Effects of Group Leisure Activities and Musical Training on Hospital Stroke Rehabilitation.

Performance in activities of daily living will be assessed using the Barthel Index, a validated measure of functional independence in individuals after stroke. The Barthel Index assesses performance in ten basic Activities of Daily Living, with total scores ranging from 0 to 100, where higher scores indicate greater independence and better functional performance.

It´s a robust measure of performance in activities of daily living with excellent psychometric properties in hospitalised subacute stroke patients. Selecting a primary outcome in studies evaluating complex behavioural interventions is challenging because these interventions address several multiple deficits and impairments. Following the reasoning that the ultimate goal of rehabilitation is functional improvement in daily activities, the Barthel Index was selected as a primary outcome as it is widely used in clinical practice to assess the degree of functional independence following hospital discharge.

Verbal learning and memory will be evaluated using the Rey Auditory Verbal Learning Test (RAVLT), which assesses immediate recall, learning capacity across repeated trials, susceptibility to interference, delayed recall, and recognition of spoken word lists.

Quality of life will be assessed using the EQ-5D-5L, which measures general health status across five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The instrument also includes a visual analogue scale where participants rate their overall health.

Experiences, perceptions, and attitudes toward the rehabilitation program will be explored using semi-structured interviews with participants at the 1-month follow-up

Motor impairment will be assessed using the Fugl-Meyer Assessment of Motor Recovery, a stroke-specific, performance-based measure designed to assess motor functioning. Total scores range from 0 to 100, with higher scores indicating less motor impairment and better motor function.

Upper limb functional performance will be assessed using the Action Research Arm Test, which evaluates grasp, grip, pinch, and gross arm movement. Total scores range from 0 to 57, with higher scores indicating better arm function.

Fine manual dexterity will be assessed using the Nine-Hole Peg Test, which measures the time required to place and remove nine pegs. Scores are recorded in seconds, with lower scores indicating better performance.

Gross manual dexterity will be assessed using the Box and Blocks Test, which measures the number of blocks transferred in 60 seconds, with higher scores indicating better manual dexterity.

Grip strength will be assessed using a calibrated hand dynamometer. Grip force is measured in kilograms, with higher values indicating greater grip strength.

Global cognitive functioning will be assessed using the Montreal Cognitive Assessment (MoCA), a screening tool designed to detect cognitive impairment across multiple domains. Total scores range from 0 to 30, with higher scores indicating better cognitive performance.

Working memory and attention will be assessed using the Digit Span subtest (forward and backward) from the Wechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV). Scores are based on the number of correctly recalled digit sequences, with higher scores indicating better working memory and attentional capacity.

Executive functioning will be assessed using the Behaviour Rating Inventory of Executive Function - Adult Version (BRIEF-A), a standardized self-report questionnaire evaluating executive functions in everyday contexts. Scores are reported as T-scores, with higher scores indicating greater executive dysfunction.

Cognitive flexibility, processing speed, and visual attention will be assessed using the Trail Making Test (Parts A and B). Performance is measured as completion time in seconds, with shorter completion times indicating better cognitive performance.

Apathy will be assessed using the Apathy Evaluation Scale (AES), which evaluates behavioural, cognitive, and emotional aspects of goal-directed behaviour. Total scores range from 18 to 72, with higher scores indicating greater levels of apathy.

Anxiety and depression will be assessed using the Hospital Anxiety and Depression Scale (HADS), a self-report questionnaire consisting of two subscales: anxiety and depression. Each subscale score ranges from 0 to 21, with higher scores indicating greater symptom severity.