McCartney Kiersten M, Pohlig Ryan T, Miller Allison E, Thompson Elizabeth D, Reisman Darcy S
Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States.
Biomechanics and Movement Science Program, University of Delaware, Newark, DE 19713, United States.
Phys Ther. 2025 Jul 1;105(7). doi: 10.1093/ptj/pzaf070.
Individualizing interventions is imperative to optimize step-activity in people with chronic stroke.
The objective was to group individuals with chronic stroke into clinical profiles based on baseline characteristics and examine if these profiles preferentially benefitted from a specific intervention to improve daily step-activity.
This is a secondary analysis of a randomized control trial.
The parent study occurred at 4 outpatient rehabilitation clinics.
Participants had strokes ≥6 months prior to enrollment, were 21 to 85 years old, had walking speeds of 0.3 to 1.0 meters per second, and took <8000 steps-per-day.
Participants were randomized to high-intensity treadmill training (FAST), a step-activity behavioral intervention (SAM), or a combined intervention (FAST+SAM).
MAIN OUTCOME(S): 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. Class 1 had the lowest walking capacity (speed and endurance), lowest balance self-efficacy, and highest area deprivation, and the greatest change in step-activity when enrolled in SAM (mean = 1624, 95% CI = 426-2821) or FAST+SAM (mean = 1150, 95% CI = 723-1577]). 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 SAM (mean = 2002, 95% CI = 1193-2811). Class 3 had the highest walking capacity, highest self-efficacy, and lowest area deprivation and the greatest change in step-activity when enrolled in FAST+SAM (mean = 1532, 95% CI = 915-2150).
People with chronic stroke require different interventions to optimize changes in step-activity.
Clinicians can use clinically relevant measures to personalize intervention selection to augment step-activity in people with chronic stroke.
个性化干预对于优化慢性卒中患者的步数活动至关重要。
目的是根据基线特征将慢性卒中患者分组为临床概况，并检查这些概况是否优先受益于特定干预措施以改善日常步数活动。
这是一项随机对照试验的二次分析。
母研究在4个门诊康复诊所进行。
参与者在入组前≥6个月发生卒中，年龄在21至85岁之间，步行速度为每秒0.3至1.0米，且每天步数<8000步。
参与者被随机分配到高强度跑步机训练（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（临床概况）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、认知和区域剥夺。
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概况。第1组步行能力（速度和耐力）最低，平衡自我效能最低，区域剥夺最高，在参加SAM（平均=1624，95%可信区间=426-2821）或FAST+SAM（平均=1150，95%可信区间=723-1577]）时步数活动变化最大。第2组的步行能力、每日基线步数和自我效能值介于第1组和第3组之间，在参加SAM时步数活动变化最大（平均=2002，95%可信区间=1193-2811）。第3组步行能力最高，自我效能最高，区域剥夺最低，在参加FAST+SAM时步数活动变化最大（平均=1532，95%可信区间=915-2150）。
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。
