A systematic review of measures of adherence to physical exercise recommendations in people with stroke.
Tamina Levy, Kate Laver, Maggie Killington and 2 others
PMID 30458647WHAT IT FOUND
No validated tools exist to measure adherence to exercise after stroke.
Clinicians currently rely on diaries and surveys with no proven accuracy. Do not assume patient-reported completion matches actual performance, as these methods lack evidence of validity.
Key findings
01The review identified seven types of adherence measurement methods used in stroke research, but found no studies reporting their psychometric properties.
02Diaries and logbooks were the most frequently used methods, yet there is no evidence they accurately measure adherence in this population.
03The Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) has some validity data in mixed disability groups, but it was not designed for adherence and lacks stroke-specific validation for this purpose.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The search was limited to English-language publications. Grey literature was not searched. The review excluded objective measures like accelerometers, so it does not assess their validity for adherence (only self-report tools). Most included studies involved community-dwelling participants with mild to moderate impairment, so findings may not apply to patients with severe disability or cognitive issues.
Declared interests
The authors declared no conflicts of interest and received no financial support.
The easy way to misread this
Do not interpret the lack of validated tools as evidence that diaries are useless. The finding is that their accuracy is unknown, not that they are proven inaccurate. However, you cannot assume a patient who records 'completed' actually performed the exercise as prescribed.