Matching Clinical Profiles With Interventions to Optimize Daily Stepping in People With Stroke.

IMPORTANCE

Individualizing interventions is imperative to optimize step-activity in people with chronic stroke.

OBJECTIVE

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.

DESIGN

This is a secondary analysis of a randomized control trial.

SETTING

The parent study occurred at 4 outpatient rehabilitation clinics.

PARTICIPANTS

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.

INTERVENTIONS

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.

RESULTS

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).

CONCLUSIONS

People with chronic stroke require different interventions to optimize changes in step-activity.

RELEVANCE

Clinicians can use clinically relevant measures to personalize intervention selection to augment step-activity in people with chronic stroke.