Archives of physical medicine and rehabilitation · 2026
Evaluating the Impact of High-Dose Inpatient Rehabilitation Gait Training on Poststroke Physical Activity: A Secondary Analysis of a Randomized Controlled Trial.
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Mackie Paul, Hung Stanley H, Klassen Tara D, Eng Janice J, DOSE Research Group
Аннотация
OBJECTIVES: To determine if higher doses of inpatient step training affect physical activity levels 12 months poststroke. A secondary aim sought to identify whether walking improvements during the subacute rehabilitation stage were predictive of 12-month physical activity.
DESIGN: Multisite, assessor-blinded, randomized controlled trial.
SETTING: Inpatient rehabilitation.
PARTICIPANTS: Patients with stroke (N=75, <10 wk poststroke) admitted to inpatient rehabilitation with lower limb hemiiparesis and able to walk 5 m wtih or without assistance.
INTERVENTIONS: Participants admitted for subacute stroke rehabilitation were randomly assigned to either control (usual therapy); determining optimal poststroke exercise (DOSE) 1, 4 weeks structured and progressive walking and aerobic exercise within usual therapy time (5h/wk); or DOSE 2, 4 weeks of walking and aerobic exercises within usual therapy time, plus an additional session (2 sessions/d, 10h/wk).
MAIN OUTCOME MEASURES: The treatment effect was examined on physical activity measured by daily steps at 12 months poststroke. Longitudinal analysis determined predictors of 12-month physical activity based on subacute period change in the 6-minute walk test from rehabilitation admission (∼1mo poststroke) to 4 weeks later.
RESULTS: Valid step data were available for 57 participants at 12 months. Participants were on average 54.91±11.45 years, predominantly men (63%), and had impaired mobility (gait speed; 0.41±0.24). There were no group effects on physical activity at 12 months after stroke. Twelve-month physical activity was relatively high (7020 steps/d) across the 3 groups. Longitudinal analysis showed a significant association between change in the 6-minute walk test during inpatient rehabilitation and combined 12-month physical activity poststroke (estimated effect: 15.80; 95% CI, 7.06-24.54).
CONCLUSIONS: Higher walking doses at inpatient rehabilitation did not impact 12-month physical activity. Longitudinal analysis found a positive association with change in distance walked and 12-month physical activity levels, with a gain of 15.8 steps 12 months poststroke per meter walked.
DESIGN: Multisite, assessor-blinded, randomized controlled trial.
SETTING: Inpatient rehabilitation.
PARTICIPANTS: Patients with stroke (N=75, <10 wk poststroke) admitted to inpatient rehabilitation with lower limb hemiiparesis and able to walk 5 m wtih or without assistance.
INTERVENTIONS: Participants admitted for subacute stroke rehabilitation were randomly assigned to either control (usual therapy); determining optimal poststroke exercise (DOSE) 1, 4 weeks structured and progressive walking and aerobic exercise within usual therapy time (5h/wk); or DOSE 2, 4 weeks of walking and aerobic exercises within usual therapy time, plus an additional session (2 sessions/d, 10h/wk).
MAIN OUTCOME MEASURES: The treatment effect was examined on physical activity measured by daily steps at 12 months poststroke. Longitudinal analysis determined predictors of 12-month physical activity based on subacute period change in the 6-minute walk test from rehabilitation admission (∼1mo poststroke) to 4 weeks later.
RESULTS: Valid step data were available for 57 participants at 12 months. Participants were on average 54.91±11.45 years, predominantly men (63%), and had impaired mobility (gait speed; 0.41±0.24). There were no group effects on physical activity at 12 months after stroke. Twelve-month physical activity was relatively high (7020 steps/d) across the 3 groups. Longitudinal analysis showed a significant association between change in the 6-minute walk test during inpatient rehabilitation and combined 12-month physical activity poststroke (estimated effect: 15.80; 95% CI, 7.06-24.54).
CONCLUSIONS: Higher walking doses at inpatient rehabilitation did not impact 12-month physical activity. Longitudinal analysis found a positive association with change in distance walked and 12-month physical activity levels, with a gain of 15.8 steps 12 months poststroke per meter walked.