An Exercise Prescription for Patients with Stroke and Sarcopenia Based on the Modified Delphi Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Participants
2.3. Sample Size
2.4. Delphi Process
2.5. Round 1
2.6. Round 2
2.7. Round 3
2.8. Statistical Analysis
3. Results
3.1. Participant Characteristics
3.2. Consensus
3.2.1. Need for Exercise
3.2.2. Priority of Exercise
3.3. Percentage of Strong Agreement
3.4. Kendall’s Coefficient of Concordance
4. Discussion
4.1. General Theme
4.2. Dosage Theme
4.3. Type Theme
4.4. Additional Exercise Theme
4.5. Evaluation Theme
4.6. Overload Themes
4.7. Study Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Participants, n (%) | |
---|---|
Age, yrs, mean (range) | 41.3 (28–59) |
Female sex | 8 (53.3) |
Profession | |
Physician—Physiatrist | 3 (20.0) |
Physician—Neurosurgeon | 1 (6.7) |
Physician—Neurologist | 1 (6.7) |
Therapist—Physical | 3 (20.0) |
Therapist—Occupational | 2 (13.3) |
Nurse—Clinical | 4 (26.6) |
Nurse—Research | 1 (6.7) |
Affiliation | |
University hospital | 10 (66.7) |
Rehabilitation hospital | 5 (33.3) |
Experience period | |
<10 yrs | 2 (13.3) |
10–19 yrs | 8 (53.3) |
≥20 yrs | 5 (33.3) |
Questionnaire about the Need for Exercise | 1st Round | 2nd Round | Final Round | |||||||
Median | IQR | % of Agreement | Median | IQR | % of Agreement | Median | IQR | % of Agreement | ||
1 | Is exercise necessary to treat preexisting sarcopenia with hemiplegic stroke? | 6.00 | 1.00 | 100.00 | 6.00 | 1.00 | 100.00 | 6.00 | 1.00 | 100.00 |
Questionnaire about Exercise Priorities | 1st Round | 2nd Round | Final Round | |||||||
Median | IQR | % of Agreement | Median | IQR | % of Agreement | Median | IQR | % of Agreement | ||
Theme 1—General; Does exercise need to be | ||||||||||
1 | Modified to each patient | 6.00 | 2.00 | 93.33 | 6.00 | 1.50 | 100.00 | 6.00 | 1.00 | 100.00 |
2 | Simple | 6.00 | 0.50 | 93.33 | 6.00 | 0.50 | 93.33 | 6.00 | 0.50 | 100.00 |
3 | Realistic | 6.00 | 1.50 | 93.33 | 6.00 | 0.50 | 93.33 | 6.00 | 0.00 | 93.33 |
4 | An achievable challenge | 6.00 | 3.00 | 66.67 | 6.00 | 1.00 | 80.00 | 6.00 | 0.50 | 86.67 |
5 | Acceptable to the patient | 7.00 | 1.00 | 100.00 | 6.00 | 1.00 | 100.00 | 6.00 | 1.00 | 100.00 |
6 | Appropriately time consuming | 6.00 | 1.00 | 100.00 | 6.00 | 1.00 | 100.00 | 6.00 | 1.00 | 100.00 |
7 | Adhered to by the patient | 7.00 | 1.00 | 100.00 | 7.00 | 1.00 | 100.00 | 7.00 | 1.00 | 100.00 |
8 | Decided in collaboration with the patient | 5.00 | 1.50 | 73.33 | 5.00 | 1.00 | 80.00 | 5.00 | 1.00 | 93.33 |
9 | Decided considering functional status and goals | 7.00 | 1.00 | 100.00 | 7.00 | 0.50 | 100.00 | 7.00 | 0.00 | 100.00 |
10 | Decided to affect neuromuscular performance | 6.00 | 1.50 | 93.33 | 6.00 | 1.00 | 93.33 | 6.00 | 0.50 | 100.00 |
11 | Decided to improve subjective symptoms | 5.00 | 1.50 | 73.33 | 5.00 | 1.00 | 80.00 | 5.00 | 1.00 | 86.67 |
12 | Monitored by the patient | 6.00 | 1.50 | 80.00 | 6.00 | 0.50 | 100.00 | 6.00 | 0.00 | 100.00 |
13 | Adapted to rehabilitation stage | 6.00 | 1.00 | 100.00 | 6.00 | 1.00 | 100.00 | 6.00 | 0.50 | 100.00 |
14 | Taught to the patient in advance | 6.00 | 2.00 | 100.00 | 6.00 | 1.00 | 100.00 | 6.00 | 0.50 | 100.00 |
15 | Decided considering equipment availability | 6.00 | 0.00 | 100.00 | 6.00 | 0.00 | 100.00 | 6.00 | 0.00 | 100.00 |
Theme 2—Exercise dosage | ||||||||||
1 | Frequency | 6.00 | 1.00 | 100.00 | 6.00 | 1.00 | 100.00 | 6.00 | 1.00 | 100.00 |
2 | Intensity of patient’s effort | 6.00 | 0.50 | 93.33 | 6.00 | 1.00 | 100.00 | 6.00 | 0.00 | 100.00 |
3 | Load of objective weight | 6.00 | 1.00 | 93.33 | 6.00 | 1.00 | 100.00 | 6.00 | 1.00 | 100.00 |
4 | Repetitions per set | 6.00 | 1.00 | 100.00 | 6.00 | 0.50 | 100.00 | 6.00 | 0.00 | 100.00 |
5 | Number of Sets | 6.00 | 0.50 | 100.00 | 6.00 | 0.50 | 93.33 | 6.00 | 0.00 | 93.33 |
6 | Exercise duration | 6.00 | 1.00 | 100.00 | 6.00 | 1.00 | 100.00 | 6.00 | 0.50 | 100.00 |
Theme 3—Exercise type | ||||||||||
1 | Exercise sequence (e.g., stretching→strengthening) | 6.00 | 1.50 | 93.33 | 6.00 | 1.50 | 100.00 | 6.00 | 1.50 | 93.33 |
2 | Exercise position (e.g., supine, prone, sitting) | 6.00 | 0.50 | 93.33 | 6.00 | 0.00 | 100.00 | 6.00 | 0.00 | 100.00 |
3 | Target muscle | 6.00 | 1.00 | 100.00 | 6.00 | 1.00 | 100.00 | 6.00 | 1.00 | 100.00 |
4 | Range of movement | 6.00 | 1.00 | 93.33 | 6.00 | 0.00 | 100.00 | 6.00 | 0.00 | 100.00 |
5 | Direction of resistance | 6.00 | 0.50 | 93.33 | 6.00 | 0.00 | 100.00 | 6.00 | 0.00 | 100.00 |
6 | Use of equipment | 6.00 | 1.00 | 93.33 | 6.00 | 1.00 | 93.33 | 6.00 | 1.00 | 86.67 |
7 | Use of weight equipment (e.g., ankle weights) | 5.00 | 1.00 | 93.33 | 5.00 | 1.00 | 86.67 | 5.00 | 0.50 | 80.00 |
8 | Use of elastic equipment (e.g., Thera band) | 5.00 | 1.00 | 93.33 | 5.00 | 1.00 | 86.67 | 5.00 | 0.50 | 86.67 |
9 | Use of balancing equipment (e.g., wall or cane) | 6.00 | 1.00 | 80.00 | 6.00 | 1.00 | 86.67 | 6.00 | 1.00 | 80.00 |
Theme 4—Additional to extremity strengthening exercise | ||||||||||
1 | Aerobic exercise | 6.00 | 1.00 | 93.33 | 6.00 | 1.00 | 100.00 | 6.00 | 0.50 | 100.00 |
2 | Stretching exercise | 6.00 | 1.00 | 93.33 | 6.00 | 1.00 | 100.00 | 6.00 | 1.00 | 100.00 |
3 | Flexibility exercise (e.g., yoga) | 5.00 | 1.50 | 73.33 | 5.00 | 1.00 | 80.00 | 5.00 | 1.00 | 80.00 |
4 | Core muscles exercise (e.g., pilates) | 6.00 | 1.00 | 86.67 | 6.00 | 1.00 | 93.33 | 6.00 | 1.00 | 100.00 |
Theme 5—Evaluation of exercise | ||||||||||
1 | Technique complexity | 6.00 | 1.50 | 73.33 | 5.00 | 1.00 | 100.00 | 5.00 | 1.00 | 93.33 |
2 | Patient effort | 6.00 | 0.00 | 100.00 | 6.00 | 0.00 | 100.00 | 6.00 | 0.00 | 100.00 |
3 | Patient compliance | 6.00 | 0.50 | 100.00 | 6.00 | 0.50 | 100.00 | 6.00 | 0.00 | 100.00 |
4 | Patient pain during exercise | 6.00 | 1.00 | 100.00 | 6.00 | 0.50 | 100.00 | 6.00 | 0.00 | 100.00 |
5 | Patient pain after exercise | 7.00 | 1.00 | 100.00 | 6.00 | 1.00 | 100.00 | 6.00 | 0.50 | 100.00 |
6 | Patient fatigue during exercise | 6.00 | 1.00 | 100.00 | 6.00 | 0.50 | 100.00 | 6.00 | 0.00 | 100.00 |
7 | Patient fatigue after exercise | 6.00 | 1.00 | 100.00 | 6.00 | 1.00 | 100.00 | 6.00 | 0.00 | 100.00 |
Theme 6—Progressive overload | ||||||||||
1 | Does the patient need progressive overload exercise? | 7.00 | 1.00 | 93.33 | 7.00 | 1.00 | 100.00 | 7.00 | 1.00 | 100.00 |
Theme 7—When to overload | ||||||||||
1 | When the patient no longer feels exercise is difficult | 6.00 | 0.50 | 93.33 | 6.00 | 0.50 | 100.00 | 6.00 | 0.00 | 100.00 |
2 | When the patient is not fatigued | 6.00 | 0.00 | 93.33 | 6.00 | 0.00 | 100.00 | 6.00 | 0.00 | 100.00 |
3 | When the patient feels ready | 6.00 | 1.00 | 80.00 | 6.00 | 0.50 | 93.33 | 6.00 | 0.00 | 93.33 |
4 | When the patient achieves functional goals | 6.00 | 1.50 | 93.33 | 6.00 | 1.00 | 100.00 | 6.00 | 0.50 | 100.00 |
5 | When the patient gains improvement of neuromuscular performance | 6.00 | 0.50 | 86.67 | 6.00 | 0.00 | 93.33 | 6.00 | 0.00 | 100.00 |
6 | When symptoms decrease | 5.00 | 1.00 | 80.00 | 5.00 | 1.00 | 86.67 | 5.00 | 1.00 | 93.33 |
Theme 8—How to overload | ||||||||||
1 | Considering patient’s functional activity | 7.00 | 1.00 | 100.00 | 7.00 | 0.50 | 100.00 | 7.00 | 0.00 | 100.00 |
2 | Frequency | 6.00 | 1.00 | 93.33 | 6.00 | 0.50 | 100.00 | 6.00 | 0.50 | 100.00 |
3 | Intensity of patient’s effort | 6.00 | 1.50 | 93.33 | 6.00 | 1.00 | 100.00 | 6.00 | 1.00 | 100.00 |
4 | Load of objective weight | 6.00 | 1.00 | 93.33 | 6.00 | 0.00 | 100.00 | 6.00 | 0.00 | 100.00 |
5 | Repetitions per set | 6.00 | 1.00 | 93.33 | 6.00 | 0.50 | 93.33 | 6.00 | 0.00 | 93.33 |
6 | Number of sets | 6.00 | 0.50 | 93.33 | 6.00 | 1.00 | 86.67 | 6.00 | 0.50 | 93.33 |
7 | Change of exercise position | 6.00 | 1.00 | 93.33 | 6.00 | 1.00 | 100.00 | 6.00 | 0.50 | 100.00 |
8 | Change of range of movement | 6.00 | 1.00 | 100.00 | 6.00 | 0.50 | 100.00 | 6.00 | 0.00 | 100.00 |
9 | Addition of exercise equipment | 5.00 | 1.00 | 86.67 | 5.00 | 1.00 | 100.00 | 5.00 | 1.00 | 100.00 |
1st Round | 2nd Round | Final Round | ||||
---|---|---|---|---|---|---|
% of Agreement | % of Strong Agreement | % of Agreement | % of Strong Agreement | % of Agreement | % of Strong Agreement | |
Theme 1 | ||||||
1 | 93.33 | 66.67 | 100.00 | 73.33 | 100.00 | 80.00 |
2 | 93.33 | 73.33 | 93.33 | 73.33 | 100.00 | 73.33 |
3 | 93.33 | 66.67 | 93.33 | 73.33 | 93.33 | 80.00 |
4 | 66.67 | 66.67 | 80.00 | 66.67 | 86.67 | 73.33 |
5 | 100.00 | 93.33 | 100.00 | 93.33 | 100.00 | 86.67 |
6 | 100.00 | 93.33 | 100.00 | 93.33 | 100.00 | 93.33 |
7 | 100.00 | 80.00 | 100.00 | 86.67 | 100.00 | 93.33 |
8 | 73.33 | 33.33 | 80.00 | 46.67 | 93.33 | 46.67 |
9 | 100.00 | 86.67 | 100.00 | 100.00 | 100.00 | 100.00 |
10 | 93.33 | 73.33 | 93.33 | 73.33 | 100.00 | 80.00 |
11 | 73.33 | 46.67 | 80.00 | 40.00 | 86.67 | 46.67 |
12 | 80.00 | 66.67 | 100.00 | 73.33 | 100.00 | 86.67 |
13 | 100.00 | 93.33 | 100.00 | 93.33 | 100.00 | 93.33 |
14 | 100.00 | 66.67 | 100.00 | 86.67 | 100.00 | 93.33 |
15 | 100.00 | 80.00 | 100.00 | 86.67 | 100.00 | 93.33 |
Theme 2 | ||||||
1 | 100.00 | 93.33 | 100.00 | 100.00 | 100.00 | 100.00 |
2 | 93.33 | 80.00 | 100.00 | 73.33 | 100.00 | 80.00 |
3 | 93.33 | 66.67 | 100.00 | 66.67 | 100.00 | 66.67 |
4 | 100.00 | 80.00 | 100.00 | 86.67 | 100.00 | 86.67 |
5 | 100.00 | 73.33 | 93.33 | 73.33 | 93.33 | 80.00 |
6 | 100.00 | 73.33 | 100.00 | 73.33 | 100.00 | 73.33 |
Theme 3 | ||||||
1 | 93.33 | 66.67 | 100.00 | 66.67 | 93.33 | 60.00 |
2 | 93.33 | 80.00 | 100.00 | 86.67 | 100.00 | 93.33 |
3 | 100.00 | 86.67 | 100.00 | 93.33 | 100.00 | 86.67 |
4 | 93.33 | 93.33 | 100.00 | 93.33 | 100.00 | 93.33 |
5 | 93.33 | 86.67 | 100.00 | 86.67 | 100.00 | 86.67 |
6 | 93.33 | 53.33 | 93.33 | 60.00 | 86.67 | 60.00 |
7 | 93.33 | 33.33 | 86.67 | 40.00 | 80.00 | 26.67 |
8 | 93.33 | 40.00 | 86.67 | 40.00 | 86.67 | 26.67 |
9 | 80.00 | 60.00 | 86.67 | 66.67 | 80.00 | 60.00 |
Theme 4 | ||||||
1 | 93.33 | 60.00 | 100.00 | 66.67 | 100.00 | 73.33 |
2 | 93.33 | 80.00 | 100.00 | 93.33 | 100.00 | 86.67 |
3 | 73.33 | 40.00 | 80.00 | 40.00 | 80.00 | 33.33 |
4 | 86.67 | 60.00 | 93.33 | 66.67 | 100.00 | 66.67 |
Theme 5 | ||||||
1 | 73.33 | 53.33 | 100.00 | 40.00 | 93.33 | 40.00 |
2 | 100.00 | 86.67 | 100.00 | 93.33 | 100.00 | 93.33 |
3 | 100.00 | 93.33 | 100.00 | 93.33 | 100.00 | 93.33 |
4 | 100.00 | 86.67 | 100.00 | 100.00 | 100.00 | 93.33 |
5 | 100.00 | 80.00 | 100.00 | 93.33 | 100.00 | 86.67 |
6 | 100.00 | 93.33 | 100.00 | 93.33 | 100.00 | 86.67 |
7 | 100.00 | 93.33 | 100.00 | 93.33 | 100.00 | 86.67 |
Theme 6 | ||||||
1 | 93.33 | 93.33 | 100.00 | 100.00 | 100.00 | 93.33 |
Theme 7 | ||||||
1 | 93.33 | 80.00 | 100.00 | 86.67 | 100.00 | 93.33 |
2 | 93.33 | 80.00 | 100.00 | 86.67 | 100.00 | 86.67 |
3 | 80.00 | 53.33 | 93.33 | 73.33 | 93.33 | 86.67 |
4 | 93.33 | 73.33 | 100.00 | 86.67 | 100.00 | 86.67 |
5 | 86.67 | 80.00 | 93.33 | 86.67 | 100.00 | 93.33 |
6 | 80.00 | 40.00 | 86.67 | 33.33 | 93.33 | 33.33 |
Theme 8 | ||||||
1 | 100.00 | 80.00 | 100.00 | 100.00 | 100.00 | 100.00 |
2 | 93.33 | 53.33 | 100.00 | 73.33 | 100.00 | 80.00 |
3 | 93.33 | 66.67 | 100.00 | 80.00 | 100.00 | 80.00 |
4 | 93.33 | 66.67 | 100.00 | 80.00 | 100.00 | 80.00 |
5 | 93.33 | 80.00 | 93.33 | 86.67 | 93.33 | 93.33 |
6 | 93.33 | 73.33 | 86.67 | 66.67 | 93.33 | 73.33 |
7 | 93.33 | 60.00 | 100.00 | 66.67 | 100.00 | 73.33 |
8 | 100.00 | 60.00 | 100.00 | 73.33 | 100.00 | 86.67 |
9 | 86.67 | 40.00 | 100.00 | 40.00 | 100.00 | 33.33 |
Final Round | |||||
---|---|---|---|---|---|
N | Kendall W | χ2 | df | p | |
All items in all themes | 15 | 0.319 | 268.094 | 56 | <0.00 1* |
Theme 1—General | 15 | 0.303 | 63.679 | 14 | <0.001 * |
Theme 2—Exercise dosage | 15 | 0.228 | 17.073 | 5 | 0.004 * |
Theme 3—Exercise type | 15 | 0.379 | 45.456 | 8 | <0.001 * |
Theme 4—Additional exercise | 15 | 0.378 | 17.012 | 3 | 0.001 * |
Theme 5—Evaluation of exercise | 15 | 0.394 | 35.486 | 6 | <0.001 * |
Theme 6—Progressive overload | 15 | NA | NA | NA | NA |
Theme 7—When to overload | 15 | 0.311 | 23.296 | 5 | <0.001 * |
Theme 8—How to overload | 15 | 0.391 | 46.860 | 8 | <0.001 * |
Category | Priority |
---|---|
General | Modification/Simplicity/Reality/Achievable challenge/Acceptability/Proper time/Adherence/Collaboration with the patient/Functional status and goals of the patients/Effect on neuromuscular performance of the patient/Improvement of patient symptoms/Patient monitoring/Adaptation of rehabilitation stage/Education about exercise for the patient/Equipment availability |
Dosage | Frequency/Intensity/Load/Repetitions per set/Number of sets/Exercise duration |
Type | Sequence/Position/Target muscle/Range of movement/Direction of resistance/Use of equipment/Use of weight equipment/Use of elastic equipment/Use of balancing equipment |
Additional exercise | Aerobic/Stretching/Flexibility/Core muscle exercise |
Evaluation | Complexity/Effort/Compliance/Pain during exercise/after exercise/Fatigue during exercise/after exercise |
Progressive overload | Need |
When to overload | When the patient feels exercise is not difficult/When the patient is not fatigued/when the patient feels ready/When the patient achieves goals/When the patient gains improved neuromuscular performance/When the patient’s symptoms decrease |
How to overload | Consideration of patient’s function/Frequency/Intensity/Load/Repetitions per set/Number of sets/Change position/Change range of movement/Additional equipment |
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© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Yoo, J.W.; Park, G.-Y.; Park, H.-Y.; Yoo, Y.J.; Yoon, M.-J.; Song, S.; Park, K.H.; Lee, H.; Choi, S.; Im, S.; et al. An Exercise Prescription for Patients with Stroke and Sarcopenia Based on the Modified Delphi Study. Life 2024, 14, 332. https://doi.org/10.3390/life14030332
Yoo JW, Park G-Y, Park H-Y, Yoo YJ, Yoon M-J, Song S, Park KH, Lee H, Choi S, Im S, et al. An Exercise Prescription for Patients with Stroke and Sarcopenia Based on the Modified Delphi Study. Life. 2024; 14(3):332. https://doi.org/10.3390/life14030332
Chicago/Turabian StyleYoo, Jae Wan, Geun-Young Park, Hae-Yeon Park, Yeun Jie Yoo, Mi-Jeong Yoon, SeungYup Song, Kyung Hyun Park, Hooman Lee, Sangui Choi, Sun Im, and et al. 2024. "An Exercise Prescription for Patients with Stroke and Sarcopenia Based on the Modified Delphi Study" Life 14, no. 3: 332. https://doi.org/10.3390/life14030332