McCartney Kiersten M, Boyne Pierce, Pohlig Ryan T, Morton Susanne M, Reisman Darcy S
Department of Physical Therapy, University of Delaware, Newark, DE, USA.
Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA.
Top Stroke Rehabil. 2025 Jun 9:1-11. doi: 10.1080/10749357.2025.2513260.
People with chronic stroke have significant impairments in their walking capacity. Minimal clinically important differences (MCIDs) can be used to interpret changes in patient outcomes following interventions. There is significant variability in the response to moderate-to-high walking interventions in people with chronic stroke. One reason for this response variability could be the lack of understanding of the threshold exercise dose needed to achieve an MCID.
The purpose of this analysis was to determine the threshold of exercise training speed most predictive of a small (≥20 m) or moderate (≥50 m) clinically important difference in 6MWT in people with chronic stroke.
Participants with chronic stroke with a walking speed of 0.3-1.0 m/s were randomized into a 12-week (1) fast-walking training or (2) fast-walking training and step-activity monitoring intervention. This analysis included participants ( = 129; age: 63.1 ± 12.5, 46% female) with complete pre- and post-intervention data. Exercise intensity was quantified as average training speed.
Receiver operating characteristic curves analyzed whether training speed is predictive of attaining a clinically important difference in the 6MWT. Training speed had poor, non-significant accuracy of predicting a small (AUC [95% CI] = 0.584 [0.475-0.693], = 0.131) or moderate (AUC [95% CI] = 0.597 [0.498-0.696], = 0.056) change in 6MWT.
The average walking training speed during this high-intensity walking intervention did not accurately predict which people with chronic stroke would attain a small or moderate clinically meaningful change in 6MWT distance.
慢性卒中患者的行走能力存在显著损害。最小临床重要差异（MCIDs）可用于解释干预后患者结局的变化。慢性卒中患者对中高强度行走干预的反应存在显著差异。这种反应差异的一个原因可能是对达到MCID所需的运动剂量阈值缺乏了解。
本分析的目的是确定运动训练速度阈值，该阈值最能预测慢性卒中患者6分钟步行试验（6MWT）中出现小幅度（≥20米）或中等幅度（≥50米）的临床重要差异。
步行速度为0.3-1.0米/秒的慢性卒中参与者被随机分为12周的（1）快走训练组或（2）快走训练及步活动监测干预组。本分析纳入了干预前后数据完整的参与者（n = 129；年龄：63.1±12.5岁，46%为女性）。运动强度以平均训练速度量化。
通过受试者工作特征曲线分析训练速度是否能预测6MWT中出现临床重要差异。训练速度对预测6MWT中小幅度（AUC [95% CI]=0.584 [0.475-0.693]，p = 0.131）或中等幅度（AUC [95% CI]=0.597 [0.498-0.696]，p = 0.056）变化的准确性较差且无统计学意义。
在这种高强度行走干预期间，平均步行训练速度不能准确预测哪些慢性卒中患者在6MWT距离上会出现小幅度或中等幅度的临床有意义变化。
