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Steps, duration and intensity of usual walking practice during subacute rehabilitation after stroke: an observational study.

ABSTRACT: BACKGROUND:Duration of therapy time is an inadequate indicator of stroke rehabilitation. Steps, duration, and intensity of active therapy time may provide a better indicator of practice. OBJECTIVE:This study quantified usual walking practice in terms of steps, duration and intensity of active therapy time, and distance walked during physical therapy sessions in people with sub-acute stroke undertaking inpatient rehabilitation and to examine whether usual walking practice differed depending on walking ability. METHODS:A prospective observational study was conducted across two metropolitan rehabilitation units in Australia. Twenty-four stroke survivors were observed over three physical therapy sessions. Walking ability was categorized as unassisted or assisted based on Item 5 of the Motor Assessment Scale. Walking practice was categorized as basic or advanced. Steps, duration, intensity and distance walked were measured during physical therapy sessions. RESULTS:Overall, participants took 560 steps (SD 309) over 13min (SD 6) at an intensity of steps 44 steps/min (SD 17) and walked 222m (SD 143) in physical therapy. Unassisted walkers (n=6, 25%) undertook more (or trended towards more) practice of advanced walking than assisted walkers in terms of steps (MD 254 steps, 95% CI 48-462), duration (MD 5min, 95% CI 0-10), intensity (MD 18steps/min, 95% CI -8 to 44) and distance (MD 112m, 95% CI -12 to 236). CONCLUSION:Stroke survivors undergoing inpatient rehabilitation spent approximately 20% of physical therapy actively engaged in walking practice. Those able to walk without assistance took more steps for longer, at a higher intensity. TRIAL REGISTRATION:ACTRN12613000764730 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364545).

SUBMITTER: Kuys SS

PROVIDER: S-EPMC6546836 | biostudies-literature | 2019 Jan - Feb

REPOSITORIES: biostudies-literature

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Steps, duration and intensity of usual walking practice during subacute rehabilitation after stroke: an observational study.

Kuys Suzanne S SS Ada Louise L Paratz Jennifer J Brauer Sandra G SG

Brazilian journal of physical therapy 20180615 1

<h4>Background</h4>Duration of therapy time is an inadequate indicator of stroke rehabilitation. Steps, duration, and intensity of active therapy time may provide a better indicator of practice.<h4>Objective</h4>This study quantified usual walking practice in terms of steps, duration and intensity of active therapy time, and distance walked during physical therapy sessions in people with sub-acute stroke undertaking inpatient rehabilitation and to examine whether usual walking practice differed ...[more]

PMID: 29937125

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Project description:ObjectiveFew effective treatments improve upper extremity (UE) function after stroke. Immersive virtual reality (imVR) is a novel and promising strategy for stroke UE recovery. We assessed the extent to which imVR-based UE rehabilitation can augment conventional treatment and explored changes in brain functional connectivity (FC) that were related to the rehabilitation.MethodsAn assessor-blinded, parallel-group randomized controlled trial was performed with 40 subjects randomly assigned to either imVR or Control group (1:1 allocation), each receiving rehabilitation 5 times per week for 3 weeks. Subjects in the imVR received both imVR and conventional rehabilitation, while those in the Control received conventional rehabilitation only. Our primary and secondary outcomes were the Fugl-Meyer assessment's upper extremity subscale (FMA-UE) and the Barthel Index (BI), respectively. Both intention-to-treat (ITT) and per-protocol (PP) analyses were performed to assess the effectiveness of the trial. For both the FMA-UE/BI, a one-way analysis of covariance (ANCOVA) model was used, with the FMA-UE/BI at post-intervention or at follow-up, respectively, as the dependent variable, the two groups as the independent variable, baseline FMA-UE/BI, age, sex, site, time since onset, hypertension and diabetes as covariates.ResultsBoth ITT and PP analyses demonstrated the effectiveness of imVR-based rehabilitation. The FMA-UE score was greater in the imVR compared with the Control at the post-intervention (mean difference: 9.1 (95% CI 1.6, 16.6); P = 0.019) and follow-up (mean difference:11.5 (95% CI 1.9, 21.0); P = 0.020). The results were consistent for BI scores. Moreover, brain FC analysis found that the motor function improvements were associated with a change in degree in ipsilesional premotor cortex and ipsilesional dorsolateral prefrontal cortex immediately following the intervention and in ipsilesional visual region and ipsilesional middle frontal gyrus after the 12-week follow-up.ConclusionsImVR-based rehabilitation is an effective tool that can improve the recovery of UE functional capabilities of subacute stroke patients when added to standard care. These improvements were associated with distinctive brain changes at two post-stroke timepoints. The study results will benefit future patients with stroke and provide evidence for a promising new method of stroke rehabilitation.Trial registrationClinicalTrials.gov identifier: NCT03086889.

Project description:BackgroundPrevious studies have reported that walking cadence (steps/min) is associated with absolutely-defined intensity (metabolic equivalents; METs), such that cadence-based thresholds could serve as reasonable proxy values for ambulatory intensities.PurposeTo establish definitive heuristic (i.e., evidence-based, practical, rounded) thresholds linking cadence with absolutely-defined moderate (3 METs) and vigorous (6 METs) intensity.MethodsIn this laboratory-based cross-sectional study, 76 healthy adults (10 men and 10 women representing each 5-year age-group category between 21 and 40 years, BMI = 24.8 ± 3.4 kg/m2) performed a series of 5-min treadmill bouts separated by 2-min rests. Bouts began at 0.5 mph and increased in 0.5 mph increments until participants: 1) chose to run, 2) achieved 75% of their predicted maximum heart rate, or 3) reported a Borg rating of perceived exertion > 13. Cadence was hand-tallied, and intensity (METs) was measured using a portable indirect calorimeter. Optimal cadence thresholds for moderate and vigorous ambulatory intensities were identified using a segmented regression model with random coefficients, as well as Receiver Operating Characteristic (ROC) models. Positive predictive values (PPV) of candidate heuristic thresholds were assessed to determine final heuristic values.ResultsOptimal cadence thresholds for 3 METs and 6 METs were 102 and 129 steps/min, respectively, using the regression model, and 96 and 120 steps/min, respectively, using ROC models. Heuristic values were set at 100 steps/min (PPV of 91.4%), and 130 steps/min (PPV of 70.7%), respectively.ConclusionsCadence thresholds of 100 and 130 steps/min can serve as reasonable heuristic thresholds representative of absolutely-defined moderate and vigorous ambulatory intensity, respectively, in 21-40 year olds. These values represent useful proxy values for recommending and modulating the intensity of ambulatory behavior and/or as measurement thresholds for processing accelerometer data.Trial registrationClinicaltrials.gov ( NCT02650258 ).

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Steps, duration and intensity of usual walking practice during subacute rehabilitation after stroke: an observational study.

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Steps, duration and intensity of usual walking practice during subacute rehabilitation after stroke: an observational study.

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