FEASIBILITY AND OUTCOMES OF AUTOGENIC RELAXATION TRAINING IN ADDITION TO USUAL PHYSIOTHERAPY FOR STROKE SURVIVORS – A PILOT STUDY

  • Deepak Thazhakkattu Vasu Center for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur.
  • Nor Azlin Mohd Nordin Center for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur.
  • See Xiao Xu Center for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur.
  • Shazli Ezzat Ghazali Center for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur.
  • Siti Norfadilah Abu Zarim Physiotherapy Unit, Department of Medical Rehabilitation Services, Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur.
Keywords: autogenic relaxation training, physiotherapy, stroke, functional ability, quality of life

Abstract

A significant percentage of stroke survivors are reported to have anxiety and depression.  Autogenic Relaxation Training (ART), a psychophysiological self-control therapy which aims to induce relaxation proved to be effective in reducing the anxiety and depression in some health conditions. However, there is lack of studies which evaluated the effects of ART in the rehabilitation of stroke survivors. The aim of this experimental pilot study is to evaluate the feasibility and outcomes of ART in addition to usual physiotherapy for stroke survivors. A total of 14 sub-acute stroke survivors from a teaching hospital were enrolled in this study. All participants received 20 minutes ART followed by 40 minutes usual physiotherapy once a week and they were requested to carry out the intervention at home for twice per week, for six weeks. Intervention outcomes were assessed using Hospital Anxiety and Depression Scale (HADS-A and HADS-D), Barthel Index (BI), Timed Up and Go (TUG) and EuroQol 5-Dimension 5 Levels (EQ5D5L). Changes in all outcome measures were analysed using paired t-test and Wilcoxon signed rank test, with level of significance set at p<0.05. Post-intervention, there is statistically significant reduction of the HADS-A (p=0.04), HADS-D (p=0.02), TUG (p=0.004) and EQ5D5L (p=0.03) scores of the participants. Although not statistically significant, the mean score ± SD of BI increased from 95 ± 12.5 to 100 ± 6.25. The intervention is feasible and acceptable by the stroke survivors with no adverse events reported. In conclusion, ART in addition to usual physiotherapy is feasible and beneficial in reducing anxiety and depression, and improving functional ability, mobility and quality of life among stroke survivors.

References

Hendricks HT, Limbeek JV, Geurts AC, Zwarts MJ. Motor recovery after stroke: A systemic review of the literature. Arch Phys Med Rehabil 2002; 83:1629-1637

Sacco RL, Kasner SE, Broderick JP, Caplan LR, Culebras A, Elkind MS, George MG, Hamdan A D, Higashida RT, Hoh BL. An updated definition of stroke for the 21st century a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44(7): 2064-2089.

World Health Organization. World malaria report. World Health Organization 2008 Ed.

Loo KW & Gan SH. Burden of stroke in Malaysia. International Journal of Stroke 2012;7(2): 165-167.

Aziz ZA, YY Lee, Ngah BA, Sidek NN, I Looi, Hanip MR & Basri HB. Acute stroke registry Malaysia, 2010-2014: Results from the national neurology registry. Journal of Stroke and Cerebrovascular Diseases 2015;24(12): 2701-2709.

Janus-Laszuk B, Mirowska-Guzel D, Sarzynska-Dlugosz I & Czlonkowska A. Effect of medical complications on the after-stroke rehabilitation outcome. Neurorehabilitation 2017; 40(2): 223-232.

Kawecka-Jaszcz K, Klocek M, Tobiasz-Adamczyk B & Bulpitt CJ. Health-related quality of life in cardiovascular patients. Springer; 2013.

Broomfield NM, Quinn TJ, Abdul-Rahim AH, Walters MR & Evans JJ. Depression and anxiety symptoms post-stroke/TIA: prevalence and associations in cross-sectional data from a regional stroke registry. BMC Neurology 2014; 14(1): 1.

Mohd Zulkifly MF, Ghazali SE, Normah CD & Subramaniam P. The Influence of demographic, clinical, psychological and functional determinants on post-stroke cognitive impairment at day care stroke center, Malaysia. Malaysian Journal of Medical Sciences 2016 ;23(2): 53-64.

Knapp P, Young J, House A & Forster A. Non-drug strategies to resolve psychosocial difficulties after stroke. Age and ageing 2000; 29(1): 23-30.

Kneebone I, Walker-Samuel N, Swanston J & Otto E. Relaxation training after stroke: potential to reduce anxiety. Disability and rehabilitation 2014;36(9): 771-774.

Sarker SJ, Rudd AG, Douiri A & Wolfe CD. Comparison of 2 extended activities of daily living scales with the Barthel index and predictors of their outcomes. Stroke 2012; 43(5): 1362-1369.

Golding K, Kneebone I & Fife-Schaw C. Self-Help relaxation for post-stroke anxiety: A randomised, controlled pilot study. Clinical rehabilitation 2016 ;30(2):174-80.

Hidderley M & Holt MA. Pilot randomized trial assessing the effects of autogenic training in early stage cancer patients in relation to psychological status and immune system responses. European Journal of Oncology Nursing 2004; 8(1): 61-65.

Manzoni GM, Pagnini F, Castelnuovo G & Molinari E. Relaxation training for anxiety: A ten-years systematic review with meta-analysis. BMC psychiatry 2008; 8(1): 1.

Morgan AJ & Jorm AF. Self-Help interventions for depressive disorders and depressive symptoms: A systematic review. Annals of general psychiatry 2008; 7(1): 1.

Sutherland G, Andersen MB & Morris T. Relaxation and health-related quality of life in multiple sclerosis: the example of autogenic training. Journal of behavioral medicine 2005; 28(3): 249-256.

Billingham SA., Whitehead AL & Julious SA. An audit of sample sizes for pilot and feasibility trials being undertaken in the United Kingdom registered in the United Kingdom Clinical Research Network database. BMC Medical Research Methodology 2013;13(1):1.

Stern AF. Questionnaire review: The hospital anxiety and depression scale. Occupational Medicine 2014;64:393–394.

Faria CD, Teixeira-Salmela LF, Neto MG & Rodrigues-de-Paula F. Performance-based tests in subjects with stroke: outcome scores, reliability and measurement errors. Clinical rehabilitation 2012; 26(5): 460-469.

Andersson Å, Kamwendo K, Seiger A & Appelros P. How to identify potential fallers in a stroke unit: validity indexes of 4 test methods. Journal of rehabilitation medicine 2006;38(3): 186-191.

Golicki D, Niewada M, Buczek J, Karlińska A, Kobayashi A, Janssen M & Pickard AS. Validity of EQ-5D-5L in stroke. Quality of life research 2015 ;24(4): 845-850.

Rensink M, Schuurmans M, Lindeman E & Hafsteinsdottir T. Task‐oriented training in rehabilitation after stroke: systematic review. Journal of advanced nursing 2009;65(4): 737-754.

Blennerhassett J & Dite W. Additional task-related practice improves mobility and upper limb function early after stroke: A randomised controlled trial. Australian Journal of Physiotherapy 2004; 50(4): 219-224.

Salbach NM, Mayo NE, Robichaud‐Ekstrand S, Hanley JA, Richards CL & Wood‐Dauphinee S. The effect of a task‐oriented walking intervention on improving balance self‐efficacy post-stroke: A randomized, controlled trial. Journal of the American Geriatrics Society 2005; 53(4): 576-582.

Published
2020-12-31
How to Cite
Thazhakkattu Vasu, D., Mohd Nordin, N. A., See Xiao Xu, Ghazali, S. E., & Abu Zarim, S. N. (2020). FEASIBILITY AND OUTCOMES OF AUTOGENIC RELAXATION TRAINING IN ADDITION TO USUAL PHYSIOTHERAPY FOR STROKE SURVIVORS – A PILOT STUDY. Malaysian Journal of Public Health Medicine, 20(3), 134-139. https://doi.org/10.37268/mjphm/vol.20/no.3/art.561