Depressive Symptoms Are Associated With Reduced Unsupervised Training Engagement in Inpatients With Subacute Stroke: A Secondary Data Analysis Study

Objective: To investigate whether depressive symptoms are associated with reduced engagement in unsupervised training among inpatients with subacute stroke. Design: A secondary analysis of a data set obtained from a previous study conducted by our research group. Setting: Convalescent rehabilitation hospitals. Participants: This study included 34 patients with stroke (19 males; median age 65 [interquartile range, 55-75] years) admitted to a convalescent rehabilitation ward. Interventions: Not applicable. Main Outcome Measures: Primary outcome was the median time spent in unsupervised training across 3 leg cycle sessions. Secondary outcomes included the Functional Independence Measure motor scores at discharge and the length of stay. Depressive symptoms were defined as the Japanese version of the Geriatric Depression Scale Short Form score of ≥7. Results: Twelve participants (35.3%) had depressive symptoms. The median total time spent in unsupervised training was significantly lower in the group with depressive symptoms (367 [249-799] s) than in the group without depressive symptoms (888 [579-901] s), with a medium effect size (U=57, P=.006, Cohen's r=.46). No significant differences were found in the secondary outcomes (P>.05). Conclusions: Depressive symptoms were associated with reduced engagement in unsupervised training among inpatients after stroke. The findings highlight the importance of considering psychological factors in designing and implementing self-rehabilitation programs at the early stages of rehabilitation.