Thompson Elizabeth D, McCartney Kiersten M, Pohlig Ryan T, Hornby T George, Kasner Scott E, Raser-Schramm Jonathan, Henderson Christopher E, Wright Henry, Wright Tamara, Reisman Darcy S
Department of Physical Therapy, University of Delaware, Newark, DE, USA.
University of Delaware, Biomechanics and Movement Science (BIOMS) program, Delaware, Newark, DE, USA.
Neurorehabil Neural Repair. 2025 Jul 10:15459683251352493. doi: 10.1177/15459683251352493.
BackgroundIndividuals with chronic stroke are less active, which is both a consequence of stroke-related impairments and a risk factor for future health complications. The PROWALKS clinical trial found significant gains in real-world walking activity (steps/day) after 12 weeks of a step activity monitoring behavioral intervention, provided either alone (SAM) or with high-intensity gait training (FAST + SAM), but not after high-intensity gait training alone (FAST). Previous research in individuals after stroke suggests that tailored behavioral counseling may lead to better long-term physical activity participation, but no previous work has focused on post-intervention maintenance of walking activity changes.ObjectiveTo investigate whether steps/day changes after training (POST) were maintained at 6 months (6MO) and 12 months (12MO) after baseline. We hypothesized that SAM and FAST + SAM groups would have better maintenance of steps/day changes than the FAST group. This analysis included all participants who completed the PROWALKS intervention (n = 200, mean[SD] age: 63.27[12.41], 102 male/98 female, >6 months post-stroke). Analysis outcomes were steps/day change from POST-6MO, and from POST-12MO.ResultsAll groups significantly decreased in steps/day from POST-6MO ( = .001, FAST decreased by mean[SE] 160[272], SAM by 1016[270], FAST + SAM by 400[300]), and POST-12MO ( < .001, FAST decreased by 610[280], SAM by 1072[306], FAST + SAM by 568[313]). There were no significant differences between groups.ConclusionsAll intervention groups showed significant declines in steps/day between POST and 6MO and between POST and 12MO. These results add to a growing body of literature suggesting that a behavioral intervention to behavior change may not be sufficient for of change.Registration:This study is registered at ClinicalTrials.gov, NCT02835313.
背景
患有慢性中风的个体活动较少，这既是中风相关损伤的结果，也是未来健康并发症的风险因素。PROWALKS临床试验发现，在进行为期12周的步数活动监测行为干预后，无论是单独进行（SAM）还是与高强度步态训练一起进行（FAST + SAM），现实世界中的步行活动（步数/天）都有显著增加，但单独进行高强度步态训练（FAST）后则没有。先前对中风后个体的研究表明，量身定制的行为咨询可能会导致更好的长期身体活动参与，但以前没有研究关注干预后步行活动变化的维持情况。
目的
调查训练后（POST）的每日步数变化在基线后6个月（6MO）和12个月（12MO）时是否得以维持。我们假设SAM组和FAST + SAM组在每日步数变化的维持方面会比FAST组更好。该分析纳入了所有完成PROWALKS干预的参与者（n = 200，平均[标准差]年龄：63.27[12.41]，男性102名/女性98名，中风后超过6个月）。分析结果为从POST到6MO以及从POST到12MO的每日步数变化。
结果
所有组从POST到6MO（P = 0.001，FAST组平均[标准误]减少160[272]，SAM组减少1016[270]，FAST + SAM组减少400[300]）以及从POST到12MO（P < 0.001，FAST组减少610[280]，SAM组减少1072[306]，FAST + SAM组减少568[313]）时，每日步数均显著减少。组间无显著差异。
结论
所有干预组在POST到6MO以及POST到12MO之间的每日步数均显著下降。这些结果进一步证明，越来越多的文献表明，旨在改变行为的行为干预可能不足以维持变化。
本研究已在ClinicalTrials.gov注册，注册号为NCT02835313。
