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Silva RSD, Silva STD, Cardoso DCR, Quirino MAF, Silva MHA, Gomes LA, Fernandes JD, Oliveira RANDS, Fernandes ABGS, Ribeiro TS. Psychometric properties of wearable technologies to assess post-stroke gait parameters: A systematic review. Gait Posture 2024; 113:543-552. [PMID: 39178597 DOI: 10.1016/j.gaitpost.2024.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 07/16/2024] [Accepted: 08/07/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Wearable technologies using inertial sensors are an alternative for gait assessment. However, their psychometric properties in evaluating post-stroke patients are still being determined. This systematic review aimed to evaluate the psychometric properties of wearable technologies used to assess post-stroke gait and analyze their reliability and measurement error. The review also investigated which wearable technologies have been used to assess angular changes in post-stroke gait. METHODS The present review included studies in English with no publication date restrictions that evaluated the psychometric properties (e.g., validity, reliability, responsiveness, and measurement error) of wearable technologies used to assess post-stroke gait. Searches were conducted from February to March 2023 in the following databases: Cochrane Central Registry of Controlled Trials (CENTRAL), Medline/PubMed, EMBASE Ovid, CINAHL EBSCO, PsycINFO Ovid, IEEE Xplore Digital Library (IEEE), and Physiotherapy Evidence Database (PEDro); the gray literature was also verified. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) risk-of-bias tool was used to assess the quality of the studies that analyzed reliability and measurement error. RESULTS Forty-two studies investigating validity (37 studies), reliability (16 studies), and measurement error (6 studies) of wearable technologies were included. Devices presented good reliability in measuring gait speed and step count; however, the quality of the evidence supporting this was low. The evidence of measurement error in step counts was indeterminate. Moreover, only two studies obtained angular results using wearable technology. SIGNIFICANCE Wearable technologies have demonstrated reliability in analyzing gait parameters (gait speed and step count) among post-stroke patients. However, higher-quality studies should be conducted to improve the quality of evidence and to address the measurement error assessment. Also, few studies used wearable technology to analyze angular changes during post-stroke gait.
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Affiliation(s)
- Raiff Simplicio da Silva
- Postgraduate Program in Physical Therapy, Department of Physical Therapy, Federal University of Rio Grande do Norte, 3000 Av. Senador Salgado Filho, Post office box: 1524, Natal, RN 59072-970, Brazil.
| | - Stephano Tomaz da Silva
- Postgraduate Program in Physical Therapy, Department of Physical Therapy, Federal University of Rio Grande do Norte, 3000 Av. Senador Salgado Filho, Post office box: 1524, Natal, RN 59072-970, Brazil.
| | - Daiane Carla Rodrigues Cardoso
- Postgraduate Program in Physical Therapy, Department of Physical Therapy, Federal University of Rio Grande do Norte, 3000 Av. Senador Salgado Filho, Post office box: 1524, Natal, RN 59072-970, Brazil.
| | - Maria Amanda Ferreira Quirino
- Graduation Program in Physical Therapy, Department of Physical Therapy, Federal University of Rio Grande do Norte, 3000 Av. Senador Salgado Filho, Post office box: 1524, Natal, RN 59072-970, Brazil.
| | - Maria Heloiza Araújo Silva
- Postgraduate Program in Physical Therapy, Department of Physical Therapy, Federal University of Rio Grande do Norte, 3000 Av. Senador Salgado Filho, Post office box: 1524, Natal, RN 59072-970, Brazil.
| | - Larissa Araujo Gomes
- Graduation Program in Physical Therapy, Department of Physical Therapy, Federal University of Rio Grande do Norte, 3000 Av. Senador Salgado Filho, Post office box: 1524, Natal, RN 59072-970, Brazil.
| | - Jefferson Doolan Fernandes
- Federal Institute of Science and Technology of Rio Grande do Norte, Natal, Rio Grande do Norte 59015-000, Brazil.
| | | | - Aline Braga Galvão Silveira Fernandes
- Postgraduate Program in Physical Therapy, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Rua Vila Trairi, Santa Cruz, RN 59200-000, Brazil.
| | - Tatiana Souza Ribeiro
- Postgraduate Program in Physical Therapy, Department of Physical Therapy, Federal University of Rio Grande do Norte, 3000 Av. Senador Salgado Filho, Post office box: 1524, Natal, RN 59072-970, Brazil.
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Miller AE, Lohse KR, Bland MD, Konrad JD, Hoyt CR, Lenze EJ, Lang CE. A Large Harmonized Upper and Lower Limb Accelerometry Dataset: A Resource for Rehabilitation Scientists. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.15.24312066. [PMID: 39185533 PMCID: PMC11343270 DOI: 10.1101/2024.08.15.24312066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Wearable sensors can measure movement in daily life, an outcome that is salient to patients, and have been critical to accelerating progress in rehabilitation research and practice. However, collecting and processing sensor data is burdensome, leaving many scientists with limited access to such data. To address these challenges, we present a harmonized, wearable sensor dataset that combines 2,885 recording days of sensor data from the upper and lower limbs from eight studies. The dataset includes 790 individuals ages 0 - 90, nearly equal sex proportions (53% male, 47% female), and representation from a range of demographic backgrounds (69.4% White, 24.9% Black, 1.8% Asian) and clinical conditions (46% neurotypical, 31% stroke, 7% Parkinson's disease, 6% orthopedic conditions, and others). The dataset is publicly available and accompanied by open source code and an app that allows for interaction with the data. This dataset will facilitate the use of sensor data to advance rehabilitation research and practice, improve the reproducibility and replicability of wearable sensor studies, and minimize costs and duplicated scientific efforts.
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Svalbjørg T, Askim T, Saltvedt I, Alme K, Lydersen S, Eldholm R. Changes in sedentary behavior in the chronic phase following stroke. J Stroke Cerebrovasc Dis 2024; 33:107827. [PMID: 38901471 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/29/2024] [Accepted: 06/18/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Sedentary behavior increases risk for cardiovascular diseases. Little is known about sedentary behavior through the chronic phase after stroke. We aimed to describe how long and short bouts of sedentary behavior changed over the first three years after stroke and if cognition at baseline was an independent risk factor for sedentary behavior. METHODS This is a sub-study of the Norwegian cognitive impairment after stroke (Nor-COAST) study, a multicenter study recruiting patients with acute stroke. Sedentary behavior was monitored with a thigh-worn sensor (ActivPal3®), at three-, 18- and 36-months post stroke. Stroke severity was assessed by National Institutes of Health Stroke Scale (NIHSS) and cognition by Montreal cognitive assessment (MoCA). Mixed model analysis with mean number of sedentary minutes accumulated daily as the dependent variable was repeated for all four zones (<30min, 30-60min, 60-90min, >90min) and for total sedentary time. RESULTS The number of included participants was 528 (mean age 71.4, NIHSS on day 1, 2.7). The total amount of sedentary time accumulated between 08.00-22.00 increased significantly from about 9.8 hours at three months to 10.1 hours at 36 months post stroke (p=0.002). Patient characteristics associated with prolonged duration of the sedentary bouts and sedentary time were age, high BMI, comorbidities, and impaired physical function. No significant associations between MoCA score and sedentary time were found. CONCLUSION The participants became increasingly sedentary and had fewer breaks in sedentary time from three to 36 months after stroke. Baseline cognition was not related to later sedentary behavior.
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Affiliation(s)
- Tone Svalbjørg
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim 7491, Norway
| | - Torunn Askim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim 7491, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim 7491, Norway; Department of Geriatrics, Clinic of internal medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Katinka Alme
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Tronheim, Norway
| | - Rannveig Eldholm
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim 7491, Norway; Department of Geriatrics, Clinic of internal medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
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Nakano W, Kobayashi S, Maezawa T, Kohno Y. Longitudinal changes in physical activity accumulation patterns during 1-year follow-up in stroke survivors. Disabil Rehabil 2023; 45:4094-4100. [PMID: 36408857 DOI: 10.1080/09638288.2022.2146216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 11/05/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Few studies have reported changes in the accumulation patterns of physical activity over a year after stroke. This study characterized the longitudinal changes in physical activity levels and their accumulation patterns for a 1-year follow-up period in stroke survivors. MATERIALS AND METHODS In this single-center, prospective, longitudinal observational study, 47 stroke survivors were assessed at rehabilitation discharge and at 6 and 12 months post-discharge. Physical activity was evaluated, and measures included the number of steps, walking duration, total number of bouts per day, and intensity (light, moderate-to-vigorous) and spread (short, medium, and long bouts). RESULTS There were no significant main or interaction effects of time on any physical activity variables. Light physical activity accounted for 90% of all walking bouts and 70% of walking duration. Regarding moderate-to-vigorous physical activity (MVPA), 85% of walking bouts and 35% of walking duration were accumulated in short and medium bouts. The number of long-bout MVPA was three per day. CONCLUSIONS Physical activity levels and accumulation patterns were highly stable throughout the 12-month follow-up period. Accumulating light physical activity and intermittent MVPA is important for maintaining physical activity levels in stroke survivors. These findings will promote a better understanding of disability and rehabilitation practice.IMPLICATIONS FOR REHABILITATIONPhysical activity levels and accumulation patterns were highly stable throughout the 12-month follow-up period.The accumulation of moderate-to-vigorous physical activity in long bouts might be challenging for stroke survivors.Accumulating light physical activity and intermittent moderate-to-vigorous physical activity may be acceptable for stroke survivors.
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Affiliation(s)
- Wataru Nakano
- Department of Physical Therapy, Tokoha University, Shizuoka, Japan
| | - Satomi Kobayashi
- Department of Physical Therapy, Tsukuba International University, Tsuchiura, Japan
| | - Takayuki Maezawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Inashiki-Gun, Japan
| | - Yutaka Kohno
- Department of Neurology, Ibaraki Prefectural University of Health Sciences Hospital, Inashiki-Gun, Japan
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Phan A, Askim T, Lydersen S, Indredavik B, Wethal T. Accelerometer-measured physical activity at 3 months as a predictor of symptoms of depression and anxiety 1 year after stroke: a multicentre prospective cohort study in central Norway. J Rehabil Med 2023; 55:jrm12309. [PMID: 37970656 PMCID: PMC10666064 DOI: 10.2340/jrm.v55.12309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 10/24/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVES To study sedentary behaviour and physical activity at 3 months as predictors for symptoms of depression and anxiety at 1-year post-stroke. DESIGN A prospective cohort study. PATIENTS Patients with first-ever ischaemic stroke. METHODS Mood was assessed 3- and 12-months post-stroke using the Hospital Anxiety and Depression Scale. Sedentary behaviour and physical activity were measured using accelerometry 3 months post-stroke. RESULTS A total of 292 participants (116 (39.7%) females; mean age 71.7 (standard deviation 11.3) years) were included. At 12 months, 16.7% experienced depression and 19.5% anxiety, respectively. Adjusting for age and sex, regression analysis showed that comorbidity burden (β 0.26; 95% confidence interval (95% CI) 0.02, 0.51; p = 0.038), stroke severity (β 0.22; 95% CI 0.10, 0.35; p = 0.001), functional disability (β 0.89, 95% CI 0.49, 1.30; p = 0.000), and global cognition (β-0.15; 95% CI -0.25, -0.05; p = 0.004) predicted depression. Multi-adjusted analysis showed sedentary behaviour and physical activity did not significantly predict depression or anxiety (p > 0.05). CONCLUSION Sedentary behaviour and physical activity did not significantly predict mood after stroke. Comorbidity burden, stroke severity, functional disability, and global cognition were identified as possible predictors of depression. More research is needed to determine the impact of physical activity on depression and anxiety symptoms.
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Affiliation(s)
- Ailan Phan
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Torunn Askim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bent Indredavik
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Department of Medical Quality Registries, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Stroke Unit, Department of Internal Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Torgeir Wethal
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Stroke Unit, Department of Internal Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Bianchini E, Galli S, Alborghetti M, De Carolis L, Zampogna A, Hansen C, Vuillerme N, Suppa A, Pontieri FE. Four Days Are Enough to Provide a Reliable Daily Step Count in Mild to Moderate Parkinson's Disease through a Commercial Smartwatch. SENSORS (BASEL, SWITZERLAND) 2023; 23:8971. [PMID: 37960670 PMCID: PMC10649244 DOI: 10.3390/s23218971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023]
Abstract
Daily steps could be a valuable indicator of real-world ambulation in Parkinson's disease (PD). Nonetheless, no study to date has investigated the minimum number of days required to reliably estimate the average daily steps through commercial smartwatches in people with PD. Fifty-six patients were monitored through a commercial smartwatch for 5 consecutive days. The total daily steps for each day was recorded and the average daily steps was calculated as well as the working and weekend days average steps. The intraclass correlation coefficient (ICC) (3,k), standard error of measurement (SEM), Bland-Altman statistics, and minimum detectable change (MDC) were used to evaluate the reliability of the step count for every combination of 2-5 days. The threshold for acceptability was set at an ICC ≥ 0.8 with a lower bound of CI 95% ≥ 0.75 and a SAM < 10%. ANOVA and Mann-Whitney tests were used to compare steps across the days and between the working and weekend days, respectively. Four days were needed to achieve an acceptable reliability (ICC range: 0.84-0.90; SAM range: 7.8-9.4%). In addition, daily steps did not significantly differ across the days and between the working and weekend days. These findings could support the use of step count as a walking activity index and could be relevant to developing monitoring, preventive, and rehabilitation strategies for people with PD.
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Affiliation(s)
- Edoardo Bianchini
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (S.G.); (M.A.)
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France;
| | - Silvia Galli
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (S.G.); (M.A.)
| | - Marika Alborghetti
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (S.G.); (M.A.)
| | - Lanfranco De Carolis
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (S.G.); (M.A.)
| | - Alessandro Zampogna
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (A.Z.); (A.S.)
| | - Clint Hansen
- Department of Neurology, Kiel University, 24105 Kiel, Germany;
| | - Nicolas Vuillerme
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France;
- LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38000 Grenoble, France
- Institut Universitaire de France, 75005 Paris, France
| | - Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (A.Z.); (A.S.)
- IRCCS Neuromed Institute, 86077 Pozzilli, Italy
| | - Francesco E. Pontieri
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (E.B.); (S.G.); (M.A.)
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Fini NA, Simpson D, Moore SA, Mahendran N, Eng JJ, Borschmann K, Moulaee Conradsson D, Chastin S, Churilov L, English C. How should we measure physical activity after stroke? An international consensus. Int J Stroke 2023; 18:1132-1142. [PMID: 37300499 PMCID: PMC10614172 DOI: 10.1177/17474930231184108] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Physical activity is important for secondary stroke prevention. Currently, there is inconsistency of outcomes and tools used to measure physical activity following stroke. AIM To establish internationally agreed recommendations to enable consistent measurement of post-stroke physical activity. METHODS Stroke survivors and carers were surveyed online once regarding what is important in physical activity measurement. Three survey rounds with expert stroke researchers and clinicians were conducted using Keeney's Value-Focused Thinking Methodology. Survey 1 identified physical activity tools, outcomes, and measurement considerations which were ranked in Survey 2. Consensus recommendations on tools were then formulated by the consensus group based on survey responses. In Survey 3, participants reviewed ranked results and evidence gathered to determine their support for consensus recommendations. RESULTS Twenty-five stroke survivors, 5 carers, 18 researchers, and 17 clinicians from 16 countries participated. Time in moderate-vigorous physical activity and step count were identified as the most important outcomes to measure. Key measurement considerations included the ability to measure across frequency, intensity, duration domains in real-world settings; user-friendliness, comfort, and ability to detect changes. Consensus recommendations included using the Actigraph, Actical, and Activ8 devices for physical activity intensity; ActivPAL for duration and Step Activity Monitor for frequency; and the IPAQ and PASE questionnaires. Survey 3 indicated 100% support for device and 96% for questionnaire recommendations. CONCLUSIONS These consensus recommendations can guide selection of physical activity measurement tools and outcomes. Tool selection will depend on measurement purpose, user-knowledge, and resources. Comprehensive measurement requires the use of devices and questionnaires.
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Affiliation(s)
- Natalie A Fini
- Physiotherapy Department, School of Health Sciences, The University of Melbourne, Parkville, VIC, Australia
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Florey Institute of Neuroscience, The University of Melbourne, Parkville, VIC, Australia
| | - Dawn Simpson
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Florey Institute of Neuroscience, The University of Melbourne, Parkville, VIC, Australia
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia
- Heart and Stroke Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Sarah A Moore
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
- Stroke Research Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Niruthikha Mahendran
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Florey Institute of Neuroscience, The University of Melbourne, Parkville, VIC, Australia
- Physiotherapy Division, School of health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Janice J Eng
- Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada
- Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Karen Borschmann
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Florey Institute of Neuroscience, The University of Melbourne, Parkville, VIC, Australia
- St Vincent’s Hospital, Melbourne, VIC, Australia
| | - David Moulaee Conradsson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Women’s Health and Allied Health Professional, Karolinska University Hospital, Stockholm, Sweden
| | - Sebastien Chastin
- Institute of Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Leonid Churilov
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Florey Institute of Neuroscience, The University of Melbourne, Parkville, VIC, Australia
- Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia
| | - Coralie English
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Florey Institute of Neuroscience, The University of Melbourne, Parkville, VIC, Australia
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia
- Heart and Stroke Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Kubo H, Kanai M, Nozoe M, Inamoto A, Taguchi A, Makihara A, Hosokawa D, Mitsue S, Asai T, Shimada S. Association of Malnutrition With Physical Activity Intensity in Patients With Subacute Stroke. Arch Phys Med Rehabil 2023; 104:1652-1660. [PMID: 37257550 DOI: 10.1016/j.apmr.2023.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/29/2023] [Accepted: 04/28/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To investigate the relationship between nutritional status measured by the Global Leadership Initiative on Malnutrition (GLIM) criteria and the intensity of physical activity, and to determine the association between these factors and the activities of daily living (ADLs) in patients with subacute stroke during hospitalization. DESIGN A cross-sectional study. SETTING The study was conducted in the rehabilitation unit at a neurosurgical hospital. PARTICIPANTS One hundred and twenty-eight patients with subacute stroke (N=128). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Nutritional status was assessed using GLIM criteria. Sedentary behavior (SB), light-intensity physical activity (LIPA), and moderate-to-vigorous physical activity (MVPA) were measured using an accelerometer. Multiple regression analysis was used to investigate the relationship between nutritional status and intensity of physical activity. Moreover, the association of nutritional status and physical activity intensity with ADLs was determined using multiple regression analysis and mediation analysis. RESULTS Malnutrition was associated with SB time (B = 16.241, P=.009) and LIPA time (B = -17.656, P=.002), but not MVPA time (B = -0.472, P=.776). SB time (B = -0.063, P=.009) and LIPA time (B = 0.093, P<.001) were associated with functional independence measure for motor function, while MVPA time (B = -0.080, P=.379) was not. SB time (coefficient = -10.785, P<.001) and LIPA time (coefficient = -12.054, P<.001) were significant mediators between nutrition status and ADLs. CONCLUSIONS Malnutrition was associated with a SB time and LIPA time, but not MVPA time, in patients with sub-acute stroke. SB and LIPA times were associated with ADLs and mediated between nutrition status and ADLs in these patients. The association of nutritional status on physical activity and ADLs should be considered in stroke rehabilitation.
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Affiliation(s)
- Hiroki Kubo
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan; Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan; Researcher, Kansai Medical University, Hirakata, Japan.
| | - Masashi Kanai
- Institute of Transdisciplinary Sciences for Innovation, Kanazawa University, Kanazawa, Japan
| | - Masafumi Nozoe
- Faculty of Rehabilitation, Kansai Medical University, Hirakata, Japan
| | - Asami Inamoto
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Akira Taguchi
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Ayano Makihara
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Daiki Hosokawa
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Shingo Mitsue
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Tsuyoshi Asai
- Faculty of Rehabilitation, Kansai Medical University, Hirakata, Japan
| | - Shinichi Shimada
- Department of Neurosurgery, Itami Kousei Neurosurgical Hospital, Itami, Japan
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Brandenbarg P, Hoekstra F, Barakou I, Seves BL, Hettinga FJ, Hoekstra T, van der Woude LHV, Dekker R, Krops LA. Measurement properties of device-based physical activity instruments in ambulatory adults with physical disabilities and/or chronic diseases: a scoping review. BMC Sports Sci Med Rehabil 2023; 15:115. [PMID: 37735403 PMCID: PMC10512652 DOI: 10.1186/s13102-023-00717-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 08/22/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND People with physical disabilities and/or chronic diseases tend to have an inactive lifestyle. Monitoring physical activity levels is important to provide insight on how much and what types of activities people with physical disabilities and/or chronic diseases engage in. This information can be used as input for interventions to promote a physically active lifestyle. Therefore, valid and reliable physical activity measurement instruments are needed. This scoping review aims 1) to provide a critical mapping of the existing literature and 2) directions for future research on measurement properties of device-based instruments assessing physical activity behavior in ambulant adults with physical disabilities and/or chronic diseases. METHODS Four databases (MEDLINE, CINAHL, Web of Science, Embase) were systematically searched from 2015 to April 16th 2023 for articles investigating measurement properties of device-based instruments assessing physical activity in ambulatory adults with physical disabilities and/or chronic diseases. For the majority, screening and selection of eligible studies were done in duplicate. Extracted data were publication data, study data, study population, device, studied measurement properties and study outcome. Data were synthesized per device. RESULTS One hundred three of 21566 Studies were included. 55 Consumer-grade and 23 research-grade devices were studied on measurement properties, using 14 different physical activity outcomes, in 23 different physical disabilities and/or chronic diseases. ActiGraph (n = 28) and Fitbit (n = 39) devices were most frequently studied. Steps (n = 68) was the most common used physical activity outcome. 97 studies determined validity, 11 studies reliability and 6 studies responsiveness. CONCLUSION This scoping review shows a large variability in research on measurement properties of device-based instruments in ambulatory adults with physical disabilities and/or chronic diseases. The variability highlights a need for standardization of and consensus on research in this field. The review provides directions for future research.
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Affiliation(s)
- Pim Brandenbarg
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands.
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands.
| | - Femke Hoekstra
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, V1V 1V7, Canada
| | - Ioulia Barakou
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Bregje L Seves
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Florentina J Hettinga
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, NE1 8ST, UK
| | - Trynke Hoekstra
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, 1081 BT, The Netherlands
| | - Lucas H V van der Woude
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Rienk Dekker
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Leonie A Krops
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
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10
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HUNG STANLEYHUGHWA, KHLIF MOHAMEDSALAH, KRAMER SHARON, WERDEN EMILIO, BIRD LAURAJ, CAMPBELL BRUCECV, BRODTMANN AMY. Poststroke White Matter Hyperintensities and Physical Activity: A CANVAS Study Exploratory Analysis. Med Sci Sports Exerc 2022; 54:1401-1409. [DOI: 10.1249/mss.0000000000002946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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11
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Greeley B, Rubino C, Denyer R, Chau B, Larssen B, Lakhani B, Boyd L. Individuals with Higher Levels of Physical Activity after Stroke Show Comparable Patterns of Myelin to Healthy Older Adults. Neurorehabil Neural Repair 2022; 36:381-389. [PMID: 35533214 PMCID: PMC9127936 DOI: 10.1177/15459683221100497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Myelin asymmetry ratios (MARs) relate and contribute to motor impairment and
function after stroke. Physical activity (PA) may induce myelin plasticity,
potentially mitigating hemispheric myelin asymmetries that can occur after a
stroke. Objective The aim of this study was to determine whether individuals with higher levels
of PA showed lower MAR compared to individuals with lower levels of PA. Methods Myelin water fraction was obtained from 5 bilateral motor regions in 22
individuals with chronic stroke and 26 healthy older adults. Activity levels
were quantified with wrist accelerometers worn for a period of 72 hours (3
days). Higher and lower PA levels were defined by a cluster analysis within
each group. Results MAR was similar regardless of PA level within the older adult group. Compared
to the higher PA stroke group, lower PA stroke participants displayed
greater MAR. There was no difference in MAR between the stroke and older
adult higher PA groups. Within the lower PA groups, individuals with stroke
showed greater MAR compared to the older adults. Arm impairment, lesion
volume, age, time since stroke, and preferential arm use were not different
between the PA stroke groups, suggesting that motor impairment severity and
extent of brain damage did not drive differences in PA. Conclusion Individuals who have had a stroke and are also physically active display
lower MAR (i.e., similar myelin in both hemispheres) in motor regions. High
levels of PA may be neuroprotective and mitigate myelin asymmetries once a
neurological insult, such as a stroke, occurs. Alternately, it is possible
that promoting high levels of PA after a stroke may reduce myelin
asymmetries.
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Affiliation(s)
- Brian Greeley
- Department of Physical Therapy, 8166University of British Columbia, Vancouver, BC, Canada
| | - Cristina Rubino
- Graduate Program in Rehabilitation Sciences, 8166University of British Columbia, Vancouver, BC, Canada
| | - Ronan Denyer
- Graduate Program in Neuroscience, 8166University of British Columbia, Vancouver, BC, Canada
| | - Briana Chau
- Graduate Program in Rehabilitation Sciences, 8166University of British Columbia, Vancouver, BC, Canada
| | - Beverley Larssen
- Graduate Program in Rehabilitation Sciences, 8166University of British Columbia, Vancouver, BC, Canada
| | - Bimal Lakhani
- Department of Physical Therapy, 8166University of British Columbia, Vancouver, BC, Canada
| | - Lara Boyd
- Department of Physical Therapy, 8166University of British Columbia, Vancouver, BC, Canada.,Graduate Program in Rehabilitation Sciences, 8166University of British Columbia, Vancouver, BC, Canada.,Graduate Program in Neuroscience, 8166University of British Columbia, Vancouver, BC, Canada
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12
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How Many Hours of Device Wear Time Are Required to Accurately Measure Physical Activity Post Stroke? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031191. [PMID: 35162217 PMCID: PMC8834432 DOI: 10.3390/ijerph19031191] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 02/05/2023]
Abstract
Background. Inadequate physical activity participation is a risk factor for secondary stroke. Before implementing appropriate management strategies, we need to accurately measure the physical activity of stroke survivors. We aimed to determine the duration of physical activity monitoring post-stroke that constitutes a valid day. Methods. We sampled stroke survivors’ physical activity for one week following discharge from inpatient rehabilitation using the Sensewear Armband (Bodymedia, Pittsburgh, PA, USA). To determine the impact of total daily wear time on activity estimate (sedentary, light, and moderate to vigorous physical activity) accuracy, we performed simulations, removing one, two, three, or four hours from a 14-h reference day, and analysed them with linear mixed models. Results. Sixty-nine participants (46 male, 65 ± 15 years) with 271 days of physical activity data were included. All physical activity variables were significantly underestimated for all data sets (10, 11, 12, or 13 h) compared to the 14-h reference data set. The number of days classified as not meeting physical activity recommendations increased as daily monitoring duration decreased: 13% misclassification with 10-h compared to 14-h dataset (p = 0.011). Conclusions. The accuracy of physical activity estimates increases with longer daily monitoring periods following stroke, and researchers should aim to monitor post-stroke physical activity for 14 daytime hours.
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13
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Torriani-Pasin C, Demers M, Polese JC, Bishop L, Wade E, Hempel S, Winstein C. mHealth technologies used to capture walking and arm use behavior in adult stroke survivors: a scoping review beyond measurement properties. Disabil Rehabil 2021; 44:6094-6106. [PMID: 34297652 DOI: 10.1080/09638288.2021.1953623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE We aimed to provide a critical review of measurement properties of mHealth technologies used for stroke survivors to measure the amount and intensity of functional skills, and to identify facilitators and barriers toward adoption in research and clinical practice. MATERIALS AND METHODS Using Arksey and O'Malley's framework, two independent reviewers determined eligibility and performed data extraction. We conducted an online consultation survey exercise with 37 experts. RESULTS Sixty-four out of 1380 studies were included. A majority reported on lower limb behavior (n = 32), primarily step count (n = 21). Seventeen studies reported on arm-hand behaviors. Twenty-two studies reported metrics of intensity, 10 reported on energy expenditure. Reliability and validity were the most frequently reported properties, both for commercial and non-commercial devices. Facilitators and barriers included: resource costs, technical aspects, perceived usability, and ecological legitimacy. Two additional categories emerged from the survey: safety and knowledge, attitude, and clinical skill. CONCLUSIONS This provides an initial foundation for a field experiencing rapid growth, new opportunities and the promise that mHealth technologies affords for envisioning a better future for stroke survivors. We synthesized findings into a set of recommendations for clinicians and clinician-scientists about how best to choose mHealth technologies for one's individual objective.Implications for RehabilitationRehabilitation professionals are encouraged to consider the measurement properties of those technologies that are used to monitor functional locomotor and object-interaction skills in the stroke survivors they serve.Multi-modal knowledge translation strategies (research synthesis, educational courses or videos, mentorship from experts, etc.) are available to rehabilitation professionals to improve knowledge, attitude, and skills pertaining to mHealth technologies.Consider the selection of commercially available devices that are proven to be valid, reliable, accurate, and responsive to the targeted clinical population.Consider usability and privacy, confidentiality and safety when choosing a specific device or smartphone application.
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Affiliation(s)
- Camila Torriani-Pasin
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil.,Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Marika Demers
- Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Janaine C Polese
- Department of Physiotherapy, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Lauri Bishop
- Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Eric Wade
- Department of Mechanical Engineering, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, CA, USA
| | - Carolee Winstein
- Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA.,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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14
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Reynolds H, Steinfort S, Tillyard J, Ellis S, Hayes A, Hanson ED, Wijeratne T, Skinner EH. Feasibility and adherence to moderate intensity cardiovascular fitness training following stroke: a pilot randomized controlled trial. BMC Neurol 2021; 21:132. [PMID: 33745454 PMCID: PMC7983371 DOI: 10.1186/s12883-021-02052-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/10/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Stroke is a leading cause of disability worldwide and the cardiovascular fitness levels of stroke survivors are diminished to an extent that impairs functioning and activities of daily living performance. While cardiovascular training seems an empirically appropriate intervention, the optimal dosage and intensity of cardiovascular training in stroke survivors remains unclear. The aim was to determine the safety and feasibility of moderate-intensity cardiovascular training following stroke, including measurement of adherence to training. METHODS A pilot, prospective, patient- and assessor-blinded randomised controlled trial conducted in a tertiary, metropolitan hospital-based community rehabilitation centre. Eligibility criteria included ambulant (> 100 m), 6 weeks-12 months post stroke. Moderate-intensity fitness training or control (low-intensity) exercise was offered biweekly for 12 weeks. Outcome measures included adverse events, peak oxygen uptake (VO2), functional exercise capacity (6-Minute Walk Test, 10-m Walk Test) and health-related quality of life (Short Form-36) and mood (Patient Health Questionnaire, PHQ9). RESULTS Feasibility: Seventy-one (50%) of 141 screened participants were eligible (29% did not agree to participate). Twenty participants (10 intervention, 10 control) were recruited. The median (%; IQR) supervised sessions was 19.5 (81%; 12, 20); and 20 (83%; 19, 22) in the intervention and control groups, respectively. Progression of duration and intensity was limited; mean of 10 sessions to achieve target duration (30 min). There were no adverse events. Baseline peak oxygen uptake (VO2) levels were low (15.94 ml/kg/min). Significant improvements in VO2 peak in both groups were observed (p < 0.05). Although there were no significant between-group differences, this feasibility trial was not powered to detect change. CONCLUSIONS Moderate-intensity fitness training was safe but achievement of target duration and intensity was challenging for stroke survivors. A definitive adequately-powered randomised trial is required. Alternative fitness training protocols may need to be explored. TRIAL REGISTRATION The trial protocol was prospectively registered on the Australian New Zealand Clinical Trials Registry ( ACTRN 12613000822785 ) on 25/07/2013.
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Affiliation(s)
- Hanna Reynolds
- Department of Physiotherapy, Western Health, 176 Furlong Rd, St Albans, 3021, Australia
| | - Sarah Steinfort
- Department of Physiotherapy, Western Health, 176 Furlong Rd, St Albans, 3021, Australia
| | - Jane Tillyard
- Department of Physiotherapy, Western Health, 176 Furlong Rd, St Albans, 3021, Australia
| | - Sarah Ellis
- Department of Physiotherapy, Western Health, 176 Furlong Rd, St Albans, 3021, Australia
| | - Alan Hayes
- Australian Institute of Musculoskeletal Science, Melbourne, Victoria, Australia.,The Institute for Health and Sport, Victoria University, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia
| | - Erik D Hanson
- The Institute for Health and Sport, Victoria University, Melbourne, Australia.,University of North Carolina, Chapel Hill, NC, USA
| | - Tissa Wijeratne
- The University of Melbourne, Melbourne, Australia.,Department of Neurology, Western Health, Melbourne, Australia
| | - Elizabeth H Skinner
- Department of Physiotherapy, Western Health, 176 Furlong Rd, St Albans, 3021, Australia. .,Australian Institute of Musculoskeletal Science, Melbourne, Victoria, Australia. .,The University of Melbourne, Melbourne, Australia. .,Monash University, Melbourne, Victoria, Australia.
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15
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Handlery R, Regan EW, Stewart JC, Pellegrini C, Monroe C, Hainline G, Handlery K, Fritz SL. Predictors of Daily Steps at 1-Year Poststroke: A Secondary Analysis of a Randomized Controlled Trial. Stroke 2021; 52:1768-1777. [PMID: 33691506 DOI: 10.1161/strokeaha.121.034249] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Reed Handlery
- Arkansas Colleges of Health Education, School of Physical Therapy, Fort Smith, AR (R.H.)
| | - Elizabeth W Regan
- Department of Exercise Science, Physical Therapy Program, University of South Carolina (E.W.R., J.C.S., G.H., S.L.F.)
| | - Jill C Stewart
- Department of Exercise Science, Physical Therapy Program, University of South Carolina (E.W.R., J.C.S., G.H., S.L.F.)
| | | | - Courtney Monroe
- Department of Health Promotion, Education, and Behavior, University of South Carolina (C.M.)
| | - Garrett Hainline
- Department of Exercise Science, Physical Therapy Program, University of South Carolina (E.W.R., J.C.S., G.H., S.L.F.)
| | - Kaci Handlery
- Arkansas Colleges of Health Education, School of Physical Therapy (K.H.)
| | - Stacy L Fritz
- Department of Exercise Science, Physical Therapy Program, University of South Carolina (E.W.R., J.C.S., G.H., S.L.F.)
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16
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Fini NA, Bernhardt J, Churilov L, Clark R, Holland AE. A 2-Year Longitudinal Study of Physical Activity and Cardiovascular Risk in Survivors of Stroke. Phys Ther 2021; 101:6029080. [PMID: 33305804 DOI: 10.1093/ptj/pzaa205] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/08/2020] [Accepted: 08/18/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The purpose of this study was to explore associations between physical activity, cardiovascular risk factors, mobility, mood, fatigue, and cognition over 2 years following stroke rehabilitation discharge. METHODS In this longitudinal observational study, survivors of first-ever stroke were evaluated at rehabilitation discharge and 6, 12, and 24 months later. Moderate to vigorous physical activity (MVPA) duration (minutes/day) assessed with an electronic monitor was the primary outcome. Further outcomes included step count, the number and duration of MVPA and sedentary bouts, cardiovascular risk factors (eg, blood pressure, fasting lipid profile, body mass index [BMI]), gait speed and endurance, mood, fatigue, and cognition. Associations between physical activity and cardiovascular risk factors over time were assessed with random-effects regression modeling. Associations between baseline characteristics and physical activity at 2 years were explored using regression modeling. RESULTS Seventy-nine participants (68.4% men) with a mean age of 65 years (SD = 14) and a median gait speed of 1.2 m/s (interquartile range = 0.8 to 1.4) were included at baseline. Associations were found between higher physical activity (MVPA duration, number and duration of MVPA bouts) and lower BMI. Better gait speed, endurance, and cognition at baseline were associated with higher MVPA and step count at 2 years. CONCLUSIONS Duration and bouts of MVPA are associated with BMI. Increasing MVPA and bouts of MVPA may be a valuable treatment goal to reduce cardiovascular risk in survivors of stroke. IMPACT This 2-year study found that MVPA is associated with important cardiovascular risk factors in people who have survived stroke. Understanding these associations could be useful for developing effective treatments to prevent recurrent stroke. LAY SUMMARY Performing MVPA and accumulating in bouts of at least 10 minutes might be challenging, but it could be an important component of treatments to reduce cardiovascular risk after stroke.
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Affiliation(s)
- Natalie A Fini
- Physiotherapy Department, Alfred Health, Melbourne, Australia.,Physiotherapy Department, La Trobe University, Melbourne, Australia.,Physiotherapy Department, The University of Melbourne, Parkville, Australia
| | - Julie Bernhardt
- Stroke Division, Florey Institute of Neurosciences and Mental Health, Heidelberg, Australia
| | - Leonid Churilov
- Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Rebecca Clark
- Physiotherapy Department, Alfred Health, Melbourne, Australia
| | - Anne E Holland
- Physiotherapy Department, Alfred Health, Melbourne, Australia.,Physiotherapy Department, La Trobe University, Melbourne, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia
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17
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Yawata A, Tsujimura T, Takeishi R, Magara J, Yu L, Inoue M. Comparison of physical properties of voluntary coughing, huffing and swallowing in healthy subjects. PLoS One 2020; 15:e0242810. [PMID: 33270679 PMCID: PMC7714348 DOI: 10.1371/journal.pone.0242810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/09/2020] [Indexed: 11/18/2022] Open
Abstract
Coughing, huffing and swallowing protect the airway from aspiration. This study was conducted to compare the physical properties of voluntary coughing, huffing and swallowing in healthy subjects. Ten healthy men were asked to huff, cough and swallow repeatedly. Electromyograms (EMGs) were recorded from the left side of the external oblique (EO), sternocleidomastoid, suprahyoid (SH) and thyrohyoid muscles. Airflow was recorded using a face mask with two-way non-rebreathing valves. The expiratory velocity of huffing and coughing and the SH EMG of all actions presented high intraclass correlation coefficients (> 0.8). The inspiratory and expiratory velocities did not differ significantly between coughing and huffing. The expiratory acceleration of coughing was significantly higher than that of huffing, whereas the expiratory volume of coughing was significantly smaller than that of huffing. The EO EMG of coughing and huffing were significantly larger than that of swallowing. The EO EMG activity during the expiratory phase was significantly higher than that of the other phases of both coughing and huffing. The SH EMG of coughing and huffing were significantly smaller than that of swallowing. Correlation analysis revealed that the expiratory velocity of coughing was strongly positively correlated with that of huffing. The expiratory volume of huffing was significantly positively correlated with hand grip strength. These results suggest that EO and SH muscle activities during huffing or coughing differ those during swallowing, and huffing and coughing may work similarly in expiratory function.
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Affiliation(s)
- Akiko Yawata
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan
| | - Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan
| | - Ryosuke Takeishi
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan
| | - Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan
| | - Li Yu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan
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18
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Fini NA, Bernhardt J, Churilov L, Clark R, Holland AE. Adherence to physical activity and cardiovascular recommendations during the 2years after stroke rehabilitation discharge. Ann Phys Rehabil Med 2020; 64:101455. [PMID: 33189943 DOI: 10.1016/j.rehab.2020.03.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/20/2020] [Accepted: 03/03/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Objective measurement is essential to represent habitual physical activity. To date only one study has objectively measured physical activity for>12months after stroke. OBJECTIVES This study aimed to measure physical activity, cardiovascular risk factors, mobility, mood, fatigue and cognition during the 2years after rehabilitation discharge and to investigate whether stroke survivors meet physical activity and cardiovascular risk recommendations. METHODS This was a longitudinal observational study. Survivors of a first-ever stroke admitted to a large metropolitan rehabilitation hospital were recruited. Outcomes were measured at rehabilitation discharge and 6, 12 and 24months later. Outcomes were physical activity measured by the SenseWear Armband (e.g., moderate-vigorous physical activity, steps/day) and cardiovascular risk factors (e.g., blood pressure, fasting lipid profile and plasma glucose, waist circumference, body mass index), mobility, mood, fatigue and cognition. Changes over time were evaluated with random-effects regression modelling. RESULTS Participants (n=79, 33% female) had mean (SD) age of 65 (14) years and median gait speed 1.2m/s (interquartile range: 0.8-1.4) at baseline. We found no change in physical activity levels over time. Step count and time spent in bouts of moderate-vigorous physical activity remained low. Many participants achieved the recommended 30min of daily moderate-vigorous physical activity at baseline, but this was decreased at 2years (72% [57/79] versus 65% [37/57]). Adherence to cardiovascular recommendations decreased over time, notably for body mass index, plasma glucose and triglyceride levels. Waist circumference and body mass index increased at each time point relative to baseline (by a mean of 3.2cm and 1.2kg.m2, respectively, at 2years, P<0.01). CONCLUSIONS This is the largest longitudinal study of objectively measured physical activity after stroke. Adherence to cardiovascular risk recommendations decreased over time post-stroke, and physical activity levels remained low. Stroke survivors may benefit from annual multidisciplinary reviews to identify increasing risk and initiate appropriate interventions.
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Affiliation(s)
- Natalie A Fini
- Physiotherapy Department, Alfred Health, Melbourne, Australia; Physiotherapy Department, La Trobe University, Melbourne, Australia; Physiotherapy Department, The University of Melbourne, Parkville, Australia.
| | - Julie Bernhardt
- Stroke Division, Florey Institute of Neurosciences and Mental Health, Heidelberg, Australia
| | - Leonid Churilov
- Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Rebecca Clark
- Physiotherapy Department, Alfred Health, Melbourne, Australia
| | - Anne E Holland
- Physiotherapy Department, Alfred Health, Melbourne, Australia; Physiotherapy Department, La Trobe University, Melbourne, Australia; Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia
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19
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Braaten RS, Askim T, Gunnes M, Indredavik B. Fatigue and activity after stroke. Secondary results from the Life After Stroke study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1851. [PMID: 32431023 DOI: 10.1002/pri.1851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/11/2020] [Accepted: 04/29/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVES The aim of this study was to describe how the prevalence of fatigue changed from the subacute phase to the chronic phase after stroke, and to investigate how activity was associated with fatigue among participants included in the randomized controlled multicentre-study Life After STroke (LAST). METHODS The present study represents secondary analysis based on data from the LAST study. One-hundred-and-forty-five patients with mild and moderate stroke (mean (SD) age: 71.5 (10.5) years, 57.2% males) recruited from St. Olav's University Hospital were included. Fatigue was assessed by the Fatigue Severity Scale (FSS-7) at inclusion, 3 months after stroke, and at follow-up 18 months later. activPAL was used to measure activity at follow-up. RESULTS A total of 46 (31.7%) participants reported fatigue at inclusion and 43 (29.7%) at follow-up (p = .736). In the univariable regression analysis, sedentary behaviour, walking and sedentary bouts were significantly associated with fatigue (p ≤ .015), whereas only time spent walking was significantly associated with fatigue in the multivariable regression analysis (p = .017). CONCLUSIONS The present study showed that fatigue is a common symptom after stroke and that the prevalence of fatigue remained unchanged from the subacute to the chronic phase. The study also showed that increased time spent walking was strongly related to lower fatigue, while no such associations were found between the other activity categories and fatigue.
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Affiliation(s)
- Ragnhild Sunde Braaten
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Clinical Services, Department of Physiotherapy, St. Olav's University Hospital, Trondheim, Norway
| | - Torunn Askim
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Mari Gunnes
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Bent Indredavik
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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20
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Thilarajah S, Bower KJ, Pua YH, Tan D, Williams G, Larik A, Bok CW, Koh G, Clark RA. Modifiable Factors Associated With Poststroke Physical Activity at Discharge From Rehabilitation: Prospective Cohort Study. Phys Ther 2020; 100:818-828. [PMID: 31995190 DOI: 10.1093/ptj/pzaa022] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 09/15/2019] [Accepted: 11/29/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND People with stroke are not meeting recommended levels of physical activity. The modifiable factors associated with poststroke physical activity levels need to be identified to develop targeted interventions. OBJECTIVE The objective of this study was to investigate the factors at discharge from inpatient rehabilitation that are associated with physical activity levels at 3 months following discharge. DESIGN This was a prospective cohort study. METHODS Sixty-four people with stroke completed baseline assessments at discharge from inpatient rehabilitation and 55 completed the follow-up 3 months later. The candidate factors (ie, gait speed, balance, strength, cognition, mood, and motivation) were measured at discharge. The primary outcome measure at follow-up was walking-related activity (measured by wrist-worn accelerometer). Secondary outcome measures were physical activity participation (Activity Card Sort) and intensity of physical activity (International Physical Activity Questionnaire-Short 7 days). Adjusted separate multivariable linear regression models or proportional odds regression models were used to evaluate the associations between candidate factors and physical activity. RESULTS Gait speed and balance were associated with all aspects of physical activity. Higher level of intrinsic motivation was also associated with higher physical activity participation. Anxiety demonstrated a significant nonlinear relationship with physical activity participation. LIMITATIONS Inclusion of fatigue and individual muscle strength could have provided further insights into associations with steps per day. CONCLUSION The results demonstrated that better physical function at discharge from inpatient rehabilitation was associated with future increased levels of physical activity. Additionally, higher levels of motivation impacted on increased physical activity participation. The influence of anxiety on physical activity participation requires further exploration. Mixed-method study designs can be utilized to further understand the factors associated with poststroke physical activity.
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Affiliation(s)
- Shamala Thilarajah
- School of Health and Exercise Science, University of the Sunshine Coast, Queensland, Australia; and Department of Physiotherapy, Singapore General Hospital, Outram Road, Singapore 169608 Singapore
| | - Kelly J Bower
- Physiotherapy Department, University of Melbourne, Melbourne, Australia
| | - Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital
| | - Dawn Tan
- Department of Physiotherapy, Singapore General Hospital
| | - Gavin Williams
- Physiotherapy Department, University of Melbourne; and Epworth HealthCare, Richmond, Melbourne, Australia
| | - Ashfaq Larik
- Department of Physiotherapy, Singapore General Hospital
| | - Chek-Wai Bok
- Department of Physiotherapy, Singapore General Hospital
| | - Gerald Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Ross A Clark
- School of Health and Exercise Science, University of the Sunshine Coast
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Using an Accelerometer-Based Step Counter in Post-Stroke Patients: Validation of a Low-Cost Tool. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093177. [PMID: 32370210 PMCID: PMC7246942 DOI: 10.3390/ijerph17093177] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 11/29/2022]
Abstract
Monitoring the real-life mobility of stroke patients could be extremely useful for clinicians. Step counters are a widely accessible, portable, and cheap technology that can be used to monitor patients in different environments. The aim of this study was to validate a low-cost commercial tri-axial accelerometer-based step counter for stroke patients and to determine the best positioning of the step counter (wrists, ankles, and waist). Ten healthy subjects and 43 post-stroke patients were enrolled and performed four validated clinical tests (10 m, 50 m, and 6 min walking tests and timed up and go tests) while wearing five step counters in different positions while a trained operator counted the number of steps executed in each test manually. Data from step counters and those collected manually were compared using the intraclass coefficient correlation and mean average percentage error. The Bland–Altman plot was also used to describe agreement between the two quantitative measurements (step counter vs. manual counting). During walking tests in healthy subjects, the best reliability was found for lower limbs and waist placement (intraclass coefficient correlations (ICCs) from 0.46 to 0.99), and weak reliability was observed for upper limb placement in every test (ICCs from 0.06 to 0.38). On the contrary, in post-stroke patients, moderate reliability was found only for the lower limbs in the 6 min walking test (healthy ankle ICC: 0.69; pathological ankle ICC: 0.70). Furthermore, the Bland–Altman plot highlighted large average discrepancies between methods for the pathological group. However, while the step counter was not able to reliably determine steps for slow patients, when applied to the healthy ankle of patients who walked faster than 0.8 m/s, it counted steps with excellent precision, similar to that seen in the healthy subjects (ICCs from 0.36 to 0.99). These findings show that a low-cost accelerometer-based step counter could be useful for measuring mobility in select high-performance patients and could be used in clinical and real-world settings.
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Costa PHV, de Jesus TPD, Winstein C, Torriani-Pasin C, Polese JC. An investigation into the validity and reliability of mHealth devices for counting steps in chronic stroke survivors. Clin Rehabil 2019; 34:394-403. [DOI: 10.1177/0269215519895796] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective: To investigate the validity and test–retest reliability of mHealth devices (Google Fit, Health, STEPZ, Pacer, and Fitbit Ultra) to estimate the number of steps in individuals after chronic stroke and to compare whether the measurement of the number of steps is affected by their location on the body (paretic and non-paretic side). Design: Observational study with repeated measures. Setting: University laboratory. Subjects: Fifty-five community-dwelling individuals with chronic stroke. Intervention: Not applicable. Main measures: The number of steps was measured using mHealth devices (Google Fit, Health, STEPZ, Pacer, and Fitbit Ultra), and compared against criterion-standard measure during the Two-Minute Walk Test using habitual speed. Results: Our sample was 54.5% men, mean age of 62.5 years (SD 14.9) with a chronicity after stroke of 66.8 months (SD 55.9). There was a statistically significant association between the actual number of steps and those estimated by the Google Fit, STEPZ Iphone and Android applications, Pacer iphone and Android, and Fitbit Ultra (0.30 ⩽ r ⩾ 0.80). The Pacer iphone application demonstrated the highest reliability coefficient (ICC(2,1) = 0.80; P < 0.001). There were no statistically significant differences in device measurements that depended on body location. Conclusions: mHealth devices (Pacer–iphone, Fitbit Ultra, Google Fit, and Pacer–Android) are valid and reliable for step counting in chronic stroke survivors. Body location (paretic or non-paretic side) does not affect validity or reliability of the step count metric.
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Affiliation(s)
| | | | - Carolee Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | | | - Janaine Cunha Polese
- Department of Physical Therapy, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
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Fini NA, Bernhardt J, Holland AE. Low gait speed is associated with low physical activity and high sedentary time following stroke. Disabil Rehabil 2019; 43:2001-2008. [PMID: 31755311 DOI: 10.1080/09638288.2019.1691273] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE This study describes physical activity levels and factors associated with physical activity at the end of stroke rehabilitation. METHODS Primary stroke survivors were assessed at completion of physical rehabilitation. Outcomes included physical activity (e.g. step count, moderate-vigorous physical activity duration) and sedentary time measured with the Sensewear Armband, gait speed, and cognition. The number of participants meeting physical activity recommendations was calculated. Differences in physical activity were examined between household ambulators (gait speed <0.4 m/s), limited community ambulators (0.4-0.8 m/s), and unlimited community ambulators (>0.8 m/s). The influence of age, cognition, and gait speed on physical activity was determined by multiple regression. RESULTS Seventy-nine stroke survivors participated. Twenty-one participants achieved 30 min/day of moderate-vigorous physical activity accumulated in 10 min bouts. Unlimited community ambulators took more steps/day (median 4975 vs. 469 limited, 355 household, p < 0.001), had higher moderate-vigorous physical activity (median 74 min/day vs. 22 limited, 31 household, p < 0.001) and lower sedentary time (mean 1105 vs. 1239 limited, 1232 household minutes/day, p < 0.001). Age, gait speed, and cognition predicted 21.3% of the variance in moderate-vigorous physical activity (p = 0.001); adding employment status to the model predicted 57.3% of the variance in step count (p < 0.001). CONCLUSIONS Physical activity is low following stroke and should be a target for treatment, particularly in those with gait speeds ≤0.8 m/s.Implications for rehabilitationSeventy-three percent of stroke survivors performed ≥30 minutes of moderate to vigorous physical activity throughout the day.Twenty-seven percent of stroke survivors accumulated ≥30 minutes of moderate to vigorous physical activity in 10 minute bouts.Despite relatively good physical ability, daily step count was low in this sample.Those with gait speeds ≤0.8 m/s had lower physical activity levels and higher sedentary time.
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Affiliation(s)
- Natalie A Fini
- Physiotherapy Department, Alfred Health, Melbourne, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, Australia.,Physiotherapy Department, The University of Melbourne, Parkville, Australia
| | - Julie Bernhardt
- Stroke Division, Florey Institute of Neurosciences and Mental Health, Heidelberg, Australia
| | - Anne E Holland
- Physiotherapy Department, Alfred Health, Melbourne, Australia.,Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
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