Effect of outpatient cardiac rehabilitation following in-hospital stroke rehabilitation on motor function and health-related quality of life in stroke survivors

Background Outpatient cardiac rehabilitation (CR) is a promising tool for improving functional outcome in stroke survivors, however, evidence for improving emotional health is limited. We aimed to clarify the effects of outpatient CR following in-hospital stroke rehabilitation on health-related quality of life (HRQOL) and motor function. Methods Patients with acute ischemic stroke or transient ischemic attack discharged directly home were recruited, and 128 patients (male, 92, mean age,73.5 years) who fulfilled criteria for insurance coverage of CR were divided into the CR (+) group (n=46) and CR (−) group (n=82). All patients underwent in-hospital stroke rehabilitation, and within 2 months after stroke onset, patients in the CR (+) group started a 3-month outpatient CR program of supervised outpatient sessions (1-3 times/week). Changes of motor function and HRQOL assessed by the short form-36 version 2 (SF-36) from discharge to 3 months post-discharge were compared between the two groups. Results Twenty-six patients in the CR (+) group completed the program and 66 patients in the CR (−) group were followed up at a 3-month examination. Least-square mean changes in 6-minute walk distance and isometric knee extension muscle strength were significantly higher in the CR (+) group than the CR (−) group (52.6 vs. 16.3 m; 10.1 vs. 3.50 kgf/kg). Improvement of HRQOL at 3 months was not observed in the CR (+) group. Conclusions Outpatient CR followed by in-hospital stroke rehabilitation within 2 months after stroke onset improved exercise tolerance and functional strength but not HRQOL after completion of CR.