Feedback about walking activity does not increase walking activity levels during inpatient rehabilitation after stroke [synopsis]

摘要

Summary of: Dorsch AK, Thomas S, Xu X, Kaiser W, Dobkin BH, on behalf of the SIRRACT investigators. SIRRACT: An international randomized clinical trial of activity feedback during inpatient stroke rehabilitation enabled by wireless sensing. Neurorehabil Neur Rep. 2015;29:407-415. Question: For people with stroke, does providing quantitative feedback about daily walking performance during inpatient rehabili- tation increase time spent walking and fastest safe gait speed at discharge? Design: Phase III, multi-site, single-blind, parallel-group, randomised, controlled trial with concealed allocation. Setting: Sixteen inpatient rehabilitation facilities in 11 countries. Partici- pants: Adults with hemiparesis following stroke who were admitted to a rehabilitation facility within 35 days of stroke and able to walk five steps within 10 days of admission. Key exclusion criteria were inability to follow a two-step command and concurrent medical conditions restricting participation in physiotherapy. Using a block- randomised design, 151 participants were assigned to a speed-only feedback group (n = 73) or an augmented-feedback group (n = 78). Interventions: Bilateral ankle sensors (accelerometers) collected daily information about walking speed, distance and step activity from each participant. During rehabilitation, both groups received feedback from therapists three times a week about their fastest safe walking speed, which was assessed by a stopwatch-timed 10-m walk test. The augmented-feedback group received additional feedback about their physical activity from the ankle sensor data, and were encouraged to increase their activity levels. Outcome measures: The primary outcome measures were: average time spent walking, which was recorded by the ankle sensors [2T_DI$DF]F; and fastest safe gait speed at discharge, which was assessed over 15 m by a blinded evaluator. [3_TDD$IFF] he1836-9553/ 2015 Australian Physiotherapy Association. Published by Elsevier B.V. Alsecondary outcomes 4[_TD$DFIF], which were all collected at discharge, were: Functional Ambulation Classification, 3-minute walk distance, and the Stroke Impact Scale D1_[T$DI]FF. Results: A total of 125 participants completed the trial. At discharge there were no significant between-group differences in average time spent walking per day (MD 1.5 [5T_Dm$FDFI] in, 95% CI C[6_TDI$DF]F3.3 to 6.3) or fastest safe walking speed (MD C 0.02 m/s, 95% CI C[7_TD$FDIF0] .20 to 0.16); both groups significantly increased their walking speed between baseline and discharge. There were no significant between-group differences in any of the secondary outcomes. Post hoc analysis showed that there were significant differences in amount of activity per day between severe, moderate and mildly impaired participants (classified on baseline gait speed), but augmented [8_TDD$IFF] feedback did not increase the amount of time spent walking in any severity group. Conclusion: Feedback during inpatient rehabilitation about the amount of walking activity as well as walking speed did not increase the daily time spent walking or walking speed more than just providing feedback about walking speed. The results of this study highlight that patients with stroke remain quite inactive during inpatient rehabilitation, even when provided with feedback and encouraged to increase their activity levels. [95% CIs calculated by the CAP Editor] Provenance: Invited. Not peer-reviewed. Prudence Plummer Division of Physical Therapy, University of North Carolina at Chapel Hill, USA http://dx.doi.org/10.1016/j.jphys.2015.07.008.