McCartney Kiersten M, Pohlig Ryan T, Miller Allison, Thompson Elizabeth D, Reisman Darcy
University of Delaware, Department of Physical Therapy, Newark, DE, USA.
University of Delaware, Biomechanics and Movement Science Program, Newark, DE, USA.
medRxiv. 2024 Nov 15:2024.11.14.24317334. doi: 10.1101/2024.11.14.24317334.
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.
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.
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.
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.
NCT02835313; https://clinicaltrials.gov/ct2/show/NCT02835313.
为了优化慢性卒中患者的身体活动，必须进行个体化干预。这项二次分析根据基线特征将慢性卒中患者分组为临床特征组，并研究这些临床特征组是否优先从特定的康复干预中获益，以改善每日步数活动。
参与者在入组前6个月以上发生非小脑卒中，年龄在21-85岁之间，步行速度为0.3-1.0米/秒，且每日步数<8000步。参与者被随机分配到3种干预措施中的一种：高强度跑步机训练（FAST）、步数活动行为干预（SAM）或联合干预（FAST+SAM）。主要结局是潜在类别（临床特征）与干预组（FAST、SAM、FAST+SAM）对每日步数变化的交互作用。识别潜在类别的关键临床特征包括步行速度、步行耐力、平衡自我效能、认知和脑区损伤面积。
在190名有完整干预前后数据的参与者中（平均[标准差]年龄，64[12]岁；93名女性[48.9%]），识别出3种不同的慢性卒中患者特征。在我们的样本中，第1类步行能力（速度和耐力）最低，平衡自我效能最低，脑区损伤面积最大，在接受SAM（平均[95%CI]，1624[426 - 2821]）或FAST+SAM（1150[723 - 1577]）干预时，步数活动变化最大。第2类的步行能力、每日基线步数和自我效能值介于第1类和第3类之间，在接受SAM（2002[1193 - 2811]）干预时，步数活动变化最大。第3类步行能力最高，自我效能最高，脑区损伤面积最小，在接受FAST+SAM（1532[915 - 2150]）干预时，步数活动变化最大。
慢性卒中患者需要不同的干预措施来优化步数活动的变化。临床医生可以使用临床相关指标来个性化干预选择，以增加慢性卒中患者的步数活动。
NCT02835313；https://clinicaltrials.gov/ct2/show/NCT02835313 。
