, how
      steep/ flat) and perceived level of difficulty.

      The primary outcome measures for this study are walking speed and quality of life. Secondary
      outcomes include metabolic cost and biomechanical function. Outcomes will be measured pre and
      post 3-month rehabilitation data collection. Walking speed and metabolic cost will be
      measured during a 3-minute walking protocol. Quality of life will be measured using the
      standardised Stroke Aphasia Quality of Life (SAQOL), Confidence after stroke measure (CaSM)
      and Nature-relatedness scale (NR). Participants will also be asked to provide three
      difficulties they have experienced post-stroke (e.g difficulty walking) and three aims (e.g
      to go back to work) .

      Biomechanical function will involve analysing joint kinetic and kinematics and measured
      during the biomechanical function protocol. Adherence to the outdoor-walking rehabilitation
      programme will be measured pre, post-rehabilitation and follow-up through the use of the
      exercise diary and questionnaires.

      The results from this project will be used as benchmark data to provide evidence to support
      the role of outdoor rehabilitation in natural outdoor environments and green spaces for
      promoting health and wellbeing of young adults who have had a stroke.
    

Intervention name(s): Intervention: Outdoor Walking Rehabilitation Programme; Control: The light Stretches Programme
Intervention type(s): Other; Other
Intervention description(s): Participants in the intervention group will take part in an instructor led outdoor walking rehabilitation programme which will last for 3 months. Alongside this participants will also be asked to complete a home exercise programme.; Participants in the control group will be asked to keep to their normal activities of daily living, and given 10 targeted active stretches of the upper and lower body.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Participants will be randomly allocated to two groups using blocked randomisation (stratified by site).
Masking: None (Open Label)
Primary purpose: Other
Keywords: Stroke; Stroke Rehabilitation; Outdoor Walking; Walking Performance; Young Adults; Quality of life