Effect of Structured Recreational Activities on Upper Extremity Functional Recovery in Chronic Stroke Survivors: A Pilot Randomized Controlled Trial
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Abstract
Background: Persistent upper-extremity impairment limits independence, quality of life, and social participation after stroke. Conventional rehabilitation is effective but may be constrained by repetitive task formats and declining adherence. This pilot randomized controlled trial evaluated whether a structured recreational-activity programme could improve upper-limb recovery and broader rehabilitation outcomes. Methods: Thirty chronic stroke survivors aged 60 years or older were randomized equally to structured recreational activities plus standard rehabilitation (n=15) or conventional rehabilitation (n=15). The 12-week programme included adaptive sports, art-based tasks, music-related activities, and virtual-reality or game-based upper-limb practice delivered three to four times weekly. Outcomes were assessed at baseline, 6 weeks, and 12 weeks using the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Stroke Impact Scale (SIS), Hospital Anxiety and Depression Scale (HADS), and Frenchay Activities Index (FAI). A 2 × 3 mixed-design ANOVA, between-group comparisons, effect sizes, and intention-to-treat analyses were applied. Results: FMA-UE scores increased from 34.5 ± 8.7 to 52.8 ± 6.9 in the intervention group and from 34.0 ± 9.0 to 41.7 ± 7.8 in controls. The group × time interaction was significant (F=7.56, p=0.002, partial η²=0.213). At 12 weeks, the adjusted between-group difference was 11.1 points (95% CI 5.3-16.9; p<0.001; Cohen's d=1.42). The intervention group also showed better SIS (mean difference 13.7; p=0.002), lower HADS (mean difference -3.9; p=0.013), higher FAI (mean difference 7.9; p=0.004), and greater attendance (90.6% vs 78.6%; p=0.006). Clinically meaningful FMA-UE improvement occurred in 93.3% versus 40.0% of participants. No significant adverse events were reported. Conclusion: Structured recreational activities produced large preliminary gains in upper-limb motor recovery, quality of life, psychological well-being, social participation, and adherence. Larger multicentre trials with longer follow-up are required.
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