Resilience Through Adaptive Recreation in Stroke Survivors: A Biopsychosocial Approach

Nicole Nagata, MOT, OTR/L1, Anne Kirby, PhD, OTR/L1, Jackie Einerson, MOT, OTR/L1, Sarah Giles, BS1,
Gareth Loosle, BS1, Steven Bell, PhD1, Steven Edgley, MD2, Alexandra L. Terrill, PhD1
1Department of Occupational & Recreational Therapies, 2University of Utah Hospital, Physical Medicine and Rehabilitation Department, University of Utah, Salt Lake City, UT, USA

Introduction Figure 1. Main Assessment Outcomes Results

• Although many rehabilitative stroke care advancements have On average, 60% of participants improved on physical
been made, issues such as depression, social isolation, and resilience assessments, and 55% reported improvement
functional impairments persist among survivors. Key - Figure 1 & Table 2
Physical on psychological and social assessments (Figure 1,
• How quickly and effectively a person recovers depends on a Significance <.05 Table 2).
RHR Trend for .05<p<.20
number of factors, including overall health and fitness (physical),
mood and self-efficacy (psychological), and social support and 10MWT Improvement
engagement (social). 2MWT Improvement Table 1. Participant Characteristics
TUG (Non-Significant) Gender, n (%)
• Existing evidence supports positive associations between
adaptive recreation and overall health and well-being, yet limited men 10 (55.56)
research exists examining resilience in stroke survivors women 5 (27.78)
participating in adaptive recreation. no data 3 (16.67)
Age (n=15), mean years (SD)
• We aim to address this gap by examining the effects of adaptive
recreation participation on resilience in this population using a Social 58.67 (12.09)
biopsychosocial model—encompassing physical, Psychological NEURO-QoL SSRA
Time since stroke (n=15), mean years (SD)
psychological, and social aspects of resilience. 9.58 (7.92)
CD-RISC ISEL-12 Tangible
Location of stroke, n (%)
• Resilience is the successful adaptation to adversity and UW-SES ISEL-12 Appraisal
left hemisphere 8 (44.44)
includes both recovery (how quickly and completely people NEURO-QoL PAW ISEL-12 Belongingness
bounce back from a stressor or challenge) and sustainability right hemisphere 6 (33.33)
(the capacity to continue forward in the face of adversity) no data 4 (22.22)
(Zautra, 2009). Participation before study, n (%)
adaptive recreation 15 (83.33)
adaptive cycling 13 (72.27)
Research Objective Table 2. Main Assessment Outcomes
The purpose of this study was to conduct a pilot test Baseline 8-Week
Assessment
to determine feasibility and examine preliminary Mean (SD) Mean (SD) Conclusion
outcome data in a small cohort of stroke survivors. Physical • Findings from this study suggest that this project is feasible for
83.59 73.24 implementation; adjustments will be made for the planned
Resting Heart Rate (RHR)
(18.29) (12.15)
Methods second cohort to strengthen design.
0.750 0.792
Design: Pilot study of an adaptive cycling program with 10 Meter Walk Test (10MWT): velocity
(0.417) (0.422) • Although significant improvements were only found for RHR,
baseline and 8-week-post assessments. preliminary pre-/post-analysis results suggest not only physical
Modified 2-minute Walk Test (2MWT): mean 75.53 75.00
distance in meters (39.92) (39.66) but also psychological and especially social aspects of
Setting: Assessments were completed in-person at resilience may be enhanced through adaptive cycling in stroke
Wasatch Adaptive Sports (WAS), a community-based Timed Up and Go (TUG): mean time in 23.69 22.39
seconds (17.41) (18.85)
survivors.
adaptive recreation program in Utah, and/or in the
Psychological • In particular, Neuro-QoL SSRA, which includes satisfaction with
participants own environment.
29.71 30.28 ability to engage in leisure activities and socializing, seems to
Participants: Participants were recruited through WAS. Connor-Davidson Resilience Scale (CD-RISC) be positively affected.
(3.91) (4.32)
Eighteen adult participants meeting inclusion criteria UW Self-Efficacy Scale (UW-SES)
20.47 20.64 • However, given the small sample size, findings should be
were enrolled in this first of two cohorts: ischemic or (3.96) (3.79) interpreted with caution. Based on post-hoc power analysis, our
hemorrhagic stroke > 6 months ago; able to understand Neurology Quality of Life Positive Affect and 33.50 33.88 sample size should be at least 25 to be adequately powered.
and respond to questions and instructions; chronic Well-being (Neuro-QoL PAW) (5.97) (6.62) • Clinical Implications: This project may enable us to better
impairments from stroke. Social understand the role and potential benefits of participating in
Intervention/Analysis: Participants engaged in an 8- Neurology Quality of Life Satisfaction with Social 21.36 23.47 adaptive recreation post-stroke. Occupational therapists may
Roles and Activities (Neuro-QoL SSRA) (4.34) (4.45) use this information for evidence-based interventions in
week adaptive cycling program. Assessments were
completed at baseline and 8-weeks (see Table 2). Interpersonal Support Evaluation List (ISEL-12) adaptive recreation to promote resilience and quality of life in
• Tangible 12.35 (2.69) 13.14 (2.41) stroke survivors.
Paired sample t-tests were used to compare outcomes
• Appraisal 11.54 (3.18) 12.14 (3.42)
to baseline.
• Belongingness 10.73 (2.59) 11.26 (3.22) In partnership with: Acknowledgement of financial support:
Skaggs Foundation for Research