THERAPY-Magazin
News on the prediction of walking ability after a stroke
A new study identifies key predictors of walking activity after stroke—endurance, age, and pre-stroke activity levels guide rehab success in the first 6 months post-discharge.
Jakob Tiebel
Business Owner, N+ Digital Health Agency
Which impairments, activity restrictions and personal factors reliably predict walking activity in the first 6 months after a stroke upon discharge from hospital? A longitudinal study published in early 2019 by Niruthikha Mahendran and colleagues from the Physiotherapy School of Health and Rehabilitation Science at the University of Queensland in Brisbane, Australia, provides new insights into this issue.
Question
In their study, the researchers investigated which impairments, activity restrictions and personal factors can predict the extent, frequency and intensity of walking activity of patients 1, 3 and 6 months after stroke when they are discharged from hospital.
In their study, the researchers investigated which impairments, activity restrictions and personal factors can predict the extent, frequency and intensity of walking activity of patients 1, 3 and 6 months after stroke when they are discharged from hospital.
Methodology
As part of a prospective longitudinal study, a total of 36 stroke patients aged 71 ±14 years were recruited at the time of discharge. 69% of the subjects were male. Data on possible predictors such as fatigue, mood, executive functions, walking speed, walking endurance, age, prestroke activity, self-efficacy, perceived stroke recovery and health were collected. After 1, 3 and 6 months, the researchers investigated the walking activity of the subjects as part of the follow-up using movement and activity profiles, which they recorded using portable sensors.
As part of a prospective longitudinal study, a total of 36 stroke patients aged 71 ±14 years were recruited at the time of discharge. 69% of the subjects were male. Data on possible predictors such as fatigue, mood, executive functions, walking speed, walking endurance, age, prestroke activity, self-efficacy, perceived stroke recovery and health were collected. After 1, 3 and 6 months, the researchers investigated the walking activity of the subjects as part of the follow-up using movement and activity profiles, which they recorded using portable sensors.
Results
The results of a regression analysis showed that after one month, walking endurance was the sole predictor for walking activity (R2 > 0.29, p < 0.01). After 3 months, walking endurance in combination with pre-stroke activity level predicted the extent and intensity of activity (R2 = 0.46-0.61, p < 0.001). In addition, activity behaviour before the stroke was a meaningful predictor of activity frequency (R2 = 0.31, p = 0.004). After 6 months, age in particular predicted the extent and frequency of walking activity (R2 = 0.34-0.35, p < 0.003), whereas activity levels before the stroke, walking endurance at discharge, and executive functions predicted intensity (R2 = 0.79, p < 0.001).
The results of a regression analysis showed that after one month, walking endurance was the sole predictor for walking activity (R2 > 0.29, p < 0.01). After 3 months, walking endurance in combination with pre-stroke activity level predicted the extent and intensity of activity (R2 = 0.46-0.61, p < 0.001). In addition, activity behaviour before the stroke was a meaningful predictor of activity frequency (R2 = 0.31, p = 0.004). After 6 months, age in particular predicted the extent and frequency of walking activity (R2 = 0.34-0.35, p < 0.003), whereas activity levels before the stroke, walking endurance at discharge, and executive functions predicted intensity (R2 = 0.79, p < 0.001).
Conclusions
The authors conclude that endurance in particular has an influence on the activity level of stroke patients in the first 6 months after hospitalisation. After one month, factors such as pre-stroke activity behaviour, age and executive functions also contribute to the results and should be taken into account in the orientation of physical activity after a stroke.
The authors conclude that endurance in particular has an influence on the activity level of stroke patients in the first 6 months after hospitalisation. After one month, factors such as pre-stroke activity behaviour, age and executive functions also contribute to the results and should be taken into account in the orientation of physical activity after a stroke.
Implications for clinical practice
The results of this study provide important information for clinical practice. Therapeutic activities in the context of stroke rehabilitation should aim in particular at improving walking endurance, as higher values are associated with higher walking activity in the first month after discharge. Factors such as a low pre-stroke activity level and a higher age predict reduced walking activity after the stroke. They represent fundamental barriers, and creative approaches are required to overcome them.
Physical activity measures should always be tailored to the individual, their environment and relevant context factors, while taking into account the individual's pre-stroke activity behaviour.
The results of this study provide important information for clinical practice. Therapeutic activities in the context of stroke rehabilitation should aim in particular at improving walking endurance, as higher values are associated with higher walking activity in the first month after discharge. Factors such as a low pre-stroke activity level and a higher age predict reduced walking activity after the stroke. They represent fundamental barriers, and creative approaches are required to overcome them.
Physical activity measures should always be tailored to the individual, their environment and relevant context factors, while taking into account the individual's pre-stroke activity behaviour.
Ambulante Rehabilitation
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THERAPY 2019-II
THERAPY Magazine
Jakob Tiebel
Business Owner, N+ Digital Health Agency
Jakob Tiebel studied applied psychology with a focus on health economics. He has clinical expertise from his previous therapeutic work in neurorehabilitation. He conducts research and publishes on the theory-practice transfer in neurorehabilitation and is the owner of Native.Health, an agency for digital health marketing.
References:
- Originalarbeit Mahendran N, Kuys S, Brauer S (2019). Which impairments, activity limitations and personal factors at hospital discharge predict walking activity across the first 6 months poststroke? Disability and Rehabilitation, DOI: 10.1080/09638288.2018.1508513
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