Factors Associated With Post-Stroke Physical Activity: A Systematic Review and Meta-Analysis

The Validity, Responsiveness, and Interpretability of the Activities-specific Balance Confidence Scale in Patients with Subacute Stroke: A Preliminary Investigation

BackgroundThe Activities-specific Balance Confidence (ABC) scale lacks sufficient psychometric evidence for use in patients with subacute stroke.ObjectiveTo investigate the floor and ceiling effects, construct validity, responsiveness, and the minimal important change (MIC) of the ABC scale in patients with subacute stroke.MethodsThe cases of patients with subacute stroke (n = 62) were analyzed for floor/ceiling effects and construct validity at baseline; those of 39 of the patients were analyzed for responsiveness and MIC at baseline and after 4 weeks. Outcome measures included the ABC scale, Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go test (TUG), comfortable walking speed (CWS), and maximal walking speed (MWS) measured at both baseline and 4-week follow-up. The MIC was calculated using a ≥ 4-point improvement on the Mini-BESTest as the anchor.ResultsThe ABC scale's total score did not exhibit any floor or ceiling effects. The ABC scale was correlated with the Mini-BESTest (ρ = 0.74), TUG (ρ = -0.56), CWS (ρ = 0.60), and MWS (ρ = 0.64). The correlation of change score between the ABC scale and Mini-BESTest was ρ = 0.39. The MIC for the ABC scale was 15.6% (95%CI: 10.4%-21.1%).ConclusionsThe ABC scale may help assess self-efficacy in patients with subacute stroke.

Effects of Paralyzed, Nonparalyzed, and Whole-Body Phase Angle on Physical Performance in Older Patients with Stroke

OBJECTIVES

This study investigated the association between phase angle (PhA) and physical performance in older patients with stroke, focusing on lower-limb PhA and predicting rehabilitation outcomes.

DESIGN

A retrospective cohort study.

SETTING AND PARTICIPANTS

Seventy-one patients with stroke aged ≥65 years at a Japanese rehabilitation hospital.

METHODS

Bioelectrical impedance analysis was used to measure whole-body PhA, paralyzed side lower-limb PhA, and nonparalyzed side lower-limb PhA. Physical performance was assessed using the Short Physical Performance Battery (SPPB) test at admission and discharge, with subdomains including balance, gait speed, and chair-rise performance. Multiple regression analysis was performed to determine whether different PhAs affected SPPB scores at discharge after adjusting for various potential confounders.

RESULTS

Higher nonparalyzed side lower-limb PhA were significantly associated with better SPPB scores at discharge (β = 0.313, P = .004), and improved balance (β = 0.281, P = .016) and chair-rise performance (β = 0.388, P = .004). Paralyzed side lower-limb PhA was a predictor of total SPPB (β = 0.290, P = .020), but nonparalyzed side lower-limb PhA was more associated with total SPPB. Whole-body PhA was not associated with either total SPPB or any of the SPPB subitems.

CONCLUSIONS AND IMPLICATIONS

Lower-limb PhA, particularly on the nonparalyzed side, is a significant predictor of physical performance in older patients with stroke. Paralyzed side lower-limb PhA plays a role, particularly in predicting walking ability. These findings suggest that site-specific PhA may represent valuable biomarkers for rehabilitation planning and prognostic assessment in patients recovering from subacute stroke events.

Developing an intensive aerobic exercise program after stroke: A pilot study

BACKGROUND

Stroke is a major cause of disability. Exercise is associated with reduced stroke recurrence and improved function. Most interventions have focused on supervised training in clinical settings rather than unsupervised home exercise.

OBJECTIVE

To determine the feasibility of conducting a randomized trial comparing unsupervised, high-intensity home aerobic training to a waitlist control group in survivors of stroke.

DESIGN

Assessor blinded randomized controlled pilot study.

SETTING

Assessments in medical center, home training.

PARTICIPANTS

Twenty-three participants who sustained a mild-moderate stroke (National Institutes of Health Stroke Scale score <15) at least 3 months prior were randomized to home aerobic training or waitlist control.

INTERVENTION

Aerobic training consisted of 8 weeks of stationary bicycle training, five times per week for 30 minutes with heart rate-guided intensity. Control group maintained their normal activities.

OUTCOME MEASURES

Adherence and retention were the primary focus of this evaluation. Secondary outcomes (aerobic capacity VO2max, gait, balance, and functional tests) were included for initial efficacy.

RESULTS

Of the 23 participants, only 15 were retained in the study. Dropouts were predominantly in the waitlist control group (3/13 in aerobic group, 5/10 in control group). No serious adverse events occurred. Self-efficacy and adherence to training duration and frequency was high, but only 50% achieved exercise intensity goals. Training benefits were modest with a VO2max increase of 1.7 mL/kg/min in the intervention group. The only statistical improvement in outcomes was with box and block testing, likely due to baseline intergroup differences.

CONCLUSIONS

Before conducting a larger trial, challenges with home aerobic training in the stroke population must be addressed. Despite high exercise self-efficacy, there was high attrition, particularly in the waitlist control group. Future study design should implement an active control. Benefits were limited, likely due to low training intensity, and efforts should be made to improve quality of unsupervised training, such as providing motivational coaching and wearable exercise trackers.

Self-reported physical activity more than 1 year after stroke and its determinants in relation to the WHO recommendations

BACKGROUND

Physical activity (PA) after stroke has significant health benefits if it is conducted regularly, with sufficient intensity and duration. Because of the health benefits, it is important to identify those below the World Health Organization (WHO) recommended level of PA. However, few studies have assessed the level of PA after stroke in relation to the WHO recommendations and which sociodemographic factors and stroke characteristics are associated with those below the WHO recommendations.

OBJECTIVE

To assess survivors of stroke at least 1 year after onset and (1) describe their self-reported level of PA; (2) explore the association between PA, sociodemographics, and stroke characteristics, and (3) determine the characteristics of those below the WHO recommended level of PA.

DESIGN

Cross-sectional descriptive survey.

SETTING

Community settings.

PARTICIPANTS

Data were collected from 160 survivors of stroke (mean age 73 years, 46% women, mean time since stroke onset 35 months).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The Swedish National Board of Health and Welfare Physical Activity Questionnaire and the following sociodemographics and stroke characteristics: gender, age, marital status, vocational situation, need for home help, use of mobility devices, time since stroke onset, first-time stroke, type of stroke, location of stroke, and stroke treatment.

RESULTS

Two thirds (66.3%) of the participants were below the WHO recommendations. The hierarchical regression analysis explained 13% of the variance in PA with need for home help as a single significant contributor. Those who did not meet the WHO recommendations were significantly older, more likely to live alone, and in need of home help and mobility devices.

CONCLUSIONS

A majority of survivors of stroke do not meet the WHO recommended level of PA. Future studies should assess how other factors characterize those who are physically inactive. This knowledge could help rehabilitation professionals to target interventions and self-management programs to promote PA among survivors of stroke.

Beyond unilateral motor impairments: Role of bilateral force control and strength asymmetry in gait coordination and falls post-stroke

Coordination between lower extremities is a fundamental aspect of walking, yet it has received limited attention in locomotor recovery post-stroke. We aimed to compare the impact of unilateral versus bilateral force impairments on gait coordination and examine the relationship between gait coordination and incidence of falls post-stroke. In adults with stroke (N = 22) and age-similar healthy controls (N = 22), we measured gait coordination with phase coordination index (PCI) during overground walking. We measured force control for ankle dorsiflexors in unilateral and bilateral conditions. Unilateral force impairments were quantified with force error during visuomotor tracking and maximum voluntary contraction force for each leg. Bilateral force impairments were measured with cross-correlation coefficient, time lag, and strength symmetry. We recorded the history of falls in the previous year for adults with stroke. Compared with controls, adults with stroke showed significantly increased PCI, decreased cross-correlation coefficient and increased time lag between bilateral forces. Force error of both paretic and non-paretic legs was increased in the stroke group. Strength symmetry and cross-correlation coefficient explained 59.5 % of the variance in PCI (p < 0.001). However, unilateral force impairments were not associated with PCI. Adults with stroke reported a previous fall incidence rate of 59.09 %. Stroke survivors with a history of fall showed significantly higher PCI relative to stroke survivors without a history of fall (p < 0.01). We found a significant relationship between falls and PCI (p < 0.05) such that poor gait coordination was related to past incidence of falls in stroke survivors. The current study provides novel insights that impairments in bilateral, but not unilateral force control influences coordination during overground walking post-stroke. Specifically, impaired timing between bilateral ankle forces and strength asymmetry negatively impacts gait coordination post-stroke. Impaired gait coordination elevates the risk for falling post-stroke, thereby compromising safe mobility in individuals with stroke.

A nationwide analysis of physical inactivity and sedentary behavior among stroke survivors in Korea

This study aimed to identify key predictors of physical inactivity and prolonged sedentary behavior among stroke survivors (SSs) using data from the 2016-2020 Korea National Health and Nutrition Surveys. Of the 28,146 participants, 633 had a history of stroke. The results showed that SSs were significantly more likely to be physically inactive and spend longer sedentary times than controls. Multivariate analysis identified that age ≥ 80 years (adjusted odds ratio [aOR] = 5.45, 95% confidence interval [CI] 1.96-15.15), lower education level (≤ 9 years) (aOR = 2.18, 95%CI 1.13-4.18), and living in rural areas (aOR = 1.91, 95%CI 1.11-3.29) were associated with aerobic physical inactivity. Female sex (aOR = 2.36, 95%CI 1.28-4.35) and lower education (aOR = 2.31, 95%CI 1.01-5.34) were linked to insufficient resistance exercises (≤ 1 day per week). Long sedentary time (≥ 8 h daily) was associated with being economically inactive (aOR = 1.90, 95%CI 1.21-2.96), single (aOR = 1.68, 95%CI 1.07-2.64), and perceiving oneself as unhealthy (aOR = 1.59, 95%CI 1.01-2.49). These findings highlight the need for targeted interventions, including community-based exercise programs and policy initiatives, to reduce sedentary behavior and promote physical activity among SSs. Implementing accessible and tailored rehabilitation strategies may help mitigate long-term health risks in this population.

Fatigue Is Associated With Perceived Effort and 2-Dimensional Reach Performance After Stroke

BACKGROUND AND PURPOSE

Poststroke fatigue (PSF) is prevalent and often manifests as high perceived effort during activities. Little is known about how PSF influences goal-directed reaching after stroke. The purpose of this study was 2-fold (1) to evaluate how perceived effort changed when individuals with stroke performed a reaching task with various demands and (2) to determine whether PSF was associated with perceived effort during reaching and reach performance.

METHODS

Thirty-six individuals with chronic stroke performed 2-dimensional reach actions under varied conditions with the more and less affected arms. Perceived effort during reaching was assessed using rating of perceived exertion (RPE) and Paas Mental Effort Rating Scale (MERS). Derived reach kinematics were used to quantify reach performance. The Fatigue Severity Scale (FSS) was administered to assess fatigue severity.

RESULTS

Perceived effort was higher when participants reached with the more affected arm, reached toward far and small targets, and performed memory-guided reaching. Both RPE and MERS significantly correlated with the FSS score ( r = 0.50 and 0.35, respectively, P < 0.05). Further, FSS correlated with movement time during the more affected arm reaching (ρ = 0.40, p < 0.05) and reach performance discrepancy between the fast and self-selected speed conditions when participants performed with the less affected arm (ρ = 0.36, P < 0.05). Exploratory analysis revealed that the relationship between fatigue and reach control appeared to be modulated by task demand.

DISCUSSION AND CONCLUSIONS

PSF is associated with perceived effort during reaching and reach performance after stroke. These relationships might offer insights into arm performance in the real world after stroke.

VIDEO ABSTRACT

for more insights from the authors Supplemental Digital Content available at http://links.lww.com/JNPT/A476.

Associations between objective and self-perceived physical activity and participation in everyday activities in mild stroke survivors

BACKGROUND AND PURPOSE

Stroke survivors present limited levels of physical activity (PA) and participation in everyday activities although the specific interaction between PA and participation in these individuals is still uncertain. This study aimed to analyse the relationship between PA and participation in everyday activities among Spanish mild stroke survivors.

METHODS

A total of 130 mild stroke survivors (61.3 ± 12.4 years, 35% female) with preserved walking ability and without cognitive and communication impairments participated in this cross-sectional study involving several rehabilitation centres from Spain. Self-reported levels of PA were reported by the International Physical Activity Questionnaire - short form (IPAQ-SF). Objective PA measures were monitored with the wristband Fitbit Inspire 2, recording the average steps/day and kilocalories/day. Participation and activity satisfaction levels were measured with the Satisfaction with Daily Occupations-Occupational Balance (SDO-OB) and participation retention through Activity Card Sort (ACS).

RESULTS

ACS total score showed a weak correlation with self-reported PA (rho = 0.324) and moderate correlations with kilocalories/day and average steps/day (rho ≥ 0.581), while stronger correlations were found for the ACS subdomain of instrumental activities (rho ≥ 0.640) compared to the subdomains of leisure activities and social participation (rho ≤ 0.454). SDO-OB participation showed moderate correlations with kilocalories/day, and average steps/day (rho ≥ 0.647), and a weak correlation with self-reported PA (rho = 0.303). Weaker correlations were found for SDO-OB satisfaction with objective PA measures (rho = 0.407) and self-reported PA (rho = 0.254). Relationships between variables were explored by calculating Spearman correlation coefficients.

DISCUSSION AND CONCLUSIONS

The objective and self-reported measures of PA in mild stroke survivors have a bilateral relationship with their current participation levels and the retained instrumental activities of daily living. However, the weaker correlations with leisure and social participation may suggest that promoting PA alone without integrating it into daily activities relevant to the stroke survivor may be insufficient to achieve comprehensive goals during rehabilitation programs.

Effects of Different Intensities of Endurance Training on Neurotrophin Levels and Functional and Cognitive Outcomes in Post-Ischaemic Stroke Adults: A Randomised Clinical Trial

This study aimed to examine the effects of different intensities of endurance training combined with standard neurorehabilitation on selected blood biomarkers and physical outcomes of post-stroke individuals. We randomised patients with first-episode ischaemic stroke to an experimental group that received 4 × 45 min sessions of moderate-intensity continuous training (MICT) each week and 2 × 45 min of standard rehabilitation each day or to a control group that received 4 × 45 min sessions of low-intensity continuous training (LICT) each week and 2 × 45 min of standard rehabilitation each day. We measured the following outcomes at baseline and 3 weeks after the intervention: aerobic capacity; cognitive and motor function; and blood levels of brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF), vascular endothelial growth factor A (VEGF-A), insulin-like growth factor-1 (IGF-1), and irisin. We included 52 patients with a mean age of 66.1 ± 8.0 years. After 3 weeks of rehabilitation, there was a clinically significant improvement in the Rivermead Motor Assessment-arm score in the MICT group. The study showed that after 3 weeks, an intervention combining MICT with standard neurorehabilitation was significantly more beneficial in improving aerobic capacity and arm motor function than an intervention combining LICT and standard neurorehabilitation.

Physical activity patterns in independently mobile adult stroke survivors: an in-depth exploratory, observational study

PURPOSE

Social/community activities contribute to incidental physical activity, which may help prevent secondary stroke. This research aims to explore stroke survivor activity patterns, physical activity levels, and self-efficacy.

MATERIALS AND METHODS

An exploratory observational study in a cohort of community-dwelling stroke survivors was conducted. Data were collected with accelerometers, activity diaries, and the Self-Efficacy for Exercise Scale. Pre-specified categories were used to describe activity context. Pearson's correlation and Kruskal-Wallis analyses were used to analyse physical activity relative to self-efficacy and time of day.

RESULTS

Forty-seven stroke survivors were recruited (47% female, aged 76 years (IQR 65-83)). Most awake time (81%) was spent in the home. Structured exercise and community and/or social activities were efficient forms of activity and accounted for 17.7% and 23.2% of steps/day, and 2.5% and 14.1% of time, respectively. Participants were most active in the afternoon and morning compared with the evening (p = 0.005 and p = 0.045). Community ambulators had higher self-efficacy scores compared to household ambulators (p = 0.007).

CONCLUSIONS

Stroke survivors can be active via structured exercise, as well as engaging in outdoor social and community activities. Those who reported higher levels of self-efficacy were more active. Health professionals should consider these factors when promoting physical activity during rehabilitation.

Post-stroke fatigue, hope and discharge readiness: A cross-sectional survey

AIMS AND OBJECTIVES

To explore the relationships among post-stroke fatigue, hope and discharge readiness in stroke patients, and to determine whether hope mediates the relationship between post-stroke fatigue and discharge readiness.

BACKGROUND

In stroke patients, inadequate discharge readiness has been found to correlate with higher readmission and mortality rates. Although previous qualitative studies have confirmed the impact of fatigue on discharge readiness, few studies explore the impact of post-stroke fatigue and hope on discharge readiness of stroke patients. Consequently, the current research on this relationship and its underlying mechanisms is still quite limited.

DESIGN

Cross-sectional study.

METHODS

Data were collected from 340 stroke patients. The research tools included demographic and disease characteristics, Discharge Readiness Assessment Scale for Stroke, Neurological Fatigue Index for Stroke and Herth Hope Index. The STROBE checklist was used to guide the presentation of this study.

RESULTS

Discharge readiness was negatively correlated with post-stroke fatigue and positively correlated with hope. Additionally, post-stroke fatigue was negatively correlated with hope. Post-stroke fatigue had a direct negative effect on discharge readiness, and it can also generate indirect effects through hope. Hope was the partial mediator between post-stroke fatigue and discharge readiness, explaining 55.8% of the total effect.

CONCLUSION

Discharge readiness of this population can be improved by reducing post-stroke fatigue and increasing hope. Therefore, effective management of post-stroke fatigue and hope will help improve discharge readiness.

RELEVANCE TO CLINICAL PRACTICE

It is recommended that nursing staff should monitor the occurrence and development of post-stroke fatigue in stroke patients, dynamically evaluate the patient's level of hope, and pay attention to the important role of positive psychological qualities in the outcome of discharge. If medical staff can formulate corresponding intervention measures based on the influence path of discharge readiness, then the discharge readiness of stroke patients can be improved.

Comparative Effectiveness of Exercise on Cardiorespiratory Function or Exercise Efficiency After Stroke: A Network Meta-analysis of Randomized Control Trials

OBJECTIVE

The network meta-analysis was to compare and rank the effectiveness of different exercises on cardiorespiratory function or exercise efficiency in poststroke patients.

DESIGN

A network meta-analysis of randomized controlled trials was conducted. PubMed, Embase, Cochrane Library, and Web of Science were searched. The impact of exercises including individual and combination of aerobic exercise, resistance exercise, task-oriented training, gait training, breathing exercise, and regular rehabilitation training on 6-min walk test, peak oxygen consumption, maximum oxygen consumption, resting heart rate, resting systolic blood pressure, and resting diastolic blood pressure were assessed.

RESULTS

In total, 36 studies were included in the meta-analysis. Aerobic exercise + GT (63.06%) had the highest likelihood of improving 6-min walk test performance in poststroke patients. Regular rehabilitation training + resistance exercise was the most favorable exercise in terms of 6-min walk test performance assessing by minimum clinically significant difference. Aerobic exercise + resistance exercise had the highest likelihood of improving peak oxygen consumption and reducing resting heart rate in poststroke patients.

CONCLUSION

Different types of exercise demonstrated the benefits of improving cardiorespiratory function in stroke patients. Further research is needed to determine the best exercise regimen to maximize the benefits of rehabilitation interventions for poststroke patients.

Development and validation of a prognostic nomogram for predicting poor outcomes following intravenous rt-PA in patients with acute ischemic stroke

Background

Intravenous administration of recombinant tissue plasminogen activator (rt-PA) within 4.5 h of symptom onset is a standard treatment for acute ischemic stroke (AIS). However, certain patients continue to develop unfavorable outcomes despite timely rt-PA therapy. Identifying those at high risk is essential for developing individualized care plans and establishing appropriate follow-up.

Methods

This retrospective study included AIS patients treated with intravenous rt-PA at 0.9 mg/kg at our center. Outcomes at three months were evaluated using the modified Rankin Scale (mRS). Patients with mRS scores ≤2 were considered to have favorable outcomes, and those with scores >2 were considered to have poor outcomes. Univariable analysis and stepwise logistic regression were used to identify independent predictors of poor prognosis, and a nomogram was subsequently developed. The model's discriminative power was assessed with area under the receiver operating characteristic curves (AUC-ROC), and its calibration was examined using calibration plots. Decision curves and clinical impact curves were applied to determine clinical utility.

Results

Among 392 enrolled patients, 77 had poor outcomes three months after rt-PA therapy. Fibrinogen (Fg), baseline NIHSS, and a history of hypertension emerged as independent predictors of poor prognosis. The nomogram achieved an AUC of 0.948 (95% CI [0.910-0.985]), with sensitivity of 0.900 and specificity of 0.916 in the training dataset, and an AUC of 0.959 (95% CI [0.907-1.000]), with sensitivity of 0.943 and specificity of 0.947 in the validation dataset. Calibration plots demonstrated close agreement between predicted and observed probabilities, and decision curves indicated a wide range of net benefit threshold probabilities.

Conclusions

This nomogram, incorporating baseline NIHSS, Fg, and a history of hypertension, accurately predicts poor three-month outcomes in AIS patients treated with intravenous rt-PA. Its ease of use may facilitate early risk stratification and assist clinicians in formulating more targeted management strategies and follow-up protocols for patients likely to experience unfavorable outcomes.

Measures to ensure safety during telerehabilitation of people with stroke: A scoping review

BACKGROUND

Measures used to prevent adverse events during the implementation of exercise sessions delivered via telerehabilitation can be varied, ranging from simple telephone monitoring to synchronous therapist-led sessions. However, this information is scattered in the literature, as evidence synthesis studies have only addressed the safety, satisfaction, and effectiveness aspects of exercise delivered via telerehabilitation.

AIMS

This scoping review aims to describe that measures are used to ensure safety during exercise sessions delivered to people with stroke through telerehabilitation, as reported by authors of primary studies. Secondarily, it describes the designs most frequently used to notify the effects of telerehabilitation and evidence level, the characteristics of the participants and type of stroke, and the characteristics of telerehabilitation.

SUMMARY OF REVIEW

A scoping review was conducted according to the Joana Briggs Institute (JBI) recommendations. A systematic search of MEDLINE (Ovid), Embase (Ovid), CENTRAL, and CINHAL was conducted from inception to August 2022, and a review of systematic review references on the topic. We included primary studies that enrolled adults with stroke who underwent exercise delivered via telerehabilitation. Two independent reviewers performed study selection and data extraction, and disagreements were resolved by consensus or a third reviewer. A qualitative analysis of the information was performed. One hundred seven primary studies (3991 participants) published between 2002 and 2022 were included. Most studies were case series (43%) and rated with an Oxford level of evidence of "4" (55.3%). Regarding randomized clinical trials, half included 53 or more participants (IQR 26.75 to 81). Most studies applied the exercises via asynchronous telerehabilitation (55.1%), of which only ten reported measures to avoid adverse events. Some of the measures included assessing the location where exercises are to be performed, only using a seated position, and using live warning systems that prevent or stop exercises when they are risky.

CONCLUSIONS

Reporting of measures implemented to prevent adverse events during exercise delivery via asynchronous telerehabilitation is scarce. Future primary studies should always consider reporting adverse events related to exercise delivery via telerehabilitation and strategies implemented to decrease the incidence of these unwanted safety events.

REGISTRATION NUMBER

INPLASY202290104.

The doctor-patient perception mismatch: Improving approaches to assessing outcomes after ischemic stroke treated with reperfusion therapy

The long-term effects of ischemic stroke on cognition and mental health are not reflected in traditional outcome metrics, like the modified Rankin Scale (mRS) for functional independence. Consequently, this may lead to mismatches in perceptions of overall recovery, despite otherwise qualifying as having good functional outcomes (mRS 0-2). In our multicenter, multinational analysis, we aim to describe the prevalence of, and factors associated with, patient-reported cognitive impairment despite achieving good functional outcomes. Acute ischemic stroke patients at Cooper University Hospital (2021-2024) and Hospital Vall d'Hebron in Barcelona, Spain (2020-2021) treated with reperfusion therapy and achieved 90-day mRS 0-2 were surveyed with the previously-validated PROMIS Global-10 scale for physical health (PROMIS-PH) and mental health (PROMIS-MH). The primary outcome was the rate of fair or poor PROMIS-MH scores (≤ 11). Univariable and multivariable linear regressions for PROMIS-MH scores were performed. Of 157, 90-day mRS 0-2 patients, the mean age was 68 (standard deviation 15) years, and 61 % were male. Fair or poor PROMIS-MH scores were reported in 43 % of patients. Clinical factors independently associated with PROMIS-MH scores in a multivariable linear regression include: sex, tobacco use, PROMIS-PH score, and National Institutes of Health Stroke Scale at 3-day follow-up. Despite achieving favorable post-stroke mRS, there is a high prevalence of patient-reported cognitive impairment, underscoring an important gap in post-stroke care. The emphasis in post-stroke care should extend beyond the scope of traditional metrics, and should encompass evaluations and interventions targeting additional domains significant to overall patient recovery, especially patient-reported cognitive symptoms.

Associations of environmental and personal factors, participation and health-related quality of life with physical activity and sedentary behavior in people with subarachnoid hemorrhage: a cross-sectional accelerometer-based study

PURPOSE

To explore associations of environmental and personal factors, participation, and health-related quality of life (HR-QoL) with physical behavior (PB) after subarachnoid hemorrhage (SAH).

MATERIALS AND METHODS

PB, expressed in duration and distribution of physical activity (PA; walking, running, cycling) and sedentary behavior (SB; lying/sitting) and PA intensity was assessed with the Activ8 accelerometer during 7 days. Environmental and personal factors (social influence, health-condition, illness-perception, self-efficacy, fatigue, mood, kinesiophobia, cognition, coping, sleep), participation and HR-QoL, were assessed with validated questionnaires. Correlation analyses were conducted.

RESULTS

In total 39 SAH survivors participated on average 9.6 months post-SAH onset, mean age was 53.2 years (SD = 13.2) and 59% were women. Moderate correlations were found (r = 0.300-0.500, p < 0.05): worse illness-perception, cognition, fatigue, social support, participation, and HR-QoL were associated with worse PA outcomes. Additionally, higher age, unemployment, smoking, longer hospital stay, aneurysmal-SAH, and discharge to outpatient rehabilitation were associated with worse PA outcomes. Worse cognition, participation, smoking, more severe SAH and longer hospital stay were associated with worse SB outcomes.

CONCLUSIONS

Targeting illness perception, cognition, fatigue, and social support, might improve PB post-SAH, which may improve participation and HR-QoL. In smokers (former/current), unemployed, older or more severely affected individuals, improving PB might be more challenging.Implications for rehabilitationBoth environmental and personal factors were associated with poorer physical behavior (PB) after subarachnoid hemorrhage (SAH).Poorer PB was associated with worse participation and HR-QoL in SAH survivors.Targeting social support, illness perception, fatigue and cognition may improve PB after SAH.Improving PB in SAH survivors who smoke or have been smoking, are unemployed, older, or more severely affected, might be challenging.

Similarities and differences in factors associated with high and low sedentary behavior after stroke: a mixed methods study

PURPOSE

To identify similarities and differences in factors affecting activity engagement between adults with stroke who are more and less sedentary.

MATERIALS AND METHODS

Data were pooled from two studies of adults with stroke (N = 36). Sedentary time was measured activPAL micro3. Participants completed activPAL interviews, which were analyzed using framework analysis. Participants were stratified into more and less sedentary groups based on activPAL data. Between-group similarities and differences were identified.

RESULTS

Adults with stroke (mean [SD] age = 65.8 [13.6] years, stroke chronicity = 40.5 [SD = 38.3] months, 36.1% female) were more sedentary (785.5 [64.7] sedentary minutes/day) and less sedentary (583.6 [87.4] sedentary minutes/day). Those who were more sedentary: engaged in basic activities of daily living, avoided activities, received assistance from other people, and did not use strategies to overcome barriers. Those who were less sedentary: engaged in instrumental and community activities, embraced new strategies, did activities with other people, and used strategies to overcome environmental barriers.

CONCLUSIONS

Factors affecting activity engagement differed between people who are more and less sedentary. Interventions that aim to reduce post-stroke sedentary behavior should consider the: (1) types of activities, (2) role of other people, and (2) application of strategies to overcome activity and environment-related barriers.

Do People With Stroke Meet Aerobic and Muscle-Strengthening Activity Guidelines? Data From the Canadian Longitudinal Study on Aging

BACKGROUND AND PURPOSE

It is unclear to what extent Canadians with stroke engage in moderate-vigorous physical activity (MVPA) and muscle-strengthening activities (MSA). The purpose of this study was to describe overall physical activity, aerobic MVPA, and MSA participation in Canadians with stroke; determine the functioning, disability, and health classes that best characterize this population; and examine the relationship between-class membership and physical activity participation.

METHODS

Activity levels were quantified using the Physical Activity Scale for the Elderly in 2094 adults with stroke or transient ischemic attack (mean age 67.9 years, 9.5 years poststroke) from the CLSA. Means and percentages were used to characterize participation. Latent class analysis was used to create health and disability classes, and activity levels were compared between classes.

RESULTS

Only 6.2% (95% confidence interval [CI], 4.8%-8.0%) met both MVPA and MSA guidelines. Most (88.2%, 95% CI, 85.0%-88.9%) engaged in MVPA <3 times/wk and 76.7% (95% CI, 73.7%-79.1%) never engaged in MSA. In latent class analyses, 2 classes for males and females were characterized by high-positive or low-negative levels of intrinsic capacity (eg, grip strength), functional mobility (eg, walking speed), and environment (eg, social support). Those in the low-negative classes had the lowest Physical Activity Scale for the Elderly scores and aerobic MVPA levels compared to the high-positive (healthiest) classes. MSA participation was not different between classes.

DISCUSSION AND CONCLUSIONS

Canadians with stroke are not engaging in sufficient physical activity. Clinicians should encourage regular participation in physical activity, especially among those with lower levels of intrinsic capacity, functional mobility, and environmental support.

Video Abstract available for more insights from the authors (see Supplementary Digital Content 3 available at: http://links.lww.com/JNPT/A494).

Effects of Physiotherapy Interventions for Poststroke Fatigue: A Systematic Review

BACKGROUND

Poststroke fatigue affects half of global patients with stroke, causing early exhaustion, weariness, and dependence. Physiotherapy interventions like exercise and aerobic training are recommended to alleviate symptoms, but their effectiveness is not well supported. This review evaluates physiotherapy's effectiveness in treating poststroke fatigue in adults.

METHODS

We conducted a systematic review using a comprehensive search across multiple databases, including ClinicalTrials.gov, PubMed, PEDro, CINAHL, Embase, Cochrane Library, MEDLINE, and WHO ICTRP. We searched for English-language articles using various keywords, without any restrictions on date, document type, or publication status, and included only randomized controlled trials. After removing duplicates through EndNote X7, 2 independent reviewers screened and reviewed the remaining articles. The Cochrane Risk of Bias Tool was applied to assess the quality of included studies.

RESULTS

A total of 712 articles were reviewed, and after removing duplicates, 450 articles were left, then only 34 articles passed the title screening and 29 were excluded due to various reasons. Therefore, only 4 randomized controlled trials were found relevant after screening out 416 irrelevant ones. The average percentage of participants across all 4 randomized controlled trials was 44.65% men and 55.35% women, with an average age of 59.1 years. The review assessed a range of physiotherapy treatments, such as caregiver-mediated exercise with e-health support, graded activity training with cognitive therapy, and circuit training exercises. Graded activity training with cognitive therapy approach has effectively reduced poststroke fatigue (P<0.001) and improved endurance levels (ηp2=0.20; P<0.001). On the contrary, circuit training is not effective. Caregiver-mediated exercises and e-health supported exercises have been shown to impact functional recovery positively.

CONCLUSIONS

Among all the studies evaluated, only 1 intervention, the graded activity training with cognitive therapy, significantly reduced fatigue after stroke. However, more research is needed to study the effect of physiotherapy interventions.

REGISTRATION

URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42017075196.

Association of physical activity level and all-cause mortality among stroke survivors: evidence from NHANES 2007-2018

BACKGROUND

Post-stroke disability diminishes the physical activity (PA) level of survivors, potentially affecting their long-term prognosis. This study endeavors to explore the correlation between daily PA level and the all-cause mortality in patients with a history of stoke in the United States.

METHODS

Data of stroke survivors were sourced from the National Health and Nutritional Examination Survey (NHANES) 2007-2018. The population was stratified into three groups based on their PA level. Kaplan-Meier method with log-rank tests for significance was used for survival analysis. Weighted Cox proportional hazards regression models were employed to estimate the hazard ratios (HRs) for all-cause mortality. Subgroup analysis was conducted to strengthen the results.

RESULTS

A total of 1395 participants were recruited, comprising 679 males and 716 females, with a median age of 68 years. Based on their PA levels, 779 individuals were classified as inactive, 156 as insufficiently active, and 460 as sufficiently active. Following a median observation period of 59 months, there were 476 recorded deaths, with 349, 47, and 80 cases in the three respective groups. Compared to the inactive group, the HRs and 95% confidence intervals (CIs) for all-cause mortality in participants who were insufficiently active and sufficiently active were 0.58 (0.40, 0.84) and 0.47 (0.33, 0.67), respectively. The Kaplan-Meier curve revealed a significant difference in overall survival between the three groups, as confirmed by the log-rank test (P < 0.0001). Subgroup analysis further validated our results and demonstrated that the protective impact of PA on stroke prognosis varies according to distinct characteristics.

CONCLUSIONS

The results indicate that increased levels of PA are associated with a protective effect on long-term mortality among stroke survivors. Further prospective longitudinal studies are necessary to elucidate the optional PA level and special exercise guideline targeting this population.

Longitudinal relationship between 24-Hour Movement behavior patterns and physical function and quality of life after stroke: a latent transition analysis

BACKGROUND

24-hour movement behavior, including Physical activity (PA), Sedentary behavior (SB), and sleep, is independently associated with health after stroke. Few studies have explored 24-hour movement behavior patterns in stroke survivors and their transitions, as well as the health implications of the transitions. This study aimed to explore the different subgroups and stability of 24-hour movement behavior patterns in people after stroke and the relationship of profile transitions with physical function and health-related quality of life (HRQoL).

METHODS

In this study, 131 people with first-ever stroke were investigated at one week (T1), one month (T2), three months (T3), and six months (T4) after discharge. The participants were asked to wear a wristband smartwatch for 7 consecutive days during each pe riod to collect 24-hour exercise data. After each period, their physical function and HRQoL were assessed. Latent profile analysis (LPA) identified typologies of 24-hour movement behaviors, and latent transition analysis (LTA) examined the stability and change in these profiles over time. The relationship of transition types with physical function and HRQoL was analyzed using a generalized linear regression model.

RESULTS

108 participants were categorized into 3 latent profiles of 24-hour movement behavior: "Active, Non-sedentary, and Short sleep," "Active and Sedentary," and "Inactive and Sedentary." The LTA results indicated that the proportion of participants with the "Active, Non-sedentary, and Short Sleep" profile and "Active and Sedentary" profile staying in the original latent profile was high. However, participants in the "Inactive and Sedentary" profile showed a high probability of transitioning to "Active and Sedentary" profile (T1→T2: 65.2%; T2→T3: 76.3%; T3→T4: 51.7%;T1→T4: 54.2%). Transition types are associated with physical function and HRQoL.

CONCLUSIONS

The results demonstrated substantial transitions in 24-hour movement behaviors within 6 months of rehabilitation after discharge, associated with later physical function and HRQoL. Furthermore, the participants' sedentary behavior was highly stable within 24-hour movement behaviors, necessitating prompt diagnosis and intervention.

Factors Associated With Physical Activity and Sedentary Behavior in People With Parkinson Disease: A Systematic Review and Meta-Analysis

OBJECTIVE

The goal of this review was to investigate factors associated with physical activity and sedentary behavior in people with Parkinson disease (PD). The magnitude of these associations was investigated in line with the International Classification of Functioning, Disability and Health components.

METHODS

A systematic literature review was conducted until February 2023, searching four databases (PubMed, EMBASE, Web of Science, and Scopus) for original articles investigating associations with physical activity or sedentary behavior in people with PD. Two independent researchers performed data extraction, and the risk of bias in the included studies was assessed using the Quality in Prognosis Studies tool. Meta-analyses were conducted to determine the magnitude of the associations, and significant regression models from the included studies were described.

RESULTS

Forty-two studies were included. Twenty-one factors associated with overall physical activity were identified. Higher levels of physical activity had a small association with cognition and body mass index and a fair association with 17 factors related to self-efficacy, physical function, mobility, quality of life, age, PD symptoms, and more. Better manual dexterity and functional gait had moderate to good associations with higher levels of physical activity. The regression model with the higher magnitude was composed mostly of contextual factors, except for the body max index. The magnitude of factors associated with physical activity intensity or sedentary behavior could not be identified.

CONCLUSION

Functional gait and manual dexterity were the strongest factors related to physical activity in people with PD. Further investigation is needed to understand the factors associated with physical activity intensity and sedentary behavior.

IMPACT

This study emphasizes the significance of considering contextual factors alongside body function and structure, activity and participation, and the health condition to enhance physical activity improvement during the rehabilitation process. By adopting such a holistic approach, rehabilitation professionals can optimize the overall health and well-being of individuals with Parkinson disease.

The effects of kinesiophobia, fatigue, and quality of life on physical activity in patients with stroke

BACKGROUND

Physical activity decreases after stroke due to various factors and the causes and effects of these factors remain unclear.

OBJECTIVES

This study aimed todetermine the effects of kinesiophobia, fatigue, and quality of life on physical activity in patients with stroke.

METHODS

The study included 32 patients (13 females/19 males), all evaluated using the Stroke Rehabilitation Assessment of Movement, Barthel Index, Tampa Kinesiophobia Scale-fatigue, Fatigue Impact Scale and Stroke-Specific Quality of Life Scale. The SenseWear multisensory activity monitor was worn on the arm of the patients for 1 week to evaluate active energy expenditure, step count, and rest periods in relation to physical activity. Multiple linear regression analysis was used to examine the effects of the independent variables kinesiophobia, fatigue, and quality of life on the dependent variables of active energy expenditure, step count, and rest periods.

RESULTS

The mean age of the patients was 52.31 ± 14.76 years. According to the multiple regression analysis results, kinesiophobia (p = 0.011) and quality of life (p = 0.009) are significant determinants of active energy expenditure and quality of life (p = 0.001) is a significant determinant of the step count in patients with stroke. Kinesiophobia, fatigue, and quality of life were not determinants of rest periods (p > 0.05).

CONCLUSIONS

The study results showed that kinesiophobia and quality of life are important determinants of physical activity in patients with stroke. Combined evaluation in the clinic of motor findings and non-motor factors, which are often ignored, and the application of target-oriented approaches to these problems will make a significant contribution to the success of stroke rehabilitation.

Genetic associations between physical activity levels and functional outcome after ischemic stroke: Insights from Mendelian randomization

OBJECTIVE

The genetic relationship between daily physical activity (PA) levels and functional outcome after ischemic stroke remains unclear. This study aimed to investigate the genetic associations of PA on functional outcome after ischemic stroke using Mendelian randomization (MR).

METHODS

We conducted two-sample MR analyses using genome-wide association studies (GWASs). This included data on light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) from the UK Biobank, and functional outcome after ischemic stroke from the Genetics of ischemic stroke Functional Outcome (GISCOME). The inverse-variance weighted (IVW) method served as our primary MR analysis approach, supplemented by several sensitivity analyses.

RESULTS

In univariable Mendelian randomization (UVMR) analysis, MVPA was significantly associated with a reduced risk of poor functional outcome (OR = 0.15, 95 % CI = 0.04-0.56, P < 0.01), whereas LPA had no genetic relationship (OR = 0.37, 95 % CI = 0.002-51.40, P = 0.69). In multivariate Mendelian randomization (MVMR) analysis adjusting for potentially confounding traits including hypertension, type 2 diabetes, and smoking, the overall patterns between MVPA and poststroke outcome remained (OR = 0.23, 95 % CI = 0.07-0.78, P = 0.02).

CONCLUSION

MVPA is a protective factor for functional outcome after ischemic stroke. This finding is important for the rehabilitation and functional outcome of stroke patients.

Cardiorespiratory fitness, physical activity, and fatigue three months after first-ever ischemic stroke

BACKGROUND

Research on cardiorespiratory fitness (CRF) in relation to physical activity (PA) and fatigue after stroke is limited. Increased knowledge of interrelationships between these factors can help optimize rehabilitation strategies and improve health-outcomes.

OBJECTIVES

We aimed to: 1) evaluate CRF, PA, and fatigue, 2) characterize patients with impaired versus non-impaired CRF, and 3) examine associations of CRF with PA and fatigue, three months after first-ever ischemic stroke.

METHODS

In this cross-sectional study CRF was measured as peak oxygen uptake (VO2peak) by cardiopulmonary exercise testing. PA was measured using accelerometers. Fatigue was assessed with the 7-item Fatigue Severity Scale (FSS).

RESULTS

The sample (n=74, mean age 64±13 years, 36% women) had a mean VO2peak of 27.0±8.7 (86% of predicted). Fifty-one percent met the World Health Organization's recommendation of ≥150 min of moderate PA/week. Mean steps-per-day was 9316±4424 (113% of predicted). Thirty-five percent of the sample had moderate-to-high fatigue (FSS≥4), mean FSS score was 3.2±1.8.  Patients with impaired CRF (VO2peak<80% of predicted) had higher body-fat-percent (p<0.01), less moderate-to-vigorous PA (MVPA) (p<0.01) and a trend toward higher fatigue (p=0.053) compared to the non-impaired. Backward regression analysis showed that higher CRF was associated with more MVPA (unstandardized beta [95% CI]: 0.38 [0.15, 0.63], p=0.002) and less fatigue (unstandardized beta [95% CI]: -3.9 [-6.4, -1.6], p=0.004).

CONCLUSIONS

Stroke patients had lower CRF compared to reference values. Impaired CRF was mainly related to overweight. Higher CRF was associated with more MVPA and less fatigue. Exercise after stroke may be especially beneficial for patients with impaired CRF.

Matching Clinical Profiles with Interventions to Optimize Daily Stepping in People with Stroke

Background

Individualizing interventions is imperative to optimize physical activity in people with chronic stroke. This secondary analysis grouped individuals with chronic stroke into clinical profiles based on baseline characteristics and examined if these clinical profiles preferentially benefitted from a specific rehabilitation intervention to improve daily step-activity.

Methods

Participants had non-cerebellar strokes ≥6 months prior to enrollment, were 21-85 years old, had walking speeds of 0.3-1.0 m/s, and took <8,000 steps-per-day. Participants were randomized to 1 of 3 interventions: high-intensity treadmill training (FAST), a step-activity behavioral intervention (SAM), or a combined intervention (FAST+SAM). The primary outcome was the interaction of latent class (clinical profile) and intervention group (FAST, SAM, FAST+SAM) on a change in steps-per-day. Key clinical characteristics to identify the latent classes included walking speed, walking endurance, balance self-efficacy, cognition, and area deprivation.

Results

Of the 190 participants with complete pre- and post-intervention data (mean [SD] age, 64 [12] years; 93 females [48.9%]), 3 distinct profiles of people with chronic stroke were identified. Within our sample, class 1 had the lowest walking capacity (speed and endurance), lowest balance self-efficacy, and highest area deprivation, and had the greatest change in step-activity when enrolled in the SAM (mean[95%CI], 1624 [426 - 2821]) or FAST+SAM (1150 [723 - 1577]) intervention. Class 2 had walking capacity, baseline steps-per-day, and self-efficacy values between Class 1 and 3, and had the greatest change in step-activity when enrolled in the SAM (2002 [1193-2811]) intervention. Class 3 had the highest walking capacity, highest self-efficacy, and lowest area deprivation and the greatest change in step-activity when enrolled in the FAST+SAM (1532 [915-2150]) intervention.

Conclusions

People with chronic stroke require different interventions to optimize a change in step-activity. Clinicians can use clinically relevant measures to personalize intervention selection to augment step-activity in people with chronic stroke.

Trial Registration

NCT02835313; https://clinicaltrials.gov/ct2/show/NCT02835313.

Physical activity and influencing factors in people post stroke or transient ischemic attack across diverse regions in Sweden

Background and purpose

Physical activity (PA) and sedentary behavior are key targets for secondary stroke prevention, yet their characteristics and contributing factors are not well understood. This study aims to explore PA and sedentary behavior in individuals' post-stroke or transient ischemic attack (TIA) and identify factors linked to low PA (≤5,000 steps/day) and prolonged sedentary time (≥8 h/day).

Methods

A cross-sectional study comparing sensor-derived (activPAL) PA and sedentary time among community-dwelling individuals post stroke or TIA residing in diverse geographical regions of Sweden. Multiple logistic regression models were performed to determine potential factors associated with low PA and prolonged sedentary time.

Results

The study included 101 participants post-stroke (n = 68) and TIA (n = 33), with a mean age of 70.5 years (65% female), mostly with no or mild disability (91%), living in metropolitan (69%) and rural (31%) areas of Sweden. Most participants (72%) had ≥ 8 h of sedentary time per day and 38% performed ≤5,000 steps per day. Using a walking aid (OR = 11.43, p = 0.002) was independently associated with low PA, whereas contextual factors; living alone (OR = 3.49, p = 0.029) and living in metropolitan areas (OR = 2.79, p = 0.036), were associated with prolonged sedentary time.

Discussion and conclusions

In this study encompassing people post stroke or TIA from diverse geographical regions across Sweden, PA was associated with mobility status whereas sedentary behavior was associated with contextual factors. The results also showed a large variation in PA highlighting the need for tailored strategies to promote PA post stroke or TIA.

Validity and stability of the international physical activity questionnaire short-form for stroke survivors with preserved walking ability

BACKGROUND

Stroke survivors usually present sedentary lifestyles and fail to comply with the World Health Organization physical activity recommendations. Reliable, low-cost, and fast tools are needed to monitor physical activity levels in this population.

OBJECTIVES

This study aimed to evaluate the content and face validity, construct validity, and test-retest stability of the International Physical Activity Questionnaire Short-Form (IPAQ-SF) in stroke survivors.

METHODS

One hundred and twenty stroke survivors able to walk independently and preserved comprehension and communication abilities (61 ± 12 years, 35% female) were involved in this psychometric study. Participants completed the interview form of the IPAQ-SF via standardized videoconference twice, one week apart, under identical conditions, to evaluate test-retest stability. Correlations between IPAQ-SF and the caloric expenditure during the minutes of activity registered with the Fitbit Inspire 2 activity tracker wristband and 6-Metre Timed Walk (6MTW) were explored to assess construct validity.

RESULTS

The IPAQ-SF showed good content and face validity. "Moderate" to "strong" correlations were found with the Fitbit Inspire 2 (rho: 0.40 to 0.63), while "weak" to "moderate" correlations were found with the 6MTW (rho: 0.35 to 0.50). Test-retest stability was "moderate" to "excellent" (κ: 0.844 to 0.881; ICC: 0.533 to 0.917).

CONCLUSIONS

The IPAQ-SF demonstrated satisfactory content and construct validity, and stability in stroke survivors, supporting its clinical and research utility when the data collection is conducted by trained evaluators using a standardized interview protocol in large samples.

Adapting a Telehealth Physical Activity and Diet Intervention to a Co-Designed Website for Self-Management After Stroke: Tutorial

People who experience a stroke are at a higher risk of recurrent stroke when compared with people who have not had a stroke. Addressing modifiable risk factors like physical inactivity and poor diet has been shown to improve blood pressure, a leading contributor to stroke. However, survivors of stroke often experience challenges with accessing risk reduction services including long wait lists, difficulty with transportation, fatigue, impaired function, and diminished exercise capacity. Providing health interventions via a website can extend the reach when compared with programs that are only offered face to face or via real-time telehealth. Given global challenges of accessing secondary prevention programs, it is important to consider alternative ways that this information can be made available to survivors of stroke worldwide. Using the "design thinking" framework and drawing on principles of the integrated knowledge translation approach, we adapted 2 co-designed telehealth programs called i-REBOUND - Let's get moving (physical activity intervention) and i-REBOUND - Eat for health (diet Intervention) to create the i-REBOUND after stroke website. The aim of this paper is to describe the systematic process undertaken to adapt resources from the telehealth delivered i-REBOUND - Let's get moving and i-REBOUND - Eat for health programs to a website prototype with a focus on navigation requirements and accessibility for survivors of stroke. We engaged a variety of key stakeholders with diverse skills and expertise in areas of stroke recovery, research, and digital health. We established a governance structure, formed a consumer advisory group, appointed a diverse project team, and agreed on scope of the project. Our process of adaptation had the following 3 phases: (1) understand, (2) explore, (3) materialize. Our approach considered the survivor of stroke at the center of all decisions, which helped establish guiding principles related to our prototype design. Careful and iterative engagement with survivors of stroke together with the application of design thinking principles allowed us to establish the functional requirements for our website prototype. Through user testing, we were able to confirm the technical requirements needed to build an accessible and easy-to-navigate website catering to the unique needs of survivors of stroke. We describe the process of adapting existing content and co-creating new digital content in partnership with, and featuring, people who have lived experience of stroke. In this paper, we provide a road map for the steps taken to adapt resources from 2 telehealth-delivered programs to a website format that meets specific navigation and accessibility needs of survivors of stroke.

Analyzing the Impact of Rehabilitation Utilizing Neurofunctional Exercises on the Functional Status of Stroke Patients

Background/Objectives: Physical rehabilitation based on neurofunctional exercises can have a positive impact on restoring functionality and enhancing the quality of life of these individuals. Therefore, the purpose of this study is to analyze the effects of rehabilitation, including neurofunctional exercises, on the functional status of stroke patients. Methods: The cohort study design included 102 male and female participants: 51 patients underwent physiotherapy rehabilitation including neurofunctional exercises (SG), while the other 51 did not follow a rehabilitation program based on neurofunctional exercises (CG). The participants were assessed twice: once during their stay in the early neurology department after the first stroke, and again six months later. The assessments were conducted using the Barthel Scale (BS), the Rankin Scale (RS), and the National Institutes of Health Stroke Scale (NIHSS). Results: Baseline comparisons revealed significantly greater BS (p = 0.001) in the CG compared to the SG. Conversely, the SG had a significantly higher NIHSS than the CG at baseline (p = 0.001), as well as higher RS (p < 0.001). Within the SG, there were significant increases in BS (p < 0.001), while no significant differences were found between baseline and post 6 months in RS (p = 0.537) and NIHSS (p = 0.475). Regarding the CG, significant increases were observed in BS (p = 0.005) and NIHSS (p < 0.001), while no significant differences were found in RS (p = 0.335). Conclusions: In conclusion, this study reveals that incorporating neurofunctional exercises does not appear to play a significant role in the patients' progress. The controlled group, engaged in home-based activities, showed greater improvements in their condition.

Association between lower extremity physical function and physical activity after ischemic stroke: Longitudinal findings from the MOBITEC-Stroke project

Background

Stroke often results in physical impairments. Physical activity is crucial for rehabilitation, enhancing mobility, strength, and overall health. This study examines the association between Timed Up-and-Go (TUG) test performance and changes in physical activity to improve lower extremity physical function.

Methods

The MOBITEC-Stroke Cohort Study ("Recovery of mobility function and life-space mobility after ischemic stroke") included patients with a first incidence of stroke. Data assessed 3 and 12 months after stroke were used for analysis. Linear regression model adjusted for age, sex, instrumental activities of daily living, Falls Efficacy Scale-International, modified Ranking Scale, and National Institutes of Health Stroke Scale-score was used to examine the relationship between lower extremity physical function (i.e., TUG) and change in physical activity (i.e., minutes of physical activity measured with a wrist-worn accelerometer over 1 week).

Results

Longitudinal data of 49 patients (65% male, mean age 71.2 (SD: 10.4) years) were analyzed. Mean daily physical activity was 291.6 (SD: 96.2) min at 3 months and 298.9 (SD: 94.4) min at 12 months, with a change from 3 to 12 months of 7.3 min (95% CI: -9.4 to 24.0; p = 0.394) post-stroke. We observed significant relationships between the baseline TUG performance and the change in total physical activity over 9 months (p = 0.011) and between the change of TUG performance over time and the change in total physical activity (p = 0.022).

Conclusion

Our findings indicate that better initial lower extremity physical function and higher improvements in function over time are associated with a greater increase in physical activity levels after stroke. This suggests that interventions aimed at maintaining and improving lower extremity physical function may positively affect physical activity levels.

Clinical Value of Impulse Oscillometry in Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

INTRODUCTION

Impulse oscillometry (IOS) is an effortless test compared to spirometry. Numerous studies explored the role of IOS in spirometry-based chronic obstructive pulmonary disease (COPD), but most of them had limited sample sizes with poor statistical power. This systematic review and meta-analysis aimed to pool the individual data and quantitatively analyze the clinical value of IOS in COPD.

METHODS

PubMed, Web of Science, Ovid, Cochrane Library, China National Knowledge Internet, and Wanfang were searched for studies with comparisons of IOS indicators between COPD patients and healthy controls, including respiratory resistance at 5 Hz (R5) and 20 Hz (R20), difference between R5 and R20 (R5-R20), respiratory reactance at 5 Hz (X5), resonant frequency (Fres), and area of reactance (Ax). Meta-analyses were conducted to calculate the weighted mean differences (WMDs) and 95% confidence intervals (CIs).

RESULTS

39 eligible studies were enrolled, involving 6,144 COPD patients and 4,611 healthy controls. Relative to healthy controls, COPD patients had significantly higher R5 (WMD: 0.17, 95% CI: 0.14, 0.20), R5-R20 (WMD: 0.13, 95% CI: 0.11, 0.15), Fres (WMD: 9.04, 95% CI: 7.66, 10.42), Ax (WMD: 1.24, 95% CI: 0.86, 1.61), and lower X5 (WMD: -0.15, 95% CI: -0.18, -0.11), and such differences became even greater as the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage escalated. Pooled correlation coefficients presented that R5, R5-R20, Fres, and X5 were significantly related to post-bronchodilator forced expiratory volume in the first second (FEV1)/forced vital capacity ratio (meta r = -0.37, -0.45, -0.53, and 0.42, respectively) and FEV1 as a percentage of predicted value (meta r = -0.43, -0.54, -0.59, and 0.56, respectively).

CONCLUSION

IOS may be a supplement to spirometry in diagnosing and assessing COPD, especially when spirometry is inappropriate. More well-designed, large sample-sized, prospective studies are warranted to establish an IOS-based criterion for COPD management.

Aerobic exercise prescription for patients after stroke: Current scenario and barriers perceived by Brazilian physical therapists

BACKGROUND

Guidelines recommend incorporating aerobic exercise into stroke rehabilitation. However, implementing this is challenging due to safety concerns, institutional and patient characteristics, and unfamiliarity with aerobic exercise guidelines. No study has assessed the parameters used and perceived barriers among Brazilian physical therapists when prescribing aerobic exercise for individuals after stroke.

OBJECTIVES

This study aimed to investigate how Brazilian physical therapists prescribe aerobic exercise for individuals after stroke and identify perceived barriers in clinical rehabilitation.

METHODS

A web-based cross-sectional observational study was performed, recruiting Brazilian physical therapists who had treated at least one individual after stroke in the last 3 months. The questionnaire was distributed via social networks.

RESULTS

79 participants were included (76% female; mean age 34 ± 8.3 years; 63% from the Southeast). Almost all (n = 78; 99%) agreed on the importance of incorporating aerobic exercise into stroke rehabilitation. Overground walking was the most prescribed aerobic exercise (89%). Moderate intensity (40%-59% of heart rate reserve) was the most common (51%) prescription. However, some respondents were unaware of the prescribed intensity (11%). On average, participants prescribed aerobic exercise for 44 ± 17 min, typically twice a week. The most cited barrier was cognitive dysfunction in individuals after stroke (58%). Only two participants reported no barriers.

CONCLUSIONS

Most Brazilian physical therapists recognize the importance of aerobic exercise in stroke rehabilitation. However, uncertainty regarding exercise intensity and multiple reported barriers challenge adequate prescription.

What factors at discharge predict physical activity and walking outcomes 6 months after stroke? A systematic review

OBJECTIVE

This study aimed to identify factors at hospital discharge that predict physical activity and walking outcomes in the first 6 months after stroke.

DATA SOURCES

Searches were conducted in CINAHL (EBSCO), Web of Science, PubMed and Scopus from inception to 30 April 2024. Reference lists of included articles were manually screened to identify additional studies.

REVIEW METHODS

Studies of adults with stroke reporting predictors at hospital discharge and outcomes of physical activity or walking across the first 6 months after hospital discharge were included. Two reviewers independently screened titles, abstracts and reviewed full texts. Quality of included studies was assessed with Quality in Prognostic Studies screening tool. A narrative synthesis was undertaken.

RESULTS

The search strategy retrieved 7834 studies, from which 6 eligible studies were identified, including a total of 1433 participants. Overall, studies had a low risk of bias. Age, balance, walking speed and walking distance at hospital discharge predicted physical activity outcomes after stroke (n = 2 studies). Cognition, lower limb cycling rhythm and self-efficacy for walking at hospital discharge predicted walking outcomes after stroke (n = 4 studies).

CONCLUSIONS

A range of factors predicted physical activity and walking outcomes 6 months after stroke. Physical capabilities at discharge appear to be a predictor of these outcomes; however, this needs to be interpreted with caution. Diverse measures and time points were used across studies to characterise physical activity and walking outcomes, highlighting the need for consistency in measurement and longitudinal studies in stroke research.

Effect of Pre-Hospitalization Fall History on Physical Activity and Sedentary Behavior After the Implementation of a Behavioral Change Approach in Patients with Minor Ischemic Stroke: A Secondary Analysis of a Randomized Controlled Trial

BACKGROUND

We aimed to determine whether a history of falls before admission affected physical activity levels and sedentary behavior negatively after implementing a behavior modification approach in patients with minor ischemic stroke.

METHODS

This study constituted a secondary analysis of an intervention trial. In the intervention study, patients with minor ischemic stroke were randomly assigned to two groups: intervention and control groups. The intervention group was encouraged to reduce sedentary behavior during hospitalization and after discharge, while the control group was encouraged to increase physical activity levels solely during hospitalization. The study included 52 patients who completed the intervention trial. The exposure factor examined was a history of falls. Upon admission, patients were queried about any falls experienced in the year preceding admission and subsequently classified into fall and non-fall groups based on their responses. The primary outcome of interest focused on changes in physical activity levels (step count, light-intensity physical activity, and moderate-to-vigorous-intensity physical activity) and sedentary behavior. Measurements were obtained at two time points: before the intervention, during hospitalization (baseline), and 3 months after discharge (post-intervention).

RESULTS

Only a significantly lower change in the number of steps taken in the fall group than in the non-fall group was found.

CONCLUSION

Those with a history of falls showed a lesser change in the number of steps taken before and after implementing a behavior change approach compared with those without a history of falls. Those with a history of falls may have engaged in activities other than walking.

The relationship between levels of physical activity and participation in everyday life in stroke survivors: A systematic review and meta-analysis

BACKGROUND

Stroke survivors demonstrate decreased physical activity (PA) and take time to return to participation in everyday life, but the relationship between the two variables is unknown.

OBJECTIVE

To investigate the correlation and trajectory over time between levels of PA and participation in everyday life in stroke survivors.

METHODS

PubMed, Web of Science, Scopus, SPORTDiscus, Rehabilitation&Sport Medicine Source, and PEDro databases were searched from inception to January 2024. Cross-sectional and prospective studies evaluating both levels of PA and participation in stroke survivors were included. Two reviewers independently conducted the study selection, data extraction, and quality assessment. Meta-analyses of pooled correlation coefficients were calculated when at least two studies reported a correlation coefficient between the same PA and participation outcomes.

RESULTS

Of 4962 studies identified, 49 were included in the systematic review. Studies were rated high (55%%) or fair (45%) quality. A wide range of monitoring methodologies for assessing PA and participation were found in the 23 prospective studies. Seven studies were included in the meta-analyses, showing a positive moderate correlation between PA time and participation in activities of daily living (n = 148; r = 0.52; P < 0.01; I2 = 81%) in participants <6 months post-stroke, and between PA time and the participation in all areas (n = 126; r = 0.44; P < 0.01; I2 = 0%) in participants ≥6 months post-stroke. Overall, while PA showed significant improvements over time, participation only showed a tendency.

CONCLUSION

Despite the heterogeneity, consistent positive associations were found between PA time and participation levels in some areas. Establishing consensus is crucial to reduce heterogeneity and facilitate data pooling.

Factors Affecting Level of Physical Activity among Stroke Survivors: A Scoping Review

Physical activity (PA) is crucial for improving stroke survivors' health outcomes and quality of life (QoL). Impaired PA levels are common among stroke survivors, a significant portion of whom spend their days in sedentary occupations. Understanding the factors that influence physical inactivity and addressing the barriers to exercise participation can contribute significantly to improving stroke survivors' health outcomes and prognoses. Therefore, in the current review, we systematically searched five databases (PubMed/Medline, Scopus, SpringerLink, ScienceDirect and Google Scholar) for published studies reporting PA levels among stroke survivors, which yielded 301 potential articles. Based on the identification and screening processes recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR), 13 articles were finally included in the analysis. The results of these studies, covering 1,318 stroke survivors, revealed physical inactivity among most of the participants and significant heterogeneity among the outcome measures used. The factors affecting PA levels among stroke survivors were mainly categorised as physical, psychological, and sociodemographic, and all were significantly associated with PA levels after strokes.

A New Perspective on Stroke Research: Unraveling the Role of Brain Oxygen Dynamics in Stroke Pathophysiology

Stroke, a leading cause of death and disability, often results from ischemic events that cut off the brain blood flow, leading to neuron death. Despite treatment advancements, survivors frequently endure lasting impairments. A key focus is the ischemic penumbra, the area around the stroke that could potentially recover with prompt oxygenation; yet its monitoring is complex. Recent progress in bioluminescence-based oxygen sensing, particularly through the Green enhanced Nano-lantern (GeNL), offers unprecedented views of oxygen fluctuations in vivo. Utilized in awake mice, GeNL has uncovered hypoxic pockets within the cerebral cortex, revealing the brain's oxygen environment as a dynamic landscape influenced by physiological states and behaviors like locomotion and wakefulness. These findings illuminate the complexity of oxygen dynamics and suggest the potential impact of hypoxic pockets on ischemic injury and recovery, challenging existing paradigms and highlighting the importance of microenvironmental oxygen control in stroke resilience. This review examines the implications of these novel findings for stroke research, emphasizing the criticality of understanding pre-existing oxygen dynamics for addressing brain ischemia. The presence of hypoxic pockets in non-stroke conditions indicates a more intricate hypoxic scenario in ischemic brains, suggesting strategies to alleviate hypoxia could lead to more effective treatments and rehabilitation. By bridging gaps in our knowledge, especially concerning microenvironmental changes post-stroke, and leveraging new technologies like GeNL, we can pave the way for therapeutic innovations that significantly enhance outcomes for stroke survivors, promising a future where an understanding of cerebral oxygenation dynamics profoundly informs stroke therapy.

Relationship between the amount of physical activity and brain structure in patients with chronic stroke

OBJECTIVES

The association between the amount of physical activity and the brain structure in patients with stroke is unclear. Therefore, this study aimed to evaluate the structural characteristics of the brain in patients with chronic stroke engaging in varying levels of physical activity.

METHODS

This study included 10 healthy participants and 10 patients with stroke. Structural images were obtained, and the physical activity of patients with stroke was measured using a triaxial accelerometer. Additionally, the brain structure was assessed using voxel-based morphometry for gray and white matter volumes. The analysis software used were Statistical Parametric Mapping 12 and MATLAB version R2020a. The differences in brain structure between healthy participants and stroke patients were investigated. The brain regions associated with the amount of physical activity were analyzed.

RESULTS

There was a significant decrease in the gray matter volume of the contralesional cerebellum and ipsilesional thalamus in stroke patients when compared with healthy participants (p < 0.001, uncorrected). Patients with stroke showed a positive correlation between physical activity and the volume of the ipsilesional precentral gyrus and ipsilesional entorhinal area (p < 0.001, uncorrected).

CONCLUSIONS

The amount of physical activity in patients with chronic hemiplegic stroke is associated with brain gray matter mass.

Neighborhood Resources and Health Outcomes Among Stroke Survivors in a Population-Based Cohort

BACKGROUND

Stroke survivors believe neighborhood resources such as community centers are beneficial; however, little is known about the influence of these resources on stroke outcomes. We evaluated whether residing in neighborhoods with greater resource density is associated with favorable post-stroke outcomes.

METHODS AND RESULTS

We included Mexican American and non-Hispanic White stroke survivors from the Brain Attack Surveillance in Corpus Christi project (2009-2019). The exposure was density of neighborhood resources (eg, community centers, restaurants, stores) within a residential census tract at stroke onset. Outcomes included time to death and recurrence, and at 3 months following stroke: disability (activities of daily living/instrumental activities of daily living), cognition (Modified Mini-Mental State Exam), depression (Patient Health Questionnaire-8), and quality of life (abbreviated Stroke-Specific Quality of Life scale). We fit multivariable Cox regression and mixed linear models. We considered interactions with stroke severity, ethnicity, and sex. Among 1786 stroke survivors, median age was 64 years (interquartile range, 56-73), 55% men, and 62% Mexican American. Resource density was not associated with death, recurrence, or depression. Greater resource density (75th versus 25th percentile) was associated with more favorable cognition (Modified Mini-Mental State Exam mean difference=0.838, 95% CI=0.092, 1.584) and among moderate-severe stroke survivors, with more favorable functioning (activities of daily living/instrumental activities of daily living=-0.156 [95% CI, -0.284 to 0.027]) and quality of life (abbreviated Stroke-Specific Quality of Life scale=0.194 [95% CI, 0.029-0.359]).

CONCLUSIONS

We observed associations between greater resource density and cognition overall and with functioning and quality of life among moderate-severe stroke survivors. Further research is needed to confirm these findings and determine if neighborhood resources may be a tool for recovery.

Enhancing physical activity and augmenting upper limb function in sedentary stroke survivors: the transformative impact of chair transitions

In post-stroke individuals with walking difficulties, prolonged sitting can lead to increased mortality. Interventions targeting increased physical activity for these individuals are limited. Consequently, many such stroke survivors become reliant on wheelchairs, leading to prolonged inactivity. This report highlights a case where a chronic stroke patient, with walking challenges, was transitioned from a wheelchair to regular chair sitting by nursing staff in a facility lacking specialised rehabilitation professionals. This simple act of transitioning from a wheelchair to a chair during daily routines led to improvements in the patient's physical activity and upper limb functionality and reduced the need for help during meals.

Prognostic value of inflammatory markers NLR, PLR, and LMR in gastric cancer patients treated with immune checkpoint inhibitors: a meta-analysis and systematic review

Background

Immune checkpoint inhibitors (ICIs) represent a groundbreaking approach to cancer therapy. Inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) have emerged as potential indicators strongly associated with tumor prognosis, albeit their prognostic significance remains contentious. The predictive value of NLR, PLR, LMR in patients with gastric cancer (GC) treated with ICIs has not been fully explored; therefore, we conducted a meta-analysis to examine the potential of inflammatory markers NLR, PLR, and LMR as survival predictors in this population.

Methods

A comprehensive search was conducted across PubMed, Embase, Web of Science, and Cochrane databases, with the search cut-off date set as March 2024. Hazard ratios (HR) and their corresponding 95% confidence intervals (CI) were calculated to assess the prognostic significance of NLR, PLR, and LMR for both progression-free survival (PFS) and overall survival (OS).

Results

Fifteen cohort studies involving 1336 gastric cancer patients were finally included in this meta-analysis. The results of the meta-analysis showed that high levels of NLR were associated with poorer OS and PFS in GC patients receiving ICIs, with combined HRs of OS [HR=2.01, 95%CI (1.72,2.34), P<0.01], and PFS PFS[HR=1.59, 95%CI (1.37,1.86), P<0.01], respectively; high levels of PLR were associated with poorer OS and PFS, and the combined HR was OS [HR=1.57, 95%CI (1.25,1.96), P<0.01], PFS [HR=1.52,95%CI (1.20, 1.94), P<0.01], respectively; and there was an association between elevated LMR and prolonged OS and PFS, and the combined HR was OS [HR=0.62, 95%CI (0.47,0.81), P<0.01], and PFS [HR=0.69, 95%CI (0.50,0.95), P<0.01].

Conclusion

In gastric cancer (GC) patients treated with immune checkpoint inhibitors (ICIs), elevated neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were associated with poorer overall survival (OS) and progression-free survival (PFS), while high lymphocyte-to-monocyte ratio (LMR) was linked to improved OS and PFS. Subgroup analyses suggested that NLR might be particularly pertinent to the prognosis of GC patients. In conclusion, the inflammatory markers NLR, PLR, and LMR serve as effective biomarkers for prognostic assessment in GC patients, offering valuable insights for therapeutic decision-making in the realm of GC immunotherapy. Prospective studies of high quality are eagerly awaited to validate these findings in the future.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/#myprospero, identifier CRD42024524321.

Factors influencing physical activity levels in elderly community-dwelling convalescent stroke survivors: A cross-sectional study

AIM

This study aimed to investigate factors affecting physical activity (PA) among elderly stroke survivors living in the community and assess the mediating role of exercise planning in the relationship between exercise self-efficacy and PA.

METHODS

300 participants were surveyed using questionnaires and scales, with data analyzed using SPSS 26.0.

RESULTS

Univariate analysis identified sociological, disease-related factors, exercise self-efficacy, and exercise planning as influencing PA. Ordered logistic regression showed significant associations between PA, exercise self-efficacy (OR 1.093, 95 % CI 1.055-1.133, P < 0.001), and exercise planning (OR 1.296, 95 % CI 1.202-1.398, P < 0.001). Exercise planning partially mediated the relationship between exercise self-efficacy and PA, accounting for 64.86 % of the total effect.

CONCLUSIONS

Multiple factors, including sociological and disease-related ones, as well as exercise self-efficacy and planning, influence PA in elderly stroke survivors. Exercise planning partially mediates the relationship between exercise self-efficacy and PA.

High-Intensity Aphasia Intervention Is Minimally Fatiguing in Chronic Aphasia: An Analysis of Participant Self-Ratings From a Large Randomized Controlled Trial

BACKGROUND

High-intensity therapy is recommended in current treatment guidelines for chronic poststroke aphasia. Yet, little is known about fatigue levels induced by treatment, which could interfere with rehabilitation outcomes. We analyzed fatigue experienced by people with chronic aphasia (>6 months) during high-dose interventions at 2 intensities.

METHODS

A retrospective observational analysis was conducted on self-rated fatigue levels of people with chronic aphasia (N=173) collected during a previously published large randomized controlled trial of 2 treatments: constraint-induced aphasia therapy plus and multi-modality aphasia therapy. Interventions were administered at a higher intensity (30 hours over 2 weeks) or lower intensity (30 hours over 5 weeks). Participants rated their fatigue on an 11-point scale before and after each day of therapy. Data were analyzed using Bayesian ordinal multilevel models. Specifically, we considered changes in self-rated participant fatigue across a therapy day and over the intervention period.

RESULTS

Data from 144 participants was analyzed. Participants were English speakers from Australia or New Zealand (mean age, 62 [range, 18-88] years) with 102 men and 42 women. Most had mild (n=115) or moderate (n=52) poststroke aphasia. Median ratings of the level of fatigue by people with aphasia were low (1 on a 0-10-point scale) at the beginning of the day. Ratings increased slightly (+1.0) each day after intervention, with marginally lower increases in the lower intensity schedule. There was no evidence of accumulating fatigue over the 2- or 5-week interventions.

CONCLUSIONS

Findings suggest that intensive intervention was not associated with large increases in fatigue for people with chronic aphasia enrolled in the COMPARE trial (Constraint-Induced or Multimodality Personalised Aphasia Rehabilitation). Fatigue did not change across the course of the intervention. This study provides evidence that intensive treatment was minimally fatiguing for stroke survivors with chronic aphasia, suggesting that fatigue is not a barrier to high-intensity treatment.

Highlighting Unseen Activity Through 48-Hour Continuous Measurement in Subacute Stroke Rehabilitation: Preliminary Cohort Study

BACKGROUND

Motor impairments not only lead to a significant reduction in patient activity levels but also trigger a further deterioration in motor function due to deconditioning, which is an issue that is particularly pronounced during hospitalization. This deconditioning can be countered by sustaining appropriate activity levels. Activities that occur outside of scheduled programs, often overlooked, are critical in this context. Wearable technology, such as smart clothing, provides a means to monitor these activities.

OBJECTIVE

This study aimed to observe activity levels in patients who had strokes during the subacute phase, focusing on both scheduled training sessions and other nontraining times in an inpatient rehabilitation environment. A smart clothing system is used to simultaneously measure heart rate and acceleration, offering insights into both the amount and intensity of the physical activity.

METHODS

In this preliminary cohort study, 11 individuals undergoing subacute stroke rehabilitation were enrolled. The 48-hour continuous measurement system, deployed at admission and reassessed 4 weeks later, monitored accelerometry data for physical activity (quantified with a moving SD of acceleration [MSDA]) and heart rate for intensity (quantified with percent heart rate reserve). The measurements were performed using a wearable activity monitoring system, the hitoe (NTT Corporation and Toray Industries, Inc) system comprising a measuring garment (wear or strap) with integrated electrodes, a data transmitter, and a smartphone. The Functional Independence Measure was used to assess the patients' daily activity levels. This study explored factors such as differences in activity during training and nontraining periods, correlations with activities of daily living (ADLs) and age, and changes observed after 4 weeks.

RESULTS

A significant increase was found in the daily total MSDA after the 4-week program, with the average percent heart rate reserve remaining consistent. Physical activity during training positively correlated with ADL levels both at admission (ρ=0.86, P<.001) and 4 weeks post admission (ρ=0.96, P<.001), whereas the correlation between age and MSDA was not significant during training periods at admission (ρ=-0.41, P=.21) or 4 weeks post admission (ρ=-0.25, P=.45). Conversely, nontraining activity showed a negative correlation with age, with significant negative correlations with age at admission (ρ=-0.82, P=.002) and 4 weeks post admission (ρ=-0.73, P=.01).

CONCLUSIONS

Inpatient rehabilitation activity levels were positively correlated with ADL levels. Further analysis revealed a strong positive correlation between scheduled training activities and ADL levels, whereas nontraining activities showed no such correlation. Instead, a negative correlation between nontraining activities and age was observed. These observations suggest the importance of providing activity opportunities for older patients, while it may also suggest the need for adjusting the activity amount to accommodate the potentially limited fitness levels of this demographic. Future studies with larger patient groups are warranted to validate and further elucidate these findings.

Improving physical movement during stroke rehabilitation: investigating associations between sleep measured by wearable actigraphy technology, fatigue, and key biomarkers

BACKGROUND

Sleep disturbance and fatigue are common in individuals undergoing inpatient rehabilitation following stroke. Understanding the relationships between sleep, fatigue, motor performance, and key biomarkers of inflammation and neuroplasticity could provide valuable insight into stroke recovery, possibly leading to personalized rehabilitation strategies. This study aimed to investigate the influence of sleep quality on motor function following stroke utilizing wearable technology to obtain objective sleep measurements. Additionally, we aimed to determine if there were relationships between sleep, fatigue, and motor function. Lastly, the study aimed to determine if salivary biomarkers of stress, inflammation, and neuroplasticity were associated with motor function or fatigue post-stroke.

METHODS

Eighteen individuals who experienced a stroke and were undergoing inpatient rehabilitation participated in a cross-sectional observational study. Following consent, participants completed questionnaires to assess sleep patterns, fatigue, and quality of life. Objective sleep was measured throughout one night using the wearable Philips Actiwatch. Upper limb motor performance was assessed on the following day and saliva was collected for biomarker analysis. Correlation analyses were performed to assess the relationships between variables.

RESULTS

Participants reported poor sleep quality, frequent awakenings, and difficulties falling asleep following stroke. We identified a significant negative relationship between fatigue severity and both sleep quality (r=-0.539, p = 0.021) and participants experience of awakening from sleep (r=-0.656, p = 0.003). A significant positive relationship was found between grip strength on the non-hemiplegic limb and salivary gene expression of Brain-derived Neurotrophic Factor (r = 0.606, p = 0.028), as well as a significant negative relationship between grip strength on the hemiplegic side and salivary gene expression of C-reactive Protein (r=-0.556, p = 0.048).

CONCLUSION

The findings of this study emphasize the importance of considering sleep quality, fatigue, and biomarkers in stroke rehabilitation to optimize recovery and that interventions may need to be tailored to the individual. Future longitudinal studies are required to explore these relationships over time. Integrating wearable technology for sleep and biomarker analysis can enhance monitoring and prediction of outcomes following stroke, ultimately improving rehabilitation strategies and patient outcomes.

A decision tree algorithm to identify predictors of post-stroke complex regional pain syndrome

This prospective cohort study aimed to identify the risk factors for post-stroke complex regional pain syndrome (CRPS) using a decision tree algorithm while comprehensively assessing upper limb and lower limb disuse and physical inactivity. Upper limb disuse (Fugl-Meyer assessment of upper extremity [FMA-UE], Action Research Arm Test, Motor Activity Log), lower limb disuse (Fugl-Meyer Assessment of lower extremity [FMA-LE]), balance performance (Berg balance scale), and physical inactivity time (International Physical Activity Questionnaire-Short Form [IPAQ-SF]) of 195 stroke patients who visited the Kishiwada Rehabilitation Hospital were assessed at admission. The incidence of post-stroke CRPS was 15.4% in all stroke patients 3 months after admission. The IPAQ, FMA-UE, and FMA-LE were extracted as risk factors for post-stroke CRPS. According to the decision tree algorithm, the incidence of post-stroke CRPS was 1.5% in patients with a short physical inactivity time (IPAQ-SF < 635), while it increased to 84.6% in patients with a long inactivity time (IPAQ-SF ≥ 635) and severe disuse of upper and lower limbs (FMA-UE score < 19.5; FMA-LE score < 16.5). The incidence of post-stroke CRPS may increase with lower-limb disuse and physical inactivity, in addition to upper-limb disuse. Increasing physical activity and addressing lower- and upper-limb motor paralysis may reduce post-stroke CRPS.

Stroke related sarcopenia in individuals with different physical activity levels: A cross-sectional study

BACKGROUND AND OBJECTIVE

Individuals after stroke are likely to deal with the possible development of sarcopenia and reduced physical activity levels. The purpose of this study was to compare sarcopenia of individuals with chronic stroke who were stratified according to their physical activity levels, and to evaluate the relationship between sarcopenia and physical activity levels.

MATERIALS AND METHODS

This cross-sectional study was conducted with individuals after chronic stroke recruited from the general community. Individuals were submitted to sarcopenia screening (SARC-F questionnaire) and assessment of physical activity levels (Human Activity Profile questionnaire) to classify the individuals as impaired, moderately active, and active according to their Adjusted Activity Status (AAS). ANOVA was used to investigate the sarcopenia between groups and Pearson's coefficient to investigate the association among variables.

RESULTS

Fifty-four individuals with a mean age of 56 ± 17.4 years were included. Twenty-one percent of the individuals were screened for sarcopenia. Inactive individuals had higher mean scores in the SARC-F (3.6 ± 2.1 points), whereas moderately active and active individuals presented lower mean scores in the same questionnaire, being 1.2 ± 1.1 points and 0.5 ± 0.7 points, respectively. A statistically significant inverse and high association was found between sarcopenia and physical activity levels (r = -0.716; p < 0.01).

CONCLUSION

Sarcopenia was found to be higher in individuals after chronic stroke with lower physical activity levels considered inactive when compared to individuals with higher physical activity levels. Furthermore, there was an inverse relationship between sarcopenia and physical activity level in stroke survivors.

Use of the Capability, Opportunity and Motivation Behaviour model (COM-B) to Understand Interventions to Support Physical Activity Behaviour in People with Stroke: An Overview of Reviews

OBJECTIVE

Physical activity in people with stroke remains low despite considerable research. This overview aimed to provide high-level synthesis and aid clinical decision-making. The Capability, Opportunity, Motivation-Behaviour (COM-B) model was used to classify interventions to understand which components improve physical activity behaviour in people with stroke.

DATA SOURCES

CINAHL, Cochrane Database, MEDLINE, PEDro, PsychINFO, SPORTDiscus.

REVIEW METHODS

A systematic search was conducted (November 2023) to identify reviews of interventions to improve physical activity in people with stroke. Results were screened and assessed for eligibility. Participant characteristics, intervention classification using COM-B, and effect of intervention were extracted. Quality was assessed using AMSTAR2, and Corrected Cover Analysis for study overlap. Narrative synthesis was used to understand components of interventions to improve physical activity behaviour.

RESULTS

1801 references were screened and 29 full-text references assessed for eligibility. Twenty reviews were included. Quality ranged from critically low (n = 3) to high (n = 10). Study overlap calculated using corrected cover area indicated slight overlap (0.028) and minimal reporting bias.The majority of participants were mobile with mild stroke and community dwelling. Twenty-three interventions were classified using COM-B. Three of twelve interventions classified to one aspect of the COM-B were effective. Fourteen of sixteen effective interventions combined at least two COM-B elements, ten of these combined capability and motivation.

CONCLUSION

Interventions including at least two elements of the COM-B are most likely to improve physical activity in mobile stroke survivors. Further research is needed to understand physical activity behaviour in those with moderate to severe stroke.

Fatigue in patients with acquired brain damage

Fatigue is a complex, multidimensional syndrome that is prevalent in patients with acquired brain damage and has a negative impact on the neurorehabilitation process. It presents from early stages after the injury, and may persist over time, regardless of whether sequelae have resolved. Fatigue is conditioned by upper neuronal circuits, and is defined as an abnormal perception of overexertion. Its prevalence ranges from 29% to 77% after stroke, from 18% to 75% after traumatic brain injury, and from 47% to 97% after brain tumours. Fatigue is associated with factors including female sex, advanced age, dysfunctional families, history of specific health conditions, functional status (eg, fatigue prior to injury), comorbidities, mood, secondary disability, and the use of certain drugs. Assessment of fatigue is fundamentally based on such scales as the Fatigue Severity Scale (FSS). Advances have recently been made in imaging techniques for its diagnosis, such as in functional MRI. Regarding treatment, no specific pharmacological treatment currently exists; however, positive results have been reported for some conventional neurorehabilitation therapies, such as bright light therapy, neurofeedback, electrical stimulation, and transcranial magnetic stimulation. This review aims to assist neurorehabilitation professionals to recognise modifiable factors associated with fatigue and to describe the treatments available to reduce its negative effect on patients.