EfS Evaluation Data. Prepared by Prof Dawn Skelton, Glasgow Caledonian University from data sent by Trish Cowie. Feb 2013.

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1 EfS Evaluation Data Prepared by Prof Dawn Skelton, Glasgow Caledonian University from data sent by Trish Cowie. Feb people have now gone through the EfS programme and have had initial assessments. 49 people have undergone second assessments (at 14 weeks) and 19 have undergone a third assessment (at 26 weeks). Methods: Data was provided in spreadsheet prepared by Trish Cowie. Statistical analysis was performed on the data of those who participated in more than one assessment (n=49 for two assessments and n=19 for three assessments). Two tailed, paired, matched t-tests were used to compare baseline and data at 14 weeks (assessment 2) and 26 weeks (assessment 3). Summary: The initial 14 weeks of the EfS programme (n=49 people) has had a significant improvement on 10m walk time (32% improvement), timed up and go (29% improvement), SIS mobility (3.4%), SIS recovery (12%) and SF12 physical health (5%) (Table 1). For those people who have now had three assessments (n=19) the initial 14 weeks also had significant improvements in SIS physical problems (16%), SIS Memory and Thinking (8%), but a lesser effect on SF12 results (Table 2). For these 19 people, there was then a continued improvement over the next 12 weeks (to week 26) in other SIS scores, such as a 6% improvement in SIS Mood and Emotions, 5% in SIS Communication and SIS Daily Activities, 21% in SIS Use of Hand and 10% in SIS Participation (Table 2). For the 19 people who have had assessments at week 26, from baseline there are important functional improvements in 10m walk time (stamina and fitness is better) and in Timed Up and Go (with an associated reduced risk of falls) (Table 2, Figure 1), as well as clinically significant improvements in Stroke Impact relating to Physical Problems, Memory and Thinking, Mood and Emotions, Mobility and Recovery as well (Table 2, Figure 2). The lack of significance seen in SF12 results (Table 2, Figure 3) is more likely related to the generic form of wording used in the SF12 and lack of disease specificity, but also most questions relate to the last 7 days and this can sometimes give spurious results if someone has a bad week. At least two of the 19 people had huge decreases in their SF12 results and although these data were not removed, it does highlight that for ongoing assessment perhaps the Stroke Impact Scale (SIS) is more appropriate to show change over time with interventions. These data show firstly that people with a history of stroke (some from quite a long time ago) can still improve their functional abilities and reduce their falls risk significantly within 14 weeks. It also shows that over a longer time period (up to 26 weeks) there is a consistently improving profile of quality of life measured on the Stroke Impact Scale. It is also important to note that mental health aspects of the Stroke Impact Scale also improved (such as Mood and Emotions and Memory and Thinking) so this infers that the exercise is having more than just a physical benefit to these stroke survivors. It is interesting to note also, that the improvements in Timed Up and Go seen in this cohort of patients with EfS training is actually BETTER (29% vs 7%) than that seen in the published STARTER trial (Mead et al. 2007).

2 Table 1: Changes in Outcome Measures over the first 14 weeks of EfS in 49 people Outcome Measure 1 Mean (SD) 10m walk time (sec) (22.05) Timed Up and Go time (sec) (25.31) SIS Physical Problems * (3.77) SIS Memory & Thinking (7.08) SIS Mood & Emotions (6.74) SIS Communication (4.74) SIS Daily Activities (9.86) SIS Mobility (7.76) SIS Use of hand * (6.77) 2 Mean (SD) (9.66) (18.47) (4.28) (6.71) (6.14) (4.88) (9.76) (8.47) (6.82) (14.70) (12.00) % improvement visit 2 to visit < (4.51) (5.19) (6.75) (4.36) (6.13) (4.93) (3.80) SIS participation (6.81) (6.92) SIS Recovery * (18.06) (18.29) SF12 Physical Health (2.25) (2.27) SF12 Mental Health (2.41) (2.39) Weight (kg) (18.71) (18.95) * N=48 (missing data set for one person) 0.92 (6.68) (18.59) (2.52) (2.65) (4.38)

3 Table 2: Changes in Outcome Measures after 26 weeks of EfS in 19 people Outcome Measure 1 Mean (SD) 2 mean (SD) 3 Mean (SD) % improvement assessment 1 to assessment 2 10m walk time (sec) (15.67) (8.47) (7.76) Timed Up and Go time (sec) (27.72) (12.35) (12.24) SIS Physical (3.66) (4.18) (4.07) Problems SIS Memory & Thinking (7.62) (7.26) (7.35) SIS Mood & Emotions (5.64) (4.80) (4.76) SIS Communication (4.26) (5.31) (4.79) SIS Daily Activities (7.75) (7.72) (7.62) SIS Mobility (6.27) (6.82) (6.84) SIS Use of hand (5.86) (7.28) (7.57) SIS participation (5.66) (6.69) (6.76) SIS Recovery (18.99) (13.18) (12.05) SF12 Physical (2.00) (2.17) (2.52) Health SF12 Mental Health (3.20) (2.52) (2.45) Weight (kg) (20.76) (18.36) (17.90) % improvement assessment 1 to assessment 3 Outcome Measure Visit 1-Visit 2 Visit 2- Visit 3 Visit 1- Visit 3 visit 1-2 visit 2-3 visit m walk time (sec) -8.10(8.47) -0.87(2.99) -8.96(9.21) < <0.001 Timed Up and Go (4.06) (17.01) < <0.001 time (sec) (17.15) SIS Physical 1.84 (3.66) 0.16 (1.01) 2.00 (3.62) Problems SIS Memory & Thinking 1.89 (3.05) 0.37 (0.83) 2.26 (2.92) <0.001 SIS Mood & Emotions 0.37 (3.55) 1.58 (2.04) 1.95 (3.50) 0.66 < SIS Communication -0.05(5.33) 1.68 (2.03) 1.63 (5.09) 0.97 < SIS Daily Activities 1.00 (7.39) 0.84 (1.30) 1.84 (6.93) SIS Mobility 2.42 (5.54) 0.74 (1.33) 3.16 (5.93) SIS Use of hand 1.11 (3.70) 0.37 (0.83) 1.47 (3.78) SIS participation 1.74 (7.05) 0.42 (0.90) 2.16 (7.10) SIS Recovery 8.84 (18.06) 5.26 (3.11) (18.11) 0.05 <0.001 <0.001 SF12 Physical 0.58 (2.78) -0.84(1.01) -0.26(3.35) 0.38 < Health SF12 Mental Health -0.53(2.99) 1.53 (0.96) 1.00 (3.09) 0.45 < Weight (kg) -0.62(6.47) 0.53 (1.91) -0.09(6.69)

4 Figure 1: Improvements in 10m walk time and Timed Up and Go over the 26 weeks of EfS Programme (n=19) 54% better than baseline 49% better than baseline Seconds m walk time (sec) Timed Up and Go time (sec)

5 Figure 2: 70 Improvements in Stroke Impact Scale over 26 weeks of EfS Programme (n=19) 21% Percentage (%) % 6.7% 6.3% 9.5%

6 Figure 3: 18 Changes in SF12 Quality of Life over 26 weeks of EfS programme (n=19) Percentage (%) SF12 Physical Health SF12 Mental Health