Association Between Therapeutic Education Delivered by a Community Post-Stroke Rehabilitation Team and Improvement in the Frenchay Activities Index: A Retrospective Cohort Study

Abstract

Background Social participation is frequently impaired after stroke. Therapeutic patient education (TPE) may promote self-management and community reintegration, but evidence regarding home-based programs delivered by Community Stroke Rehabilitation Teams (CSRTs) remains limited. Objective To investigate the association between participation in a home-based TPE program, including physical activity (PA) workshops, and changes in social participation after stroke. Methods This retrospective comparative cohort study included 163 stroke survivors managed by a CSRT between 2019 and 2020. Among them, 110 participated in a home-based TPE program and 53 received standard CSRT care. Within the TPE group, 52 patients attended PA workshops. Social participation was assessed using the Frenchay Activities Index (FAI) at admission and discharge. Changes in FAI scores were compared using Mann–Whitney tests and adjusted analyses of covariance controlling for baseline FAI score, age, Barthel Index, time since stroke, duration of care, and lockdown status. Results Patients receiving TPE showed greater improvement in FAI scores than those receiving standard care (mean change: 6.02 ± 8.22 vs. 1.62 ± 3.98; p < 0.001). Among TPE participants, those attending PA workshops demonstrated greater improvement than those receiving TPE without PA workshops (7.87 ± 8.37 vs. 4.36 ± 7.78; p = 0.006). These associations remained significant after adjustment for potential confounders and were confirmed by bootstrap sensitivity analyses. Conclusions Home-based TPE delivered by a CSRT was associated with greater improvement in social participation after stroke, particularly when combined with PA workshops. Prospective controlled studies are needed to determine the effectiveness of this approach.