Program in Physical Therapy (C.L.H., M.D.B., G.M.E., C.E.L.), Program in Occupational Therapy (M.D.B., C.E.L.), Department of Neurology (C.L.H., M.D.B., G.M.E., C.E.L.), and Department of Neuroscience (G.M.E.), Washington University School of Medicine, St Louis, Missouri; Department of Physical Therapy, University of Delaware, Newark (D.S.R.); and Department of Physical Therapy & Athletic Training, College of Health & Rehabilitation Sciences: Sargent, Boston University, Boston, Massachusetts (T.D.E.).
J Neurol Phys Ther. 2020 Oct;44(4):241-247. doi: 10.1097/NPT.0000000000000327.
Improvement of walking performance is a primary goal for individuals poststroke or with Parkinson disease (PD) who receive physical therapy. More data about day-to-day variability of walking performance are critical for determining if changes in performance have occurred.
Baseline assessments were utilized from an ongoing, observational, prospective cohort study including 84 individuals poststroke (n = 37) or with PD (n = 47) receiving outpatient physical therapy services to improve mobility. Participants wore step activity monitors for up to 7 days to measure walking performance (steps per day, walking duration, maximum 30-minute output, and peak activity index) in daily life. Correlation analyses evaluated relationships between both capacity and performance measures as well as the relationships between mean performance variables and day-to-day variability. Regression analyses explored factors that contribute to variability in day-to-day performance variables.
Mean steps per day for participants poststroke (5376 ± 2804) and with PD (8149 ± 4490) were consistent with previously reported cohorts. Greater amounts of walking were related to more day-to-day variability, with moderate correlations found between the mean and day-to-day variability of each performance measure, regardless of medical diagnosis or walking speed. Day-to-day variability is large (upwards of 50% of the mean), with the amount of walking performance serving as the primary predictor of day-to-day variability in walking performance.
The results of this study elucidate the factors that are related to and predict day-to-day variability of performance. Walking performance metrics should be evaluated over multiple days and greater variability should be anticipated with greater amounts of performance.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A319).
提高步行能力是脑卒中或帕金森病（PD）患者接受物理治疗后的主要目标。更多关于步行能力日常变化的资料对于确定是否发生了性能变化至关重要。
本研究利用了一项正在进行的、观察性的前瞻性队列研究中的基线评估数据，该研究纳入了 84 名接受门诊物理治疗以改善移动能力的脑卒中后患者（n=37）或 PD 患者（n=47）。参与者佩戴步活动监测器最多 7 天，以测量日常生活中的步行能力（每日步数、步行持续时间、最大 30 分钟输出和峰值活动指数）。相关分析评估了能力和表现测量之间的关系，以及平均表现变量与日常表现变化之间的关系。回归分析探讨了导致日常表现变量变化的因素。
脑卒中后患者（5376±2804 步）和 PD 患者（8149±4490 步）的每日平均步数与之前报道的队列一致。步行量越大，日常变化越大，无论医学诊断或步行速度如何，每个表现测量的平均值与日常变化之间都存在中度相关性。日常变化较大（高达平均值的 50%），行走表现的数量是行走表现日常变化的主要预测因素。
本研究结果阐明了与日常表现变化相关和预测的因素。步行表现指标应在多天内进行评估，并应预计随着表现量的增加而出现更大的变化。作者的更多见解可查看视频摘要（参见全文，补充数字内容 1，可在 http://links.lww.com/JNPT/A319 获得）。
