School of Physical Therapy, 6221University of Western Ontario, Ontario, Canada.
Department of Physical Therapy, University of British Columbia, Vancouver, Canada.
Neurorehabil Neural Repair. 2022 Feb;36(2):97-102. doi: 10.1177/15459683211062894. Epub 2021 Dec 23.
While higher therapeutic intensity improves motor recovery after stroke, translating findings from successful studies is challenging without clear exercise intensity targets. We show in the DOSE trial more than double the steps and aerobic minutes within a session can be achieved compared with usual care and translates to improved long-term walking outcomes.
We modeled data from this successful higher intensity multi-site RCT to develop targets for prescribing and progressing exercise for varying levels of walking impairment after stroke.
In twenty-five individuals in inpatient rehabilitation, twenty sessions were monitored for a total of 500 one-hour physical therapy sessions. For the 500 sessions, step number and aerobic minute progression were modeled using linear mixed effects regression. Using formulas from the linear mixed effects regression, targets were calculated.
The model for step number included session number and baseline walking speed, and for aerobic minutes, session number and age. For steps, there was an increase of 73 steps per session. With baseline walking speed, for every 0.1 m/s increase, a corresponding increase of 302 steps was predicted. For aerobic minutes, there was an increase of .56 minutes of aerobic activity (ie, 34 seconds) per session. For every year increase in age, a decrease of .39 minutes (ie, 23 seconds) was predicted.
Using data associated with better walking outcomes, we provide step number and aerobic minute targets that future studies can cross-validate. As walking speed and age are collected at admission, these models allow for uptake of routine measurement of therapeutic intensity.Registration: www.clinicaltrials.gov; NCT01915368.
虽然更高的治疗强度可以改善中风后的运动恢复，但如果没有明确的运动强度目标，将成功研究的结果转化为简体中文是具有挑战性的。我们在 DOSE 试验中表明，与常规护理相比，每次治疗可以多走两倍以上的步数，多做有氧分钟，从而改善长期的步行效果。
我们对这项成功的高强度多中心 RCT 的数据进行建模，为不同程度中风后步行障碍的患者制定运动处方和进展目标。
在 25 名住院康复患者中，监测了 20 次治疗，共进行了 500 次 1 小时物理治疗。对于这 500 次治疗，我们使用线性混合效应回归模型来预测步数和有氧分钟的进展。使用线性混合效应回归公式计算目标。
步数模型包括治疗次数和基线步行速度，而有氧分钟模型则包括治疗次数和年龄。对于步数，每次治疗增加 73 步。考虑到基线步行速度，每增加 0.1 米/秒，预计会增加 302 步。对于有氧分钟，每次治疗增加 0.56 分钟的有氧运动（即 34 秒）。年龄每增加 1 岁，预计会减少 0.39 分钟（即 23 秒）。
利用与更好的步行结果相关的数据，我们提供了未来研究可以交叉验证的步数和有氧分钟目标。由于在入院时就可以测量步行速度和年龄，因此这些模型可以接受治疗强度的常规测量。
