Purpose: The 5A (Ask, Advise, Assist, Arrange and Agree) protocol is a behavior counseling technique which may improve patients' adherence to health promoting behavior. This study aimed to investigate the effects of utilizing the 5A protocol on the adherence of home rehabilitation program and on motor function recovery in stroke patients. Method: This was a randomized, controlled, double-blind clinical trial. Eighteen subacute stroke in-patients (average age: 60.8 y/o; male/female=13/5) were recruited and randomly assigned into the Adherence Enhancement (AE) group or the Conventional Home Program (CHP) group. Both groups received home exercise instructions and demonstrative sheets before discharge from the rehabilitation ward. Only the AE group instructed based on the 5A Behavior Intervention Protocol and used self-reports of daily activity diary and pedometer while walking as enhancers for 4 weeks. The outcome measurements included the 10-meter walking test (10MWT), the Functional Ambulation Category (FAC), the Berg Balance Scale (BBS), the daily activity diary, and the Specific Home Exercise Checklist between the two groups at the end of the 4th week post discharge. Follow-up was scheduled during the 12th week post discharge. Results: There were no significant differences on the parameters of basic data, except the hemiplegic side. The AE group subjects exhibited better adherence in some of self-reported of daily activity diary such as flexibility exercise (AE=211%; CHP=90%) and balance exercise (AE=38%; CHP=15%) at 4th week, but not at 12th week after discharge. Both groups improved significantly on 10MWT and BBS (p<0.001) at both 4th and 12th weeks after discharge. The AE group subjects exhibited better performance in the 10MWT and FAC than the CHP group subjects (p<0.05) at follow up. However, the groups did not differ significantly on the BBS, Physical Activity Scale for Individuals with Physical Disability, and Specific Home Exercise checklist. Conclusion: Stroke patients with enhanced intervention program on the adherence of home rehabilitation program exhibited better adherence in some of the home program exercise, and better performance in gait speed and community walking ability than the patients who did not receive the intervention program. Therefore, we can conclude that there are some effects of an enhanced intervention program on the adherence of home rehabilitation program in stroke patients. It is suggested that the 5A protocol be adopted by physical therapists for home exercise instructions of stroke patients.
Purpose: The 5A (Ask, Advise, Assist, Arrange and Agree) protocol is a behavior counseling technique which may improve patients' adherence to health promoting behavior. This study aimed to investigate the effects of utilizing the 5A protocol on the adherence of home rehabilitation program and on motor function recovery in stroke patients. Method: This was a randomized, controlled, double-blind clinical trial. Eighteen subacute stroke in-patients (average age: 60.8 y/o; male/female=13/5) were recruited and randomly assigned into the Adherence Enhancement (AE) group or the Conventional Home Program (CHP) group. Both groups received home exercise instructions and demonstrative sheets before discharge from the rehabilitation ward. Only the AE group instructed based on the 5A Behavior Intervention Protocol and used self-reports of daily activity diary and pedometer while walking as enhancers for 4 weeks. The outcome measurements included the 10-meter walking test (10MWT), the Functional Ambulation Category (FAC), the Berg Balance Scale (BBS), the daily activity diary, and the Specific Home Exercise Checklist between the two groups at the end of the 4th week post discharge. Follow-up was scheduled during the 12th week post discharge. Results: There were no significant differences on the parameters of basic data, except the hemiplegic side. The AE group subjects exhibited better adherence in some of self-reported of daily activity diary such as flexibility exercise (AE=211%; CHP=90%) and balance exercise (AE=38%; CHP=15%) at 4th week, but not at 12th week after discharge. Both groups improved significantly on 10MWT and BBS (p<0.001) at both 4th and 12th weeks after discharge. The AE group subjects exhibited better performance in the 10MWT and FAC than the CHP group subjects (p<0.05) at follow up. However, the groups did not differ significantly on the BBS, Physical Activity Scale for Individuals with Physical Disability, and Specific Home Exercise checklist. Conclusion: Stroke patients with enhanced intervention program on the adherence of home rehabilitation program exhibited better adherence in some of the home program exercise, and better performance in gait speed and community walking ability than the patients who did not receive the intervention program. Therefore, we can conclude that there are some effects of an enhanced intervention program on the adherence of home rehabilitation program in stroke patients. It is suggested that the 5A protocol be adopted by physical therapists for home exercise instructions of stroke patients.