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de Diego-Alonso C, Bellosta-López P, Blasco-Abadía J, Buesa-Estéllez A, Roldán-Pérez P, Medina-Rincón A, López-Royo MP, Giner-Nicolás R, Doménech-García V, Fini NA. The relationship between levels of physical activity and participation in everyday life in stroke survivors: A systematic review and meta-analysis. Disabil Health J 2024; 17:101640. [PMID: 38777677 DOI: 10.1016/j.dhjo.2024.101640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/01/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Stroke survivors demonstrate decreased physical activity (PA) and take time to return to participation in everyday life, but the relationship between the two variables is unknown. OBJECTIVE To investigate the correlation and trajectory over time between levels of PA and participation in everyday life in stroke survivors. METHODS PubMed, Web of Science, Scopus, SPORTDiscus, Rehabilitation&Sport Medicine Source, and PEDro databases were searched from inception to January 2024. Cross-sectional and prospective studies evaluating both levels of PA and participation in stroke survivors were included. Two reviewers independently conducted the study selection, data extraction, and quality assessment. Meta-analyses of pooled correlation coefficients were calculated when at least two studies reported a correlation coefficient between the same PA and participation outcomes. RESULTS Of 4962 studies identified, 49 were included in the systematic review. Studies were rated high (55%%) or fair (45%) quality. A wide range of monitoring methodologies for assessing PA and participation were found in the 23 prospective studies. Seven studies were included in the meta-analyses, showing a positive moderate correlation between PA time and participation in activities of daily living (n = 148; r = 0.52; P < 0.01; I2 = 81%) in participants <6 months post-stroke, and between PA time and the participation in all areas (n = 126; r = 0.44; P < 0.01; I2 = 0%) in participants ≥6 months post-stroke. Overall, while PA showed significant improvements over time, participation only showed a tendency. CONCLUSION Despite the heterogeneity, consistent positive associations were found between PA time and participation levels in some areas. Establishing consensus is crucial to reduce heterogeneity and facilitate data pooling.
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Affiliation(s)
- Cristina de Diego-Alonso
- Universidad San Jorge. Campus Universitario, Autov, A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Pablo Bellosta-López
- Universidad San Jorge. Campus Universitario, Autov, A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain.
| | - Julia Blasco-Abadía
- Universidad San Jorge. Campus Universitario, Autov, A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Almudena Buesa-Estéllez
- Universidad San Jorge. Campus Universitario, Autov, A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Patricia Roldán-Pérez
- Universidad San Jorge. Campus Universitario, Autov, A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Almudena Medina-Rincón
- Universidad San Jorge. Campus Universitario, Autov, A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - María Pilar López-Royo
- Universidad San Jorge. Campus Universitario, Autov, A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Rafael Giner-Nicolás
- Universidad San Jorge. Campus Universitario, Autov, A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Víctor Doménech-García
- Universidad San Jorge. Campus Universitario, Autov, A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Natalie A Fini
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Zhou H, Wang J, Zhu Z, Hu L, An E, Lu J, Zhao H. A New Perspective on Stroke Research: Unraveling the Role of Brain Oxygen Dynamics in Stroke Pathophysiology. Aging Dis 2024:AD.2024.0548. [PMID: 39226161 DOI: 10.14336/ad.2024.0548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 08/02/2024] [Indexed: 09/05/2024] Open
Abstract
Stroke, a leading cause of death and disability, often results from ischemic events that cut off the brain blood flow, leading to neuron death. Despite treatment advancements, survivors frequently endure lasting impairments. A key focus is the ischemic penumbra, the area around the stroke that could potentially recover with prompt oxygenation; yet its monitoring is complex. Recent progress in bioluminescence-based oxygen sensing, particularly through the Green enhanced Nano-lantern (GeNL), offers unprecedented views of oxygen fluctuations in vivo. Utilized in awake mice, GeNL has uncovered hypoxic pockets within the cerebral cortex, revealing the brain's oxygen environment as a dynamic landscape influenced by physiological states and behaviors like locomotion and wakefulness. These findings illuminate the complexity of oxygen dynamics and suggest the potential impact of hypoxic pockets on ischemic injury and recovery, challenging existing paradigms and highlighting the importance of microenvironmental oxygen control in stroke resilience. This review examines the implications of these novel findings for stroke research, emphasizing the criticality of understanding pre-existing oxygen dynamics for addressing brain ischemia. The presence of hypoxic pockets in non-stroke conditions indicates a more intricate hypoxic scenario in ischemic brains, suggesting strategies to alleviate hypoxia could lead to more effective treatments and rehabilitation. By bridging gaps in our knowledge, especially concerning microenvironmental changes post-stroke, and leveraging new technologies like GeNL, we can pave the way for therapeutic innovations that significantly enhance outcomes for stroke survivors, promising a future where an understanding of cerebral oxygenation dynamics profoundly informs stroke therapy.
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Affiliation(s)
- Hongmei Zhou
- Anesthesiology Department, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jialing Wang
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Joint Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Zhipeng Zhu
- Anesthesiology Department, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Li Hu
- Anesthesiology Department, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Erdan An
- Anesthesiology Department, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jian Lu
- Anesthesiology Department, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Heng Zhao
- Anesthesiology Department, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Joint Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
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Kobari T, Murayama T, Ikeda Y. Relationship between the amount of physical activity and brain structure in patients with chronic stroke. Neurol Res 2024; 46:781-786. [PMID: 38873919 DOI: 10.1080/01616412.2024.2354619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 05/07/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES The association between the amount of physical activity and the brain structure in patients with stroke is unclear. Therefore, this study aimed to evaluate the structural characteristics of the brain in patients with chronic stroke engaging in varying levels of physical activity. METHODS This study included 10 healthy participants and 10 patients with stroke. Structural images were obtained, and the physical activity of patients with stroke was measured using a triaxial accelerometer. Additionally, the brain structure was assessed using voxel-based morphometry for gray and white matter volumes. The analysis software used were Statistical Parametric Mapping 12 and MATLAB version R2020a. The differences in brain structure between healthy participants and stroke patients were investigated. The brain regions associated with the amount of physical activity were analyzed. RESULTS There was a significant decrease in the gray matter volume of the contralesional cerebellum and ipsilesional thalamus in stroke patients when compared with healthy participants (p < 0.001, uncorrected). Patients with stroke showed a positive correlation between physical activity and the volume of the ipsilesional precentral gyrus and ipsilesional entorhinal area (p < 0.001, uncorrected). CONCLUSIONS The amount of physical activity in patients with chronic hemiplegic stroke is associated with brain gray matter mass.
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Affiliation(s)
- Tomoyoshi Kobari
- Faculty of Health Care and Medical Sports, Department of Rehabilitation, Teikyo Heisei University, Chiba, Japan
| | - Takashi Murayama
- Department of Rehabilitation Therapy, Chiba Rehabilitation Center, Chiba, Japan
| | - Yumi Ikeda
- Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
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Nayak N, Mahendran N, Kuys S, Brauer SG. What factors at discharge predict physical activity and walking outcomes 6 months after stroke? A systematic review. Clin Rehabil 2024:2692155241261698. [PMID: 39053141 DOI: 10.1177/02692155241261698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
OBJECTIVE This study aimed to identify factors at hospital discharge that predict physical activity and walking outcomes in the first 6 months after stroke. DATA SOURCES Searches were conducted in CINAHL (EBSCO), Web of Science, PubMed and Scopus from inception to 30 April 2024. Reference lists of included articles were manually screened to identify additional studies. REVIEW METHODS Studies of adults with stroke reporting predictors at hospital discharge and outcomes of physical activity or walking across the first 6 months after hospital discharge were included. Two reviewers independently screened titles, abstracts and reviewed full texts. Quality of included studies was assessed with Quality in Prognostic Studies screening tool. A narrative synthesis was undertaken. RESULTS The search strategy retrieved 7834 studies, from which 6 eligible studies were identified, including a total of 1433 participants. Overall, studies had a low risk of bias. Age, balance, walking speed and walking distance at hospital discharge predicted physical activity outcomes after stroke (n = 2 studies). Cognition, lower limb cycling rhythm and self-efficacy for walking at hospital discharge predicted walking outcomes after stroke (n = 4 studies). CONCLUSIONS A range of factors predicted physical activity and walking outcomes 6 months after stroke. Physical capabilities at discharge appear to be a predictor of these outcomes; however, this needs to be interpreted with caution. Diverse measures and time points were used across studies to characterise physical activity and walking outcomes, highlighting the need for consistency in measurement and longitudinal studies in stroke research.
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Affiliation(s)
- Neelam Nayak
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Niruthikha Mahendran
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Suzanne Kuys
- Physiotherapy, School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
| | - Sandra G Brauer
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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Delhey LM, Shi X, Morgenstern LB, Brown DL, Smith MA, Case EC, Springer MV, Lisabeth LD. Neighborhood Resources and Health Outcomes Among Stroke Survivors in a Population-Based Cohort. J Am Heart Assoc 2024; 13:e034308. [PMID: 38958125 PMCID: PMC11292760 DOI: 10.1161/jaha.124.034308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/05/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Stroke survivors believe neighborhood resources such as community centers are beneficial; however, little is known about the influence of these resources on stroke outcomes. We evaluated whether residing in neighborhoods with greater resource density is associated with favorable post-stroke outcomes. METHODS AND RESULTS We included Mexican American and non-Hispanic White stroke survivors from the Brain Attack Surveillance in Corpus Christi project (2009-2019). The exposure was density of neighborhood resources (eg, community centers, restaurants, stores) within a residential census tract at stroke onset. Outcomes included time to death and recurrence, and at 3 months following stroke: disability (activities of daily living/instrumental activities of daily living), cognition (Modified Mini-Mental State Exam), depression (Patient Health Questionnaire-8), and quality of life (abbreviated Stroke-Specific Quality of Life scale). We fit multivariable Cox regression and mixed linear models. We considered interactions with stroke severity, ethnicity, and sex. Among 1786 stroke survivors, median age was 64 years (interquartile range, 56-73), 55% men, and 62% Mexican American. Resource density was not associated with death, recurrence, or depression. Greater resource density (75th versus 25th percentile) was associated with more favorable cognition (Modified Mini-Mental State Exam mean difference=0.838, 95% CI=0.092, 1.584) and among moderate-severe stroke survivors, with more favorable functioning (activities of daily living/instrumental activities of daily living=-0.156 [95% CI, -0.284 to 0.027]) and quality of life (abbreviated Stroke-Specific Quality of Life scale=0.194 [95% CI, 0.029-0.359]). CONCLUSIONS We observed associations between greater resource density and cognition overall and with functioning and quality of life among moderate-severe stroke survivors. Further research is needed to confirm these findings and determine if neighborhood resources may be a tool for recovery.
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Affiliation(s)
- Leanna M. Delhey
- Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborMIUSA
| | - Xu Shi
- Department of BiostatisticsUniversity of Michigan School of Public HealthAnn ArborMIUSA
| | - Lewis B. Morgenstern
- Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborMIUSA
- Stroke Program, University of Michigan Medical SchoolAnn ArborMIUSA
| | - Devin L. Brown
- Stroke Program, University of Michigan Medical SchoolAnn ArborMIUSA
| | - Melinda A. Smith
- Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborMIUSA
| | - Erin C. Case
- Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborMIUSA
| | | | - Lynda D. Lisabeth
- Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborMIUSA
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Hasegawa A, Yamaga T, Nakanishi K. Enhancing physical activity and augmenting upper limb function in sedentary stroke survivors: the transformative impact of chair transitions. BMJ Case Rep 2024; 17:e259080. [PMID: 38991574 DOI: 10.1136/bcr-2023-259080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
In post-stroke individuals with walking difficulties, prolonged sitting can lead to increased mortality. Interventions targeting increased physical activity for these individuals are limited. Consequently, many such stroke survivors become reliant on wheelchairs, leading to prolonged inactivity. This report highlights a case where a chronic stroke patient, with walking challenges, was transitioned from a wheelchair to regular chair sitting by nursing staff in a facility lacking specialised rehabilitation professionals. This simple act of transitioning from a wheelchair to a chair during daily routines led to improvements in the patient's physical activity and upper limb functionality and reduced the need for help during meals.
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Affiliation(s)
- Aya Hasegawa
- Occupational Therapy, Nagoya Women's University, Nagoya, Japan
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Tan S, Zheng Q, Zhang W, Zhou M, Xia C, Feng W. Prognostic value of inflammatory markers NLR, PLR, and LMR in gastric cancer patients treated with immune checkpoint inhibitors: a meta-analysis and systematic review. Front Immunol 2024; 15:1408700. [PMID: 39050856 PMCID: PMC11266030 DOI: 10.3389/fimmu.2024.1408700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Background Immune checkpoint inhibitors (ICIs) represent a groundbreaking approach to cancer therapy. Inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) have emerged as potential indicators strongly associated with tumor prognosis, albeit their prognostic significance remains contentious. The predictive value of NLR, PLR, LMR in patients with gastric cancer (GC) treated with ICIs has not been fully explored; therefore, we conducted a meta-analysis to examine the potential of inflammatory markers NLR, PLR, and LMR as survival predictors in this population. Methods A comprehensive search was conducted across PubMed, Embase, Web of Science, and Cochrane databases, with the search cut-off date set as March 2024. Hazard ratios (HR) and their corresponding 95% confidence intervals (CI) were calculated to assess the prognostic significance of NLR, PLR, and LMR for both progression-free survival (PFS) and overall survival (OS). Results Fifteen cohort studies involving 1336 gastric cancer patients were finally included in this meta-analysis. The results of the meta-analysis showed that high levels of NLR were associated with poorer OS and PFS in GC patients receiving ICIs, with combined HRs of OS [HR=2.01, 95%CI (1.72,2.34), P<0.01], and PFS PFS[HR=1.59, 95%CI (1.37,1.86), P<0.01], respectively; high levels of PLR were associated with poorer OS and PFS, and the combined HR was OS [HR=1.57, 95%CI (1.25,1.96), P<0.01], PFS [HR=1.52,95%CI (1.20, 1.94), P<0.01], respectively; and there was an association between elevated LMR and prolonged OS and PFS, and the combined HR was OS [HR=0.62, 95%CI (0.47,0.81), P<0.01], and PFS [HR=0.69, 95%CI (0.50,0.95), P<0.01]. Conclusion In gastric cancer (GC) patients treated with immune checkpoint inhibitors (ICIs), elevated neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were associated with poorer overall survival (OS) and progression-free survival (PFS), while high lymphocyte-to-monocyte ratio (LMR) was linked to improved OS and PFS. Subgroup analyses suggested that NLR might be particularly pertinent to the prognosis of GC patients. In conclusion, the inflammatory markers NLR, PLR, and LMR serve as effective biomarkers for prognostic assessment in GC patients, offering valuable insights for therapeutic decision-making in the realm of GC immunotherapy. Prospective studies of high quality are eagerly awaited to validate these findings in the future. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/#myprospero, identifier CRD42024524321.
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Affiliation(s)
- Shufa Tan
- Shaanxi University of Traditional Chinese Medicine the First Clinical Medical College, Shaanxi, China
| | - Qin Zheng
- Fuling District Zhenxi Central Health Center, Inpatient Department, Chongqing, China
| | - Wei Zhang
- Shaanxi University of Traditional Chinese Medicine the First Clinical Medical College, Shaanxi, China
| | - Mi Zhou
- Physical Examination Center of Fuling Hospital Affiliated to Chongqing University, Chongqing, China
| | - Chunyan Xia
- Physical Examination Center of Fuling Hospital Affiliated to Chongqing University, Chongqing, China
| | - Wenzhe Feng
- Anorectal Department, Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Shaanxi, China
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8
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Hao J, Qian L, Ye F, Luo Y, Xu C, Wang J, Qiu Y. Factors influencing physical activity levels in elderly community-dwelling convalescent stroke survivors: A cross-sectional study. Geriatr Nurs 2024; 58:472-479. [PMID: 38955038 DOI: 10.1016/j.gerinurse.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/05/2024] [Accepted: 06/21/2024] [Indexed: 07/04/2024]
Abstract
AIM This study aimed to investigate factors affecting physical activity (PA) among elderly stroke survivors living in the community and assess the mediating role of exercise planning in the relationship between exercise self-efficacy and PA. METHODS 300 participants were surveyed using questionnaires and scales, with data analyzed using SPSS 26.0. RESULTS Univariate analysis identified sociological, disease-related factors, exercise self-efficacy, and exercise planning as influencing PA. Ordered logistic regression showed significant associations between PA, exercise self-efficacy (OR 1.093, 95 % CI 1.055-1.133, P < 0.001), and exercise planning (OR 1.296, 95 % CI 1.202-1.398, P < 0.001). Exercise planning partially mediated the relationship between exercise self-efficacy and PA, accounting for 64.86 % of the total effect. CONCLUSIONS Multiple factors, including sociological and disease-related ones, as well as exercise self-efficacy and planning, influence PA in elderly stroke survivors. Exercise planning partially mediates the relationship between exercise self-efficacy and PA.
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Affiliation(s)
- Jianru Hao
- Wuxi School of Medicine, Jiangnan University, Wuxi, 214126, China
| | - Lei Qian
- Department of Rehabilitation, Wuxi 9th Affiliated Hospital of Soochow University, Wuxi, 214023, China
| | - Fen Ye
- Department of Neurology, Affiliated Hospital of Jiangnan University, Wuxi, 214062, China
| | - Yanfang Luo
- Department of Gastroenterology, Affiliated Hospital of Jiangnan University, Wuxi, 214062, China
| | - Chen Xu
- Wuxi School of Medicine, Jiangnan University, Wuxi, 214126, China
| | - Jun Wang
- Department of Rehabilitation, Wuxi 9th Affiliated Hospital of Soochow University, Wuxi, 214023, China
| | - Yuyu Qiu
- Wuxi School of Medicine, Jiangnan University, Wuxi, 214126, China.
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Pierce JE, Cavanaugh R, Harvey S, Dickey MW, Nickels L, Copland D, Togher L, Godecke E, Meinzer M, Rai T, Cadilhac DA, Kim J, Hurley M, Foster AM, Carragher M, Wilcox C, Rose ML. High-Intensity Aphasia Intervention Is Minimally Fatiguing in Chronic Aphasia: An Analysis of Participant Self-Ratings From a Large Randomized Controlled Trial. Stroke 2024; 55:1877-1885. [PMID: 38836352 DOI: 10.1161/strokeaha.123.046031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/18/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND High-intensity therapy is recommended in current treatment guidelines for chronic poststroke aphasia. Yet, little is known about fatigue levels induced by treatment, which could interfere with rehabilitation outcomes. We analyzed fatigue experienced by people with chronic aphasia (>6 months) during high-dose interventions at 2 intensities. METHODS A retrospective observational analysis was conducted on self-rated fatigue levels of people with chronic aphasia (N=173) collected during a previously published large randomized controlled trial of 2 treatments: constraint-induced aphasia therapy plus and multi-modality aphasia therapy. Interventions were administered at a higher intensity (30 hours over 2 weeks) or lower intensity (30 hours over 5 weeks). Participants rated their fatigue on an 11-point scale before and after each day of therapy. Data were analyzed using Bayesian ordinal multilevel models. Specifically, we considered changes in self-rated participant fatigue across a therapy day and over the intervention period. RESULTS Data from 144 participants was analyzed. Participants were English speakers from Australia or New Zealand (mean age, 62 [range, 18-88] years) with 102 men and 42 women. Most had mild (n=115) or moderate (n=52) poststroke aphasia. Median ratings of the level of fatigue by people with aphasia were low (1 on a 0-10-point scale) at the beginning of the day. Ratings increased slightly (+1.0) each day after intervention, with marginally lower increases in the lower intensity schedule. There was no evidence of accumulating fatigue over the 2- or 5-week interventions. CONCLUSIONS Findings suggest that intensive intervention was not associated with large increases in fatigue for people with chronic aphasia enrolled in the COMPARE trial (Constraint-Induced or Multimodality Personalised Aphasia Rehabilitation). Fatigue did not change across the course of the intervention. This study provides evidence that intensive treatment was minimally fatiguing for stroke survivors with chronic aphasia, suggesting that fatigue is not a barrier to high-intensity treatment.
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Affiliation(s)
- John E Pierce
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation (J.E.P., L.N., M.H., A.M.F., M.C., C.W., M.L.R., S.H., L.T., E.G., D.A.C., D.C.), Melbourne, VIC, Australia
- La Trobe University, and School of Allied Health, Human Services and Sport (A.M.F., J.E.P., M.L.R., M.C., C.W.), Melbourne, VIC, Australia
| | - Robert Cavanaugh
- Observational Health Data Sciences and Informatics Center, Roux Institute, Northeastern University, Boston, MA (R.C.)
| | - Sam Harvey
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation (J.E.P., L.N., M.H., A.M.F., M.C., C.W., M.L.R., S.H., L.T., E.G., D.A.C., D.C.), Melbourne, VIC, Australia
- Queensland Aphasia Research Centre (D.C. S.H.), School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Michael Walsh Dickey
- Communication Science and Disorders, University of Pittsburgh, and Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, PA (M.W.D.)
| | - Lyndsey Nickels
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation (J.E.P., L.N., M.H., A.M.F., M.C., C.W., M.L.R., S.H., L.T., E.G., D.A.C., D.C.), Melbourne, VIC, Australia
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia (L.N.)
| | - David Copland
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation (J.E.P., L.N., M.H., A.M.F., M.C., C.W., M.L.R., S.H., L.T., E.G., D.A.C., D.C.), Melbourne, VIC, Australia
- Queensland Aphasia Research Centre (D.C. S.H.), School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Australia (D.C.)
| | - Leanne Togher
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation (J.E.P., L.N., M.H., A.M.F., M.C., C.W., M.L.R., S.H., L.T., E.G., D.A.C., D.C.), Melbourne, VIC, Australia
- Faculty of Medicine and Health, The University of Sydney, NSW, Australia (L.T.)
| | - Erin Godecke
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation (J.E.P., L.N., M.H., A.M.F., M.C., C.W., M.L.R., S.H., L.T., E.G., D.A.C., D.C.), Melbourne, VIC, Australia
- School of Medical and Health Sciences, Edith Cowan University and Sir Charles Gairdner Osborne Park Health Care Group, Perth, WA, Australia (E.G.)
| | - Marcus Meinzer
- Department of Neurology, Healthy Aging and Prevention of Dementia Group, University Medicine Greifswald, Germany (M.M.)
| | - Tapan Rai
- School of Mathematical and Physical Sciences, University of Technology Sydney, Ultimo, NSW, Australia (T.R.)
| | - Dominique A Cadilhac
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation (J.E.P., L.N., M.H., A.M.F., M.C., C.W., M.L.R., S.H., L.T., E.G., D.A.C., D.C.), Melbourne, VIC, Australia
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (D.A.C., J.K.)
- Stroke Team, Florey Institute, The University of Melbourne, VIC, Australia (D.A.C.)
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (D.A.C., J.K.)
| | - Melanie Hurley
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation (J.E.P., L.N., M.H., A.M.F., M.C., C.W., M.L.R., S.H., L.T., E.G., D.A.C., D.C.), Melbourne, VIC, Australia
| | - Abby M Foster
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation (J.E.P., L.N., M.H., A.M.F., M.C., C.W., M.L.R., S.H., L.T., E.G., D.A.C., D.C.), Melbourne, VIC, Australia
- La Trobe University, and School of Allied Health, Human Services and Sport (A.M.F., J.E.P., M.L.R., M.C., C.W.), Melbourne, VIC, Australia
- Monash Health, Melbourne, VIC, Australia (A.M.F.)
- School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia (A.M.F.)
| | - Marcella Carragher
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation (J.E.P., L.N., M.H., A.M.F., M.C., C.W., M.L.R., S.H., L.T., E.G., D.A.C., D.C.), Melbourne, VIC, Australia
- La Trobe University, and School of Allied Health, Human Services and Sport (A.M.F., J.E.P., M.L.R., M.C., C.W.), Melbourne, VIC, Australia
| | - Cassie Wilcox
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation (J.E.P., L.N., M.H., A.M.F., M.C., C.W., M.L.R., S.H., L.T., E.G., D.A.C., D.C.), Melbourne, VIC, Australia
- La Trobe University, and School of Allied Health, Human Services and Sport (A.M.F., J.E.P., M.L.R., M.C., C.W.), Melbourne, VIC, Australia
| | - Miranda L Rose
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation (J.E.P., L.N., M.H., A.M.F., M.C., C.W., M.L.R., S.H., L.T., E.G., D.A.C., D.C.), Melbourne, VIC, Australia
- La Trobe University, and School of Allied Health, Human Services and Sport (A.M.F., J.E.P., M.L.R., M.C., C.W.), Melbourne, VIC, Australia
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10
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Goh HT, Stewart J, Becker K. Fatigue Is Associated With Perceived Effort and 2-Dimensional Reach Performance After Stroke. J Neurol Phys Ther 2024:01253086-990000000-00071. [PMID: 38934610 DOI: 10.1097/npt.0000000000000483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
BACKGROUND AND PURPOSE Poststroke fatigue (PSF) is prevalent and often manifests as high perceived effort during activities. Little is known about how PSF influences goal-directed reaching after stroke. The purpose of this study was 2-fold (1) to evaluate how perceived effort changed when individuals with stroke performed a reaching task with various demands and (2) to determine whether PSF was associated with perceived effort during reaching and reach performance. METHODS Thirty-six individuals with chronic stroke performed 2-dimensional reach actions under varied conditions with the more and less affected arms. Perceived effort during reaching was assessed using rating of perceived exertion (RPE) and Paas Mental Effort Rating Scale (MERS). Derived reach kinematics were used to quantify reach performance. The Fatigue Severity Scale (FSS) was administered to assess fatigue severity. RESULTS Perceived effort was higher when participants reached with the more affected arm, reached toward far and small targets, and performed memory-guided reaching. Both RPE and MERS significantly correlated with the FSS score (r = 0.50 and 0.35, respectively, P < 0.05). Further, FSS correlated with movement time during the more affected arm reaching (ρ = 0.40, p < 0.05) and reach performance discrepancy between the fast and self-selected speed conditions when participants performed with the less affected arm (ρ = 0.36, P < 0.05). Exploratory analysis revealed that the relationship between fatigue and reach control appeared to be modulated by task demand. DISCUSSION AND CONCLUSIONS PSF is associated with perceived effort during reaching and reach performance after stroke. These relationships might offer insights into arm performance in the real world after stroke. VIDEO ABSTRACT for more insights from the authors Supplemental Digital Content available at http://links.lww.com/JNPT/A476.
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Affiliation(s)
- Hui-Ting Goh
- Author Affiliations: School of Physical Therapy, Texas Woman's University, Dallas, Texas (H.-T.G.); Physical Therapy Program, Department of Exercise Science. University of South Carolina, Columbus, South Carolina (J.S.); and Department of Kinesiology, Recreation, and Sport Studies. University of Tennessee, Knoxville, Tennessee (K.B.)
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11
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Mizuno E, Ogasawara T, Mukaino M, Yamaguchi M, Tsukada S, Sonoda S, Otaka Y. Highlighting Unseen Activity Through 48-Hour Continuous Measurement in Subacute Stroke Rehabilitation: Preliminary Cohort Study. JMIR Form Res 2024; 8:e51546. [PMID: 38809596 PMCID: PMC11170042 DOI: 10.2196/51546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Motor impairments not only lead to a significant reduction in patient activity levels but also trigger a further deterioration in motor function due to deconditioning, which is an issue that is particularly pronounced during hospitalization. This deconditioning can be countered by sustaining appropriate activity levels. Activities that occur outside of scheduled programs, often overlooked, are critical in this context. Wearable technology, such as smart clothing, provides a means to monitor these activities. OBJECTIVE This study aimed to observe activity levels in patients who had strokes during the subacute phase, focusing on both scheduled training sessions and other nontraining times in an inpatient rehabilitation environment. A smart clothing system is used to simultaneously measure heart rate and acceleration, offering insights into both the amount and intensity of the physical activity. METHODS In this preliminary cohort study, 11 individuals undergoing subacute stroke rehabilitation were enrolled. The 48-hour continuous measurement system, deployed at admission and reassessed 4 weeks later, monitored accelerometry data for physical activity (quantified with a moving SD of acceleration [MSDA]) and heart rate for intensity (quantified with percent heart rate reserve). The measurements were performed using a wearable activity monitoring system, the hitoe (NTT Corporation and Toray Industries, Inc) system comprising a measuring garment (wear or strap) with integrated electrodes, a data transmitter, and a smartphone. The Functional Independence Measure was used to assess the patients' daily activity levels. This study explored factors such as differences in activity during training and nontraining periods, correlations with activities of daily living (ADLs) and age, and changes observed after 4 weeks. RESULTS A significant increase was found in the daily total MSDA after the 4-week program, with the average percent heart rate reserve remaining consistent. Physical activity during training positively correlated with ADL levels both at admission (ρ=0.86, P<.001) and 4 weeks post admission (ρ=0.96, P<.001), whereas the correlation between age and MSDA was not significant during training periods at admission (ρ=-0.41, P=.21) or 4 weeks post admission (ρ=-0.25, P=.45). Conversely, nontraining activity showed a negative correlation with age, with significant negative correlations with age at admission (ρ=-0.82, P=.002) and 4 weeks post admission (ρ=-0.73, P=.01). CONCLUSIONS Inpatient rehabilitation activity levels were positively correlated with ADL levels. Further analysis revealed a strong positive correlation between scheduled training activities and ADL levels, whereas nontraining activities showed no such correlation. Instead, a negative correlation between nontraining activities and age was observed. These observations suggest the importance of providing activity opportunities for older patients, while it may also suggest the need for adjusting the activity amount to accommodate the potentially limited fitness levels of this demographic. Future studies with larger patient groups are warranted to validate and further elucidate these findings.
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Affiliation(s)
- Emi Mizuno
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Takayuki Ogasawara
- NTT Basic Research Laboratories and Bio-medical Informatics Research Center, NTT Corporation, Atsugi, Japan
| | - Masahiko Mukaino
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
- Department of Rehabilitation Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Masumi Yamaguchi
- NTT Basic Research Laboratories and Bio-medical Informatics Research Center, NTT Corporation, Atsugi, Japan
| | - Shingo Tsukada
- NTT Basic Research Laboratories and Bio-medical Informatics Research Center, NTT Corporation, Atsugi, Japan
| | - Shigeru Sonoda
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
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12
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Smith MJ, Pellegrini M, Major B, Graco M, Porter S, Kramer S, Sewell K, Salberg S, Chen Z, Mychasiuk R, Lannin NA. Improving physical movement during stroke rehabilitation: investigating associations between sleep measured by wearable actigraphy technology, fatigue, and key biomarkers. J Neuroeng Rehabil 2024; 21:84. [PMID: 38802847 PMCID: PMC11131210 DOI: 10.1186/s12984-024-01380-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 05/10/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Sleep disturbance and fatigue are common in individuals undergoing inpatient rehabilitation following stroke. Understanding the relationships between sleep, fatigue, motor performance, and key biomarkers of inflammation and neuroplasticity could provide valuable insight into stroke recovery, possibly leading to personalized rehabilitation strategies. This study aimed to investigate the influence of sleep quality on motor function following stroke utilizing wearable technology to obtain objective sleep measurements. Additionally, we aimed to determine if there were relationships between sleep, fatigue, and motor function. Lastly, the study aimed to determine if salivary biomarkers of stress, inflammation, and neuroplasticity were associated with motor function or fatigue post-stroke. METHODS Eighteen individuals who experienced a stroke and were undergoing inpatient rehabilitation participated in a cross-sectional observational study. Following consent, participants completed questionnaires to assess sleep patterns, fatigue, and quality of life. Objective sleep was measured throughout one night using the wearable Philips Actiwatch. Upper limb motor performance was assessed on the following day and saliva was collected for biomarker analysis. Correlation analyses were performed to assess the relationships between variables. RESULTS Participants reported poor sleep quality, frequent awakenings, and difficulties falling asleep following stroke. We identified a significant negative relationship between fatigue severity and both sleep quality (r=-0.539, p = 0.021) and participants experience of awakening from sleep (r=-0.656, p = 0.003). A significant positive relationship was found between grip strength on the non-hemiplegic limb and salivary gene expression of Brain-derived Neurotrophic Factor (r = 0.606, p = 0.028), as well as a significant negative relationship between grip strength on the hemiplegic side and salivary gene expression of C-reactive Protein (r=-0.556, p = 0.048). CONCLUSION The findings of this study emphasize the importance of considering sleep quality, fatigue, and biomarkers in stroke rehabilitation to optimize recovery and that interventions may need to be tailored to the individual. Future longitudinal studies are required to explore these relationships over time. Integrating wearable technology for sleep and biomarker analysis can enhance monitoring and prediction of outcomes following stroke, ultimately improving rehabilitation strategies and patient outcomes.
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Affiliation(s)
- Madeleine J Smith
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Michael Pellegrini
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Brendan Major
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
- Alfred Health, Melbourne, VIC, 3004, Australia
| | | | | | - Sharon Kramer
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
- Alfred Health, Melbourne, VIC, 3004, Australia
| | - Katherine Sewell
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Sabrina Salberg
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Zhibin Chen
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Natasha A Lannin
- Department of Neuroscience, School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
- Alfred Health, Melbourne, VIC, 3004, Australia.
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13
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Katsura Y, Ohga S, Shimo K, Hattori T, Yamada T, Matsubara T. A decision tree algorithm to identify predictors of post-stroke complex regional pain syndrome. Sci Rep 2024; 14:9893. [PMID: 38689114 PMCID: PMC11061160 DOI: 10.1038/s41598-024-60597-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 04/25/2024] [Indexed: 05/02/2024] Open
Abstract
This prospective cohort study aimed to identify the risk factors for post-stroke complex regional pain syndrome (CRPS) using a decision tree algorithm while comprehensively assessing upper limb and lower limb disuse and physical inactivity. Upper limb disuse (Fugl-Meyer assessment of upper extremity [FMA-UE], Action Research Arm Test, Motor Activity Log), lower limb disuse (Fugl-Meyer Assessment of lower extremity [FMA-LE]), balance performance (Berg balance scale), and physical inactivity time (International Physical Activity Questionnaire-Short Form [IPAQ-SF]) of 195 stroke patients who visited the Kishiwada Rehabilitation Hospital were assessed at admission. The incidence of post-stroke CRPS was 15.4% in all stroke patients 3 months after admission. The IPAQ, FMA-UE, and FMA-LE were extracted as risk factors for post-stroke CRPS. According to the decision tree algorithm, the incidence of post-stroke CRPS was 1.5% in patients with a short physical inactivity time (IPAQ-SF < 635), while it increased to 84.6% in patients with a long inactivity time (IPAQ-SF ≥ 635) and severe disuse of upper and lower limbs (FMA-UE score < 19.5; FMA-LE score < 16.5). The incidence of post-stroke CRPS may increase with lower-limb disuse and physical inactivity, in addition to upper-limb disuse. Increasing physical activity and addressing lower- and upper-limb motor paralysis may reduce post-stroke CRPS.
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Affiliation(s)
- Yuichi Katsura
- Faculty of Rehabilitation, Kobe Gakuin University Graduate School, 518, Arise, Ikawadani-cho, Nishi-ku, Kobe, Hyogo, 651-2180, Japan
- Department of Rehabilitation, Kishiwada Rehabilitation Hospital, 8-10, Kanmatsu-cho, Kishiwada-shi, Osaka, 596-0827, Japan
| | - Satoshi Ohga
- Faculty of Rehabilitation, Kobe Gakuin University, 518, Arise, Ikawadani-cho, Nishi-ku, Kobe, Hyogo, 651-2180, Japan.
| | - Kazuhiro Shimo
- Faculty of Rehabilitation, Kobe Gakuin University, 518, Arise, Ikawadani-cho, Nishi-ku, Kobe, Hyogo, 651-2180, Japan
| | - Takafumi Hattori
- Faculty of Rehabilitation, Kobe Gakuin University, 518, Arise, Ikawadani-cho, Nishi-ku, Kobe, Hyogo, 651-2180, Japan
| | - Tsukasa Yamada
- Faculty of Rehabilitation, Kobe Gakuin University Graduate School, 518, Arise, Ikawadani-cho, Nishi-ku, Kobe, Hyogo, 651-2180, Japan
- Department of Rehabilitation, Kishiwada Rehabilitation Hospital, 8-10, Kanmatsu-cho, Kishiwada-shi, Osaka, 596-0827, Japan
| | - Takako Matsubara
- Faculty of Rehabilitation, Kobe Gakuin University Graduate School, 518, Arise, Ikawadani-cho, Nishi-ku, Kobe, Hyogo, 651-2180, Japan
- Faculty of Rehabilitation, Kobe Gakuin University, 518, Arise, Ikawadani-cho, Nishi-ku, Kobe, Hyogo, 651-2180, Japan
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14
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Kringle EA, Kersey J, Lewis MA, Gibbs BB, Skidmore ER. Similarities and differences in factors associated with high and low sedentary behavior after stroke: a mixed methods study. Disabil Rehabil 2024:1-9. [PMID: 38632899 DOI: 10.1080/09638288.2024.2341867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To identify similarities and differences in factors affecting activity engagement between adults with stroke who are more and less sedentary. MATERIALS AND METHODS Data were pooled from two studies of adults with stroke (N = 36). Sedentary time was measured activPAL micro3. Participants completed activPAL interviews, which were analyzed using framework analysis. Participants were stratified into more and less sedentary groups based on activPAL data. Between-group similarities and differences were identified. RESULTS Adults with stroke (mean [SD] age = 65.8 [13.6] years, stroke chronicity = 40.5 [SD = 38.3] months, 36.1% female) were more sedentary (785.5 [64.7] sedentary minutes/day) and less sedentary (583.6 [87.4] sedentary minutes/day). Those who were more sedentary: engaged in basic activities of daily living, avoided activities, received assistance from other people, and did not use strategies to overcome barriers. Those who were less sedentary: engaged in instrumental and community activities, embraced new strategies, did activities with other people, and used strategies to overcome environmental barriers. CONCLUSIONS Factors affecting activity engagement differed between people who are more and less sedentary. Interventions that aim to reduce post-stroke sedentary behavior should consider the: (1) types of activities, (2) role of other people, and (2) application of strategies to overcome activity and environment-related barriers.
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Affiliation(s)
- Emily A Kringle
- School of Kinesiology, University of MN, Minneapolis, MN, USA
| | - Jessica Kersey
- Program in Occupational Therapy, School of Medicine, WA University, St. Louis, MO, USA
| | | | - Bethany Barone Gibbs
- Department of Epidemiology and Biostatistics, West VA University, Morgantown, WV, USA
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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15
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Galvão ACJ, Dias C, Miranda AL, Moura D, Palhares CVT, Oliveira Leopoldino A, Polese JC. Stroke related sarcopenia in individuals with different physical activity levels: A cross-sectional study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2084. [PMID: 38529736 DOI: 10.1002/pri.2084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/21/2023] [Accepted: 02/29/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND AND OBJECTIVE Individuals after stroke are likely to deal with the possible development of sarcopenia and reduced physical activity levels. The purpose of this study was to compare sarcopenia of individuals with chronic stroke who were stratified according to their physical activity levels, and to evaluate the relationship between sarcopenia and physical activity levels. MATERIALS AND METHODS This cross-sectional study was conducted with individuals after chronic stroke recruited from the general community. Individuals were submitted to sarcopenia screening (SARC-F questionnaire) and assessment of physical activity levels (Human Activity Profile questionnaire) to classify the individuals as impaired, moderately active, and active according to their Adjusted Activity Status (AAS). ANOVA was used to investigate the sarcopenia between groups and Pearson's coefficient to investigate the association among variables. RESULTS Fifty-four individuals with a mean age of 56 ± 17.4 years were included. Twenty-one percent of the individuals were screened for sarcopenia. Inactive individuals had higher mean scores in the SARC-F (3.6 ± 2.1 points), whereas moderately active and active individuals presented lower mean scores in the same questionnaire, being 1.2 ± 1.1 points and 0.5 ± 0.7 points, respectively. A statistically significant inverse and high association was found between sarcopenia and physical activity levels (r = -0.716; p < 0.01). CONCLUSION Sarcopenia was found to be higher in individuals after chronic stroke with lower physical activity levels considered inactive when compared to individuals with higher physical activity levels. Furthermore, there was an inverse relationship between sarcopenia and physical activity level in stroke survivors.
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Affiliation(s)
| | - Camila Dias
- Post-Graduate Program of Health Sciences, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Luiza Miranda
- Post-Graduate Program of Health Sciences, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Daniela Moura
- Post-Graduate Program of Health Sciences, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Amanda Oliveira Leopoldino
- Post-Graduate Program of Health Sciences, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Janaine Cunha Polese
- Physiotherapy Department, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Paterson S, Dawes H, Winward C, Bartram E, Dodds E, McKinon J, Gaskell H, Collett J. Use of the Capability, Opportunity and Motivation Behaviour model (COM-B) to Understand Interventions to Support Physical Activity Behaviour in People with Stroke: An Overview of Reviews. Clin Rehabil 2024; 38:543-557. [PMID: 38192225 PMCID: PMC10898199 DOI: 10.1177/02692155231224365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 12/15/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Physical activity in people with stroke remains low despite considerable research. This overview aimed to provide high-level synthesis and aid clinical decision-making. The Capability, Opportunity, Motivation-Behaviour (COM-B) model was used to classify interventions to understand which components improve physical activity behaviour in people with stroke. DATA SOURCES CINAHL, Cochrane Database, MEDLINE, PEDro, PsychINFO, SPORTDiscus. REVIEW METHODS A systematic search was conducted (November 2023) to identify reviews of interventions to improve physical activity in people with stroke. Results were screened and assessed for eligibility. Participant characteristics, intervention classification using COM-B, and effect of intervention were extracted. Quality was assessed using AMSTAR2, and Corrected Cover Analysis for study overlap. Narrative synthesis was used to understand components of interventions to improve physical activity behaviour. RESULTS 1801 references were screened and 29 full-text references assessed for eligibility. Twenty reviews were included. Quality ranged from critically low (n = 3) to high (n = 10). Study overlap calculated using corrected cover area indicated slight overlap (0.028) and minimal reporting bias.The majority of participants were mobile with mild stroke and community dwelling. Twenty-three interventions were classified using COM-B. Three of twelve interventions classified to one aspect of the COM-B were effective. Fourteen of sixteen effective interventions combined at least two COM-B elements, ten of these combined capability and motivation. CONCLUSION Interventions including at least two elements of the COM-B are most likely to improve physical activity in mobile stroke survivors. Further research is needed to understand physical activity behaviour in those with moderate to severe stroke.
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Affiliation(s)
- Sarah Paterson
- Centre for Movement, Occupation and Rehabilitation Sciences (MOReS), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Helen Dawes
- College of Medicine, Department of Public Health & Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Medical School Building, College of Medicine and Health, Exeter, UK
| | - Charlotte Winward
- Allied Health Professions Research Unit, John Radcliffe Hospital, Oxford, UK
| | - Emilia Bartram
- Oxford Centre for Enablement, Nuffield Orthopaedic Centre, Oxford, UK
| | - Emma Dodds
- Oxford Centre for Enablement, Nuffield Orthopaedic Centre, Oxford, UK
| | - Jane McKinon
- Oxford Centre for Enablement, Nuffield Orthopaedic Centre, Oxford, UK
| | - Helen Gaskell
- Oxford Centre for Enablement, Nuffield Orthopaedic Centre, Oxford, UK
| | - Johnny Collett
- Centre for Movement, Occupation and Rehabilitation Sciences (MOReS), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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17
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Larsson P, Edvardsen E, Gay CL, Ursin M, Mack U, Lerdal A. Cardiorespiratory fitness, physical activity, and fatigue three months after first-ever ischemic stroke. Top Stroke Rehabil 2024:1-11. [PMID: 38533786 DOI: 10.1080/10749357.2024.2333191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/17/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Research on cardiorespiratory fitness (CRF) in relation to physical activity (PA) and fatigue after stroke is limited. Increased knowledge of interrelationships between these factors can help optimize rehabilitation strategies and improve health-outcomes. OBJECTIVES We aimed to: 1) evaluate CRF, PA, and fatigue, 2) characterize patients with impaired versus non-impaired CRF, and 3) examine associations of CRF with PA and fatigue, three months after first-ever ischemic stroke. METHODS In this cross-sectional study CRF was measured as peak oxygen uptake (VO2peak) by cardiopulmonary exercise testing. PA was measured using accelerometers. Fatigue was assessed with the 7-item Fatigue Severity Scale (FSS). RESULTS The sample (n=74, mean age 64±13 years, 36% women) had a mean VO2peak of 27.0±8.7 (86% of predicted). Fifty-one percent met the World Health Organization's recommendation of ≥150 min of moderate PA/week. Mean steps-per-day was 9316±4424 (113% of predicted). Thirty-five percent of the sample had moderate-to-high fatigue (FSS≥4), mean FSS score was 3.2±1.8. Patients with impaired CRF (VO2peak<80% of predicted) had higher body-fat-percent (p<0.01), less moderate-to-vigorous PA (MVPA) (p<0.01) and a trend toward higher fatigue (p=0.053) compared to the non-impaired. Backward regression analysis showed that higher CRF was associated with more MVPA (unstandardized beta [95% CI]: 0.38 [0.15, 0.63], p=0.002) and less fatigue (unstandardized beta [95% CI]: -3.9 [-6.4, -1.6], p=0.004). CONCLUSIONS Stroke patients had lower CRF compared to reference values. Impaired CRF was mainly related to overweight. Higher CRF was associated with more MVPA and less fatigue. Exercise after stroke may be especially beneficial for patients with impaired CRF.
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Affiliation(s)
- Petra Larsson
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Surgical Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Elisabeth Edvardsen
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Pulmonary Medicine, Oslo University Hospital, Oslo, Norway
| | - Caryl L Gay
- Department of Family Health Care Nursing, University of California, San Francisco, CA, USA
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Marie Ursin
- Department of Medical Research, Bærum Hospital, Gjettum, Norway
| | - Ulrich Mack
- Medical Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Anners Lerdal
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
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18
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Sütçü Uçmak G, Kılınç M. The effects of kinesiophobia, fatigue, and quality of life on physical activity in patients with stroke. Top Stroke Rehabil 2024:1-7. [PMID: 38529783 DOI: 10.1080/10749357.2024.2333159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/17/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Physical activity decreases after stroke due to various factors and the causes and effects of these factors remain unclear. OBJECTIVES This study aimed todetermine the effects of kinesiophobia, fatigue, and quality of life on physical activity in patients with stroke. METHODS The study included 32 patients (13 females/19 males), all evaluated using the Stroke Rehabilitation Assessment of Movement, Barthel Index, Tampa Kinesiophobia Scale-fatigue, Fatigue Impact Scale and Stroke-Specific Quality of Life Scale. The SenseWear multisensory activity monitor was worn on the arm of the patients for 1 week to evaluate active energy expenditure, step count, and rest periods in relation to physical activity. Multiple linear regression analysis was used to examine the effects of the independent variables kinesiophobia, fatigue, and quality of life on the dependent variables of active energy expenditure, step count, and rest periods. RESULTS The mean age of the patients was 52.31 ± 14.76 years. According to the multiple regression analysis results, kinesiophobia (p = 0.011) and quality of life (p = 0.009) are significant determinants of active energy expenditure and quality of life (p = 0.001) is a significant determinant of the step count in patients with stroke. Kinesiophobia, fatigue, and quality of life were not determinants of rest periods (p > 0.05). CONCLUSIONS The study results showed that kinesiophobia and quality of life are important determinants of physical activity in patients with stroke. Combined evaluation in the clinic of motor findings and non-motor factors, which are often ignored, and the application of target-oriented approaches to these problems will make a significant contribution to the success of stroke rehabilitation.
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Affiliation(s)
- Gülşah Sütçü Uçmak
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Akdeniz University, Antalya, Turkey
| | - Muhammed Kılınç
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Juárez-Belaúnde A, Orcajo E, Lejarreta S, Davila-Pérez P, León N, Oliviero A. Fatigue in patients with acquired brain damage. Neurologia 2024; 39:178-189. [PMID: 38278413 DOI: 10.1016/j.nrleng.2024.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/22/2021] [Indexed: 01/28/2024] Open
Abstract
Fatigue is a complex, multidimensional syndrome that is prevalent in patients with acquired brain damage and has a negative impact on the neurorehabilitation process. It presents from early stages after the injury, and may persist over time, regardless of whether sequelae have resolved. Fatigue is conditioned by upper neuronal circuits, and is defined as an abnormal perception of overexertion. Its prevalence ranges from 29% to 77% after stroke, from 18% to 75% after traumatic brain injury, and from 47% to 97% after brain tumours. Fatigue is associated with factors including female sex, advanced age, dysfunctional families, history of specific health conditions, functional status (eg, fatigue prior to injury), comorbidities, mood, secondary disability, and the use of certain drugs. Assessment of fatigue is fundamentally based on such scales as the Fatigue Severity Scale (FSS). Advances have recently been made in imaging techniques for its diagnosis, such as in functional MRI. Regarding treatment, no specific pharmacological treatment currently exists; however, positive results have been reported for some conventional neurorehabilitation therapies, such as bright light therapy, neurofeedback, electrical stimulation, and transcranial magnetic stimulation. This review aims to assist neurorehabilitation professionals to recognise modifiable factors associated with fatigue and to describe the treatments available to reduce its negative effect on patients.
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Affiliation(s)
- A Juárez-Belaúnde
- Fundación Instituto San José Hospital, Área de Neurorrehabilitación y Atención al Daño Cerebral, Madrid, España.
| | - E Orcajo
- Fundación Instituto San José Hospital, Área de Neurorrehabilitación y Atención al Daño Cerebral, Madrid, España; Unidad avanzada de neurorehabilitación, Hospital Los Madroños, Madrid, España
| | - S Lejarreta
- Fundación Instituto San José Hospital, Área de Neurorrehabilitación y Atención al Daño Cerebral, Madrid, España; Consorci Sanitari Alt Penedès-Garraf, Departmento de Neurología, Cataluña, España
| | - P Davila-Pérez
- Unidad avanzada de neurorehabilitación, Hospital Los Madroños, Madrid, España; Hospital Universitario Rey Juan Carlos (HURJC), Departmento de Neurofisiología Clínica, Madrid, España; Health Research Institute - Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid, España
| | - N León
- Fundación Instituto San José Hospital, Área de Neurorrehabilitación y Atención al Daño Cerebral, Madrid, España; Unidad avanzada de neurorehabilitación, Hospital Los Madroños, Madrid, España
| | - A Oliviero
- Fundación Instituto San José Hospital, Área de Neurorrehabilitación y Atención al Daño Cerebral, Madrid, España; Unidad avanzada de neurorehabilitación, Hospital Los Madroños, Madrid, España; Hospital Nacional para Paraplégicos (SESCAM), Grupo FENNSI, Toledo, España
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Choi YA, Lee JS, Kim YH. Associated Factors of Time Spent Walking for Community-Dwelling Stroke Survivors. J Phys Act Health 2024; 21:222-228. [PMID: 37597844 DOI: 10.1123/jpah.2022-0415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 05/21/2023] [Accepted: 07/15/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND This study aimed to investigate the factors associated with the time that community-dwelling stroke survivors spent walking. METHODS We analyzed the cross-sectional data of 1534 community-dwelling stroke survivors from the Korean National Health and Nutrition Examination Survey. Complex-sample logistic regression analyses were performed to determine the factors associated with insufficient walking time (<90 min/wk). The mean time spent walking was examined according to age, sex, resistance exercise level, and self-reported disability using complex-sample general linear models. RESULTS Women (odds ratio [OR] 1.5; 95% confidence interval [CI], 1.0-2.3), current smokers (OR 1.7; 95% CI, 1.1-2.8), insufficient resistance exercise (OR 2.3; 95% CI, 1.5-3.5), and those with rural residences (OR 1.4; 95% CI, 1.0-1.9) were independently associated with insufficient walking time. The mean time spent walking was significantly lower in older adults aged ≥65 years than in young adults aged <65 years (200.0 ± 42.0 min/wk vs 287.2 ± 36.6 min/wk, P = .002), in women than in men (200.9 ± 44.9 vs 286.2 ± 37.7 min/wk, P = .027), and in individuals engaging in insufficient resistance exercise compared with those engaging in sufficient resistance exercise (203.2 ± 36.2 vs 283.9 ± 43.0 min/wk, P = .008). The mean walking time did not vary according to the presence of self-reported disabilities. CONCLUSIONS Environmental and personal factors are associated with insufficient walking time in community-dwelling stroke survivors.
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Affiliation(s)
- Young-Ah Choi
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul,Republic of Korea
| | - Jung Soo Lee
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul,Republic of Korea
| | - Yeo Hyung Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul,Republic of Korea
- Department of Rehabilitation Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, Gyeonggi-do,Republic of Korea
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21
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Karadag-Saygi E, Giray E, Eren N, Yolcu G, Coskun OK, Cifcili S. Barriers and facilitators to physical activity participation among community-dwelling physically inactive individuals after stroke: a qualitative exploratory study. Int J Rehabil Res 2024; 47:34-40. [PMID: 38323888 DOI: 10.1097/mrr.0000000000000610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Physical activity has been shown to reduce the risk for first-ever stroke as well as recurrent stroke with positive effects on almost all known modifiable risk factors. However, the perceived barriers and facilitators for engaging in physical activity have been insufficiently studied and may differ between cultures. Therefore, the aim of this study was to explore the perceptions of community-dwelling physically inactive individuals with stroke about barriers and facilitators to their participation in physical activity. This qualitative study included two focus groups of ten individuals with stroke classified as physically inactive based on accelerometer recordings. A semi-structured set of questions was posed in each focus group session and the transcripts were analysed using thematic analysis. The results revealed three main themes and subthemes: individual factors (physical impairments, psychological factors, spirituality), interaction with the family (attitudes of family members/close community) and social and environmental factors (hobbies, lack of or presence of facilities, the use of orthosis). We conclude that physical activity participation is affected by a multitude of factors as well as cultural differences. Thus, interventions aimed at increasing participation in physical activity after stroke should not only be planned according to individual clinical characteristics but also take into account a range of personal-to-social factors, including cultural differences.
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Affiliation(s)
- Evrim Karadag-Saygi
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine
| | - Esra Giray
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, Istanbul
| | - Nurullah Eren
- Department of Health Services Vocational School, Trakya University
| | - Gunay Yolcu
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine
| | - Ozge Kenis Coskun
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine
| | - Serap Cifcili
- Department of Family Medicine, Marmara University School of Medicine, Istanbul, Turkey
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22
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Xian Yi H, Shuang L, Jie Y, Yan L, Yu L, Li C. Post-stroke fatigue, hope and discharge readiness: A cross-sectional survey. J Clin Nurs 2024. [PMID: 38356194 DOI: 10.1111/jocn.17039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/07/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024]
Abstract
AIMS AND OBJECTIVES To explore the relationships among post-stroke fatigue, hope and discharge readiness in stroke patients, and to determine whether hope mediates the relationship between post-stroke fatigue and discharge readiness. BACKGROUND In stroke patients, inadequate discharge readiness has been found to correlate with higher readmission and mortality rates. Although previous qualitative studies have confirmed the impact of fatigue on discharge readiness, few studies explore the impact of post-stroke fatigue and hope on discharge readiness of stroke patients. Consequently, the current research on this relationship and its underlying mechanisms is still quite limited. DESIGN Cross-sectional study. METHODS Data were collected from 340 stroke patients. The research tools included demographic and disease characteristics, Discharge Readiness Assessment Scale for Stroke, Neurological Fatigue Index for Stroke and Herth Hope Index. The STROBE checklist was used to guide the presentation of this study. RESULTS Discharge readiness was negatively correlated with post-stroke fatigue and positively correlated with hope. Additionally, post-stroke fatigue was negatively correlated with hope. Post-stroke fatigue had a direct negative effect on discharge readiness, and it can also generate indirect effects through hope. Hope was the partial mediator between post-stroke fatigue and discharge readiness, explaining 55.8% of the total effect. CONCLUSION Discharge readiness of this population can be improved by reducing post-stroke fatigue and increasing hope. Therefore, effective management of post-stroke fatigue and hope will help improve discharge readiness. RELEVANCE TO CLINICAL PRACTICE It is recommended that nursing staff should monitor the occurrence and development of post-stroke fatigue in stroke patients, dynamically evaluate the patient's level of hope, and pay attention to the important role of positive psychological qualities in the outcome of discharge. If medical staff can formulate corresponding intervention measures based on the influence path of discharge readiness, then the discharge readiness of stroke patients can be improved.
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Affiliation(s)
- Huang- Xian Yi
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Liu Shuang
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Yue Jie
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Liu Yan
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Li Yu
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Chen Li
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
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23
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Zhang LK, Liu L, Liu Q, Zhang Y, Li Z, Xu H, Bai W, Guo Y, Zhang D, Chen Z, Xia K, Li CH, Ge J, Guan YQ. Hippocampal-derived extracellular vesicle synergistically deliver active adenosine hippocampus targeting to promote cognitive recovery after stroke. Colloids Surf B Biointerfaces 2024; 234:113746. [PMID: 38199187 DOI: 10.1016/j.colsurfb.2024.113746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/29/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024]
Abstract
Ischemic stroke is a neurological disease that leads to brain damage and severe cognitive impairment. In this study, extracellular vesicles(Ev) derived from mouse hippocampal cells (HT22) were used as carriers, and adenosine (Ad) was encapsulated to construct Ev-Ad to target the damaged hippocampus. The results showed that, Ev-Ad had significant antioxidant effect and inhibited apoptosis. In vivo, Ev-Ad reduced cell death and reversed inflammation in hippocampus of ischemic mice, and improved long-term memory and learning impairment by regulating the expression of the A1 receptor and the A2A receptor in the CA1 region. Thus, the developmental approach based on natural carriers that encapsulating Ad not only successfully restored nerves after ischemic stroke, but also improved cognitive impairment in the later stage of ischemic stroke convalescence. The development and design of therapeutic drugs provides a new concept and method for the treatment of cognitive impairment in the convalescent phase after ischemic stroke.
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Affiliation(s)
- Ling-Kun Zhang
- School of Life Science, South China Normal University, Guangzhou 510631, China; MOE Key laboratory of Laser Life Science & Institute of Laser Life Science, Guangdong Provincial Key Laboratory of Laser Life Science, Guangzhou Key Laboratory of Spectral Analysis and Functional Probes, College of Biophotonics, South China Normal University, Guangzhou 510631, China; School of Engineering, Westlake University, Hangzhou 310030, China
| | - Li Liu
- School of Life Science, South China Normal University, Guangzhou 510631, China
| | - Qingpeng Liu
- School of Life Science, South China Normal University, Guangzhou 510631, China
| | - Yiquan Zhang
- School of Life Science, South China Normal University, Guangzhou 510631, China
| | - Ziqing Li
- School of Life Science, South China Normal University, Guangzhou 510631, China
| | - Haoming Xu
- School of Life Science, South China Normal University, Guangzhou 510631, China; South China Normal University-Panyu Central Hospital Joint Laboratory of Translational Medical Research, Panyu Central Hospital, Guangzhou 511400, China
| | - Weiwei Bai
- School of Life Science, South China Normal University, Guangzhou 510631, China
| | - Yiyan Guo
- School of Life Science, South China Normal University, Guangzhou 510631, China
| | - Dandan Zhang
- School of Life Science, South China Normal University, Guangzhou 510631, China
| | - Zhendong Chen
- School of Life Science, South China Normal University, Guangzhou 510631, China; South China Normal University-Panyu Central Hospital Joint Laboratory of Translational Medical Research, Panyu Central Hospital, Guangzhou 511400, China
| | - Kunwen Xia
- School of Life Science, South China Normal University, Guangzhou 510631, China
| | - Chu-Hua Li
- School of Life Science, South China Normal University, Guangzhou 510631, China.
| | - Jian Ge
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, China.
| | - Yan-Qing Guan
- School of Life Science, South China Normal University, Guangzhou 510631, China; MOE Key laboratory of Laser Life Science & Institute of Laser Life Science, Guangdong Provincial Key Laboratory of Laser Life Science, Guangzhou Key Laboratory of Spectral Analysis and Functional Probes, College of Biophotonics, South China Normal University, Guangzhou 510631, China; South China Normal University-Panyu Central Hospital Joint Laboratory of Translational Medical Research, Panyu Central Hospital, Guangzhou 511400, China.
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24
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Oliveira SG, Ribeiro JAM, Silva ÉSM, Uliam NR, Silveira AF, Araújo PN, Camargo AI, Urruchia VRR, Nogueira SL, Russo TL. Interventions to Change Movement Behaviors After Stroke: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024; 105:381-410. [PMID: 37541356 DOI: 10.1016/j.apmr.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVE This systematic review aimed to determine which interventions increase physical activity (PA) and decrease sedentary behavior (SB) based on objective measures of movement behavior in individuals with stroke. DATA SOURCES The PubMed (Medline), EMBASE, Scopus, CINAHL (EBSCO), and Web of Science databases were searched for articles published up to January 3, 2023. STUDY SELECTION The StArt 3.0.3 BETA software was used to screen titles, abstracts, and full texts for studies with randomized controlled trial designs; individuals with stroke (≥18 years of age); interventions aimed at increasing PA or decreasing SB; and objective measurement instruments. DATA EXTRACTION Data extraction was standardized, considering participants and assessments of interest. The risk of bias and quality of evidence of the included studies were assessed. DATA SYNTHESIS Twenty-eight studies involving 1855 patients were included. Meta-analyses revealed that in the post-stroke acute/subacute phase, exercise interventions combined with behavior change techniques (BCTs) increased both daily steps (standardized mean difference [SMD]=0.65, P=.0002) and time spent on moderate-to-vigorous intensity physical activities (MVPAs) duration of PA (SMD=0.68, P=.0004) with moderate-quality evidence. In addition, interventions based only on BCTs increased PA levels with very low-quality evidence (SMD (low-intensity physical activity)=0.36, P=.02; SMD (MVPA)=0.56, P=.0004) and decreased SB with low-quality evidence (SMD=0.48, P=.03). In the post-stroke chronic phase, there is statistical significance in favor of exercise-only interventions in PA frequency (steps/day) with moderate-quality evidence (SMD=0.68, P=.002). In general, the risk of bias in the included studies was low. CONCLUSIONS In the acute/subacute phase after stroke, the use of BCTs combined with exercise can increase the number of daily steps and time spent on MVPA. In contrast, in the post-stroke chronic phase, exercise-only interventions resulted in a significant increase in daily steps.
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Affiliation(s)
| | | | | | - Nicoly Ribeiro Uliam
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Ana Flávia Silveira
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | | | - Ana Isabela Camargo
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | | | | | - Thiago Luiz Russo
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.
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25
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Yamamoto M, Nozoe M, Ikeji R, Seike H, Yoshida Y, Shomoto K. Anorexia assessment using the Simplified Nutritional Appetite Questionnaire and its association with activities of daily living in patients with stroke. Nutrition 2024; 117:112238. [PMID: 37924625 DOI: 10.1016/j.nut.2023.112238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 09/12/2023] [Accepted: 09/21/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE This study aimed to validate the assessment of anorexia in patients with acute stroke using the Simplified Nutritional Appetite Questionnaire. METHODS This cross-sectional observational study assessed appetite using the Simplified Nutritional Appetite Questionnaire in patients with acute stroke at discharge from an acute care hospital. Additionally, the relationship between the Simplified Nutritional Appetite Questionnaire and Mini Nutritional Assessment, Mini Nutritional Assessment - Short Form scores, skeletal muscle mass, muscle strength, and activities of daily living measured using the Functional Independence Measures for the motor domain was investigated. A multiple regression analysis was conducted with the Functional Independence Measure for the motor domain as the dependent variable and the Simplified Nutritional Appetite Questionnaire and other confounding factors as explanatory variables to evaluate the association between the Simplified Nutritional Appetite Questionnaire and functional outcomes. RESULTS Among the 234 patients with stroke analyzed in this study, the median Simplified Nutritional Appetite Questionnaire score was 15 (IQR = 13-16) points. The Simplified Nutritional Appetite Questionnaire score significantly correlated with weight change, Functional Independence Measure for the motor domain, nutritional assessment index, and energy and protein intake. However, no significant differences in body mass index, muscle mass, or muscle strength were observed. In the multiple regression analysis adjusted for confounders, the Simplified Nutritional Appetite Questionnaire score (β = 0.106; P = 0.007) was independently associated with the Functional Independence Measure for the motor domain (adjusted R2 = 0.662). CONCLUSIONS This study's results found a significant correlation between Simplified Nutritional Appetite Questionnaire scores and nutritional status as well as an independent association with functional outcomes in patients with stroke. These findings suggest that the Simplified Nutritional Appetite Questionnaire can be a valuable tool for evaluating anorexia in this patient population.
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Affiliation(s)
- Miho Yamamoto
- Department of Rehabilitation Medicine, Nishiyamato Rehabilitation Hospital, Nara, Japan; Graduate School of Health Sciences, Kio University, Nara, Japan
| | - Masafumi Nozoe
- Department of Physical Therapy, Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan.
| | - Rio Ikeji
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Haruka Seike
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Yosuke Yoshida
- Department of Rehabilitation, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Koji Shomoto
- Graduate School of Health Sciences, Kio University, Nara, Japan
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26
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Thompson ED, Pohlig RT, McCartney KM, Hornby TG, Kasner SE, Raser-Schramm J, Miller AE, Henderson CE, Wright H, Wright T, Reisman DS. Increasing Activity After Stroke: A Randomized Controlled Trial of High-Intensity Walking and Step Activity Intervention. Stroke 2024; 55:5-13. [PMID: 38134254 PMCID: PMC10752299 DOI: 10.1161/strokeaha.123.044596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/09/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Physical inactivity in people with chronic stroke profoundly affects daily function and increases recurrent stroke risk and mortality, making physical activity improvements an important target of intervention. We compared the effects of a high-intensity walking intervention (FAST), a step activity monitoring behavioral intervention (SAM), or a combined intervention (FAST+SAM) on physical activity (ie, steps/day). We hypothesized the combined intervention would yield the greatest increase in steps/day. METHODS This assessor-blinded multisite randomized controlled trial was conducted at 4 university/hospital-based laboratories. Participants were 21 to 85 years old, walking without physical assistance following a single, unilateral noncerebellar stroke of ≥6 months duration, and randomly assigned to FAST, SAM, or FAST+SAM for 12 weeks (2-3 sessions/week). FAST training consisted of walking-related activities at 70% to 80% heart rate reserve, while SAM received daily feedback and goal setting of walking activity (steps/day). Assessors and study statistician were masked to group assignment. The a priori-determined primary outcome and end point was a comparison of the change in steps/day between the 3 intervention groups from pre- to post-intervention. Adverse events were tracked after randomization. All randomized participants were included in the intent-to-treat analysis. RESULTS Participants were enrolled from July 18, 2016, to November 16, 2021. Of 2385 participants initially screened, 250 participants were randomized (mean [SE] age, 63 [0.80] years; 116 females/134 males), with 89 assigned to FAST, 81 to SAM, and 80 to FAST+SAM. Steps/day significantly increased in both the SAM (mean [SE], 1542 [267; 95% CI, 1014-2069] P<0.001) and FAST+SAM group (1307 [280; 95% CI, 752-1861] P<0.001) but not in the FAST group (406 [238; 95% CI, -63 to 876] P=0.09). There were no deaths or serious study-related adverse events. CONCLUSIONS Only individuals with chronic stroke who completed a step activity monitoring behavioral intervention with skilled coaching and goal progression demonstrated improvements in physical activity (steps/day). REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02835313.
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Affiliation(s)
- Elizabeth D Thompson
- Department of Physical Therapy (E.D.T., K.M.M., H.W., T.W., D.S.R.), University of Delaware, Newark
| | - Ryan T Pohlig
- Biostatistics Core (R.T.P.), University of Delaware, Newark
| | - Kiersten M McCartney
- Department of Physical Therapy (E.D.T., K.M.M., H.W., T.W., D.S.R.), University of Delaware, Newark
| | - T George Hornby
- Department of Physical Medicine and Rehabilitation, Indiana University, Indianapolis (T.G.H., C.E.H.)
| | - Scott E Kasner
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.E.K.)
| | | | - Allison E Miller
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO (A.E.M.)
| | - Christopher E Henderson
- Department of Physical Medicine and Rehabilitation, Indiana University, Indianapolis (T.G.H., C.E.H.)
| | - Henry Wright
- Department of Physical Therapy (E.D.T., K.M.M., H.W., T.W., D.S.R.), University of Delaware, Newark
| | - Tamara Wright
- Department of Physical Therapy (E.D.T., K.M.M., H.W., T.W., D.S.R.), University of Delaware, Newark
| | - Darcy S Reisman
- Department of Physical Therapy (E.D.T., K.M.M., H.W., T.W., D.S.R.), University of Delaware, Newark
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27
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Clancy B, Bonevski B, English C, Callister R, Baker AL, Collins C, Pollack M, Magin P, Turner A, Faulkner J, Guillaumier A. Health risk factors in Australian Stroke Survivors: A latent class analysis. Health Promot J Austr 2024; 35:37-44. [PMID: 36799087 PMCID: PMC10952979 DOI: 10.1002/hpja.706] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
ISSUES ADDRESSED To (i) determine the prevalence of health risk factors (physical activity, diet, alcohol, smoking, blood pressure medication use and mental health) in community-dwelling stroke survivors; and (ii) examine how these health risk factors cluster, and identify associations with physical functioning, independent living, or sociodemographic factors. METHODS A secondary analysis of data obtained during a national randomised controlled trial. Participants had experienced stroke and completed a baseline telephone survey on demographic and stroke characteristics, health risk factors, physical functioning and independence in activities of daily living. A latent class analysis was performed to determine health risk profiles. Univariate logistic regressions were performed to identify if participant characteristics were associated with resulting classes. RESULTS Data analysed from 399 participants. Two classes of health risk factors were identified: Low Mood, Food & Moves Risk (16% of participants) and Alcohol Use Risk (84% of participants). The Low Mood, Food & Moves Risk group had poorer diet quality, lower physical activity levels and higher levels of depression and anxiety. Lower levels of independence and physical functioning were predictor variables for this group. In contrast, the Alcohol Use Risk group had better physical activity and diet scores, significantly lower probability of depression and anxiety, but a higher probability of risky drinking. CONCLUSIONS We identified two distinct health risk factor groups in our population. SO WHAT?: Future interventions may benefit from targeting the specific needs and requirements of people who have experienced stroke based on their distinct risk group. Alcohol consumption in poststroke populations requires further attention.
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Affiliation(s)
- Brigid Clancy
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of NewcastleCallaghanNSWAustralia
- Hunter Medical Research Institute, John Hunter HospitalNew Lambton HeightsNSWAustralia
| | - Billie Bonevski
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders UniversityBedford ParkSAAustralia
| | - Coralie English
- Hunter Medical Research Institute, John Hunter HospitalNew Lambton HeightsNSWAustralia
- School of Health Sciences, College of Health Medicine and Wellbeing, The University of NewcastleCallaghanNSWAustralia
| | - Robin Callister
- Hunter Medical Research Institute, John Hunter HospitalNew Lambton HeightsNSWAustralia
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, The University of NewcastleCallaghanNSWAustralia
| | - Amanda L. Baker
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of NewcastleCallaghanNSWAustralia
- Hunter Medical Research Institute, John Hunter HospitalNew Lambton HeightsNSWAustralia
| | - Clare Collins
- Hunter Medical Research Institute, John Hunter HospitalNew Lambton HeightsNSWAustralia
- School of Health Sciences, College of Health Medicine and Wellbeing, The University of NewcastleCallaghanNSWAustralia
- Hunter New England Local Health District, John Hunter HospitalNew Lambton HeightsNSWAustralia
| | - Michael Pollack
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of NewcastleCallaghanNSWAustralia
- Hunter New England Local Health District, John Hunter HospitalNew Lambton HeightsNSWAustralia
| | - Parker Magin
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of NewcastleCallaghanNSWAustralia
| | - Alyna Turner
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of NewcastleCallaghanNSWAustralia
- IMPACT Strategic Research Centre, School of Medicine, Deakin UniversityGeelongVic.Australia
| | - Jack Faulkner
- Hunter Medical Research Institute, John Hunter HospitalNew Lambton HeightsNSWAustralia
| | - Ashleigh Guillaumier
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of NewcastleCallaghanNSWAustralia
- Hunter Medical Research Institute, John Hunter HospitalNew Lambton HeightsNSWAustralia
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Boyne P, Miller A, Kubalak O, Mink C, Reisman DS, Fulk G. Moderate to Vigorous Intensity Locomotor Training After Stroke: A Systematic Review and Meta-analysis of Mean Effects and Response Variability. J Neurol Phys Ther 2024; 48:15-26. [PMID: 37678805 PMCID: PMC10843766 DOI: 10.1097/npt.0000000000000456] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND AND PURPOSE This meta-analysis quantified mean effects of moderate to vigorous intensity locomotor training (LT mv ) on walking outcomes in subacute and chronic stroke, and the magnitude of variability in LT mv response. METHODS Databases were searched for randomized trials comparing LT mv with no intervention, nongait intervention, or low-intensity gait training. Comfortable gait speed (CGS), fastest gait speed (FGS), 6-minute walk test (6MWT), walking activity (steps per day), and adverse effect/event (AE) data were extracted. Pooled estimates were calculated for mean changes, AE relative risks, and the standard deviation of response (SD response ) to LT mv versus control groups, stratified by study chronicity where possible. RESULTS There were 19 eligible studies (total N = 1096): 14 in chronic stroke (N = 839) and 5 in subacute stroke (N = 257). Compared with control interventions, LT mv yielded significantly greater increases in CGS (chronic, +0.06 m/s [95% confidence interval (CI), 0.01-0.10]; subacute, +0.16 [0.12-0.19]; subacute vs chronic, P = 0.03), FGS (chronic, +0.07 m/s [0.02-0.13]; subacute, +0.21 [0.01, 0.41]; P = 0.04), and 6MWT (chronic, +33 m [24-42]; subacute, +51 [26-77]; P = 0.054) but not steps/day (+260 [-1159 to 1679]). There were no treatment-related serious AEs among 398 LT mv participants in 14 AE-reporting studies. SD response estimates indicated substantial response variability: CGS, 0.11 m/s [0.00-0.15]; FGS, 0.14 m/s [-0.00 to 0.20]; and 6MWT, 41 m [27-51]. DISCUSSION AND CONCLUSIONS LT mv improves mean walking capacity outcomes in subacute and chronic stroke and does not appear to have high risk of serious harm. Response magnitude varies within and between chronicity subgroups, and few studies have tested effects on daily walking activity or non-serious AEs.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A452 ).
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Affiliation(s)
- Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH
| | - Allison Miller
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE
| | - Owen Kubalak
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH
| | - Caroline Mink
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH
| | - Darcy S. Reisman
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE
| | - George Fulk
- Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, GA
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Luzum G, Gunnes M, Lydersen S, Saltvedt I, Tan X, Thingstad P, Thrane G, Askim T. Physical Activity Behavior and Its Association With Global Cognitive Function Three Months After Stroke: The Nor-COAST Study†. Phys Ther 2023; 103:pzad092. [PMID: 37440440 PMCID: PMC10733132 DOI: 10.1093/ptj/pzad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 03/15/2023] [Accepted: 05/22/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE The purposes of this study were to determine the association between physical activity (PA) behavior and global cognitive function 3 months after stroke and to explore the role of physical capacity as a mediating factor. METHODS Participants with stroke were successively recruited at 5 different hospitals in Norway. PA was measured using accelerometers, with a follow-up period of 7 consecutive days, and global cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). The general pattern of PA and the percentage of participants adhering to World Health Organization PA recommendations (at least 150 minutes of moderate-intensity aerobic PA per week) were investigated using descriptive statistics. Multiple regression and mediator analyses were used to examine the relationship between PA behavior and MoCA scores; physical capacity, measured with the Short Physical Performance Battery, served as the mediating variable. RESULTS A total of 193 women (42.6%) and 260 men (57.4%) with a median age of 73.7 years (25th and 75th percentiles = 65.8 and 80.4, respectively) and a median MoCA score of 25 points (25th and 75th percentiles = 22 and 27, respectively) were included. Mean total time spent walking at moderate intensity was 251.7 (SD = 164.6) min/wk (mean bout length = 20.9 [SD = 7.3] seconds), which indicated 69.3% adherence to World Health Organization guidelines. With each point decrease in the MoCA score, there was an expected 8.6% increase in the odds of nonadherence to PA recommendations. Physical capacity was identified as an important mediating factor, explaining the strength of the association between cognition and PA behavior. CONCLUSIONS In contrast to previous research, in the present study, most participants adhered to the updated global PA guidelines. However, people who had survived stroke and had reduced cognitive function were at higher risk of inactivity, an association mediated by physical capacity. IMPACT A better understanding of the association between cognition and PA behavior after stroke might help for developing more targeted early-onset interventions.
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Affiliation(s)
- Geske Luzum
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Mari Gunnes
- Department of Health Research, SINTEF, Trondheim, Norway
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department of Geriatric Medicine, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Xiangchun Tan
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health and Welfare Services, City of Trondheim, Trondheim, Norway
| | - Gyrd Thrane
- Department of Health and Care Science, Faculty of Health, The Arctic University of Norway, Tromsø, Norway
| | - Torunn Askim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
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Tanaka H, Kitamura G, Tamura M, Nankaku M, Taniguchi M, Kikuchi T, Maki T, Ikeguchi R, Miyamoto S, Takahashi R, Matsuda S, Ichihashi N. Pre-stroke physical activity is associated with post-stroke physical activity and sedentary behavior in the acute phase. Sci Rep 2023; 13:21298. [PMID: 38042921 PMCID: PMC10693571 DOI: 10.1038/s41598-023-48232-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/23/2023] [Indexed: 12/04/2023] Open
Abstract
This study investigated the link between pre-stroke and acute-stage physical activity (PA) and sedentary behavior. Forty individuals with stroke (aged 73.6 ± 8.9 years) were enrolled. Post-stroke activity, including metabolic equivalents (METs), sedentary behavior, light PA, and moderate-to-vigorous PA (MVPA), was measured using a tri-axial accelerometer (ActiGraph wGT3X-BT) over 11 consecutive days starting from the 4th day post-stroke. Pre-stroke PA levels were assessed using the International Physical Activity Questionnaire (IPAQ). We measured skeletal muscle mass index (SMI) and phase angle using a bioelectrical impedance analyzer (Inbody S10) upon admission. Physical therapists assessed the Brunnstrom recovery stage (BRS) within 3 days post-stroke. Total daily activity averaged 1.05 ± 0.05 METs. Throughout the day, 91.2 ± 5.1, 7.6 ± 4.1, and 1.2 ± 1.3% was spent in sedentary behavior, light PA, and MVPA, respectively. Only pre-stroke PA was independently associated with METs (β = 0.66), sedentary behavior (β = -0.58), light PA (β = 0.50), and MVPA (β = 0.71) after adjusting for age, sex, stroke severity, and activities of daily living. This suggests that pre-stroke PA might play a crucial role in reducing sedentary behavior and promoting PA during the acute phase.
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Affiliation(s)
- Hiroki Tanaka
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Gakuto Kitamura
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Mayu Tamura
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Manabu Nankaku
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Masashi Taniguchi
- Graduate School of Medicine, Human Health Sciences, Kyoto University, Kyoto, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takakuni Maki
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryosuke Ikeguchi
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Noriaki Ichihashi
- Graduate School of Medicine, Human Health Sciences, Kyoto University, Kyoto, Japan
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Nakano W, Kobayashi S, Maezawa T, Kohno Y. Longitudinal changes in physical activity accumulation patterns during 1-year follow-up in stroke survivors. Disabil Rehabil 2023; 45:4094-4100. [PMID: 36408857 DOI: 10.1080/09638288.2022.2146216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 11/05/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Few studies have reported changes in the accumulation patterns of physical activity over a year after stroke. This study characterized the longitudinal changes in physical activity levels and their accumulation patterns for a 1-year follow-up period in stroke survivors. MATERIALS AND METHODS In this single-center, prospective, longitudinal observational study, 47 stroke survivors were assessed at rehabilitation discharge and at 6 and 12 months post-discharge. Physical activity was evaluated, and measures included the number of steps, walking duration, total number of bouts per day, and intensity (light, moderate-to-vigorous) and spread (short, medium, and long bouts). RESULTS There were no significant main or interaction effects of time on any physical activity variables. Light physical activity accounted for 90% of all walking bouts and 70% of walking duration. Regarding moderate-to-vigorous physical activity (MVPA), 85% of walking bouts and 35% of walking duration were accumulated in short and medium bouts. The number of long-bout MVPA was three per day. CONCLUSIONS Physical activity levels and accumulation patterns were highly stable throughout the 12-month follow-up period. Accumulating light physical activity and intermittent MVPA is important for maintaining physical activity levels in stroke survivors. These findings will promote a better understanding of disability and rehabilitation practice.IMPLICATIONS FOR REHABILITATIONPhysical activity levels and accumulation patterns were highly stable throughout the 12-month follow-up period.The accumulation of moderate-to-vigorous physical activity in long bouts might be challenging for stroke survivors.Accumulating light physical activity and intermittent moderate-to-vigorous physical activity may be acceptable for stroke survivors.
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Affiliation(s)
- Wataru Nakano
- Department of Physical Therapy, Tokoha University, Shizuoka, Japan
| | - Satomi Kobayashi
- Department of Physical Therapy, Tsukuba International University, Tsuchiura, Japan
| | - Takayuki Maezawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Inashiki-Gun, Japan
| | - Yutaka Kohno
- Department of Neurology, Ibaraki Prefectural University of Health Sciences Hospital, Inashiki-Gun, Japan
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Rintala A, Kossi O, Bonnechère B, Evers L, Printemps E, Feys P. Mobile health applications for improving physical function, physical activity, and quality of life in stroke survivors: a systematic review. Disabil Rehabil 2023; 45:4001-4015. [PMID: 36325613 DOI: 10.1080/09638288.2022.2140844] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To evaluate the effectiveness of mobile health applications (mHealth apps) containing a physical training component on physical function and physical activity in stroke rehabilitation. MATERIALS AND METHODS A systematic literature search was conducted in three databases for studies published from inception to 12 July 2022. Clinical trials including mHealth apps with a physical training component were included using outcomes of physical function and physical activity. Quality of life was extracted as a secondary outcome. RESULTS Five RCTs, two non-RCTs, and four uncontrolled clinical trials were included with a total of 264 stroke survivors. Eleven apps were identified with a physical training component using features of gamification (six apps), exercise prescription (three apps), and physical activity (two apps). Six out of seven studies reported statistically significant improvements in physical function in favor of the experimental group, with the most robust findings for upper extremity function. For physical activity, statistically significant improvements were seen in the experimental groups. Only one study showed significant improvement in quality of life. Overall study quality was fair. CONCLUSIONS mHealth apps containing a physical training component are promising for physical function and physical activity in stroke rehabilitation. Further research is warranted to confirm these conclusions.Implications for rehabilitationDesign content of mobile apps with a physical training component were focused on gamification, exercise prescription, and physical activityUsing mobile app-delivered therapy seem promising for improving upper extremity function in stroke rehabilitationUsing mobile apps also supported an increase of physical activity in people with strokeStudies using mobile apps should report more specifically the dosage of physical training and adherenceUsing mobile apps seems promising as an additional tool for clinical work, however, more studies are required to understand their effectiveness in stroke rehabilitation.
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Affiliation(s)
- A Rintala
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Faculty of Social Services and Health Care, LAB University of Applied Sciences, Lahti, Finland
| | - O Kossi
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- ENATSE, National School of Public Health and Epidemiology, University of Parakou, Parakou, Benin
| | - B Bonnechère
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - L Evers
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - E Printemps
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - P Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
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Goncalves S, Le Bourvellec M, Mandigout S, Duclos NC. Impact of Active Physiotherapy on Physical Activity Level in Stroke Survivors: A Systematic Review and Meta-Analysis. Stroke 2023; 54:3097-3106. [PMID: 37909205 DOI: 10.1161/strokeaha.123.043629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/05/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Stroke survivors are frequently physically inactive. However, evidence of the effectiveness of active physiotherapy on physical activity level in stroke survivors is scarce. METHODS We conducted a systematic review and meta-analysis of randomized controlled trials according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement, covering electronic searches from inception to March 16, 2022. Participants: Stroke survivors living in the community. Intervention: Any active physiotherapy, that is, involving exercises that require voluntary effort. Outcome measure: Objective and subjective physical activity level. RESULTS Of 5590 identified references, 25 randomized controlled trials were eligible, and 21 had available data. The random-effects meta-analysis resulted in a small, significant effect size in favor of active physiotherapy measured using objective or subjective tools (21 studies, 1834 participants, standardized mean difference, 0.22 [95% CI, 0.04-0.40]; heterogeneity I2=65%), and a medium significant effect when objective tools were used (9 studies, 424 participants, standardized mean differences, 0.48 [95% CI, 0.03-0.92]; I2=73%). Meta-regression showed that 35% of the variance in trial outcome was explained by the measurement tool (objective or subjective) and 23% by age. None of the variances were associated with a specific dosage in terms of frequency, time, exercise duration, or the severity of the disability. CONCLUSIONS Active physiotherapy seems to increase objective physical activity in community-dwelling stroke survivors. However, the evidence is of very low certainty. REGISTRATION URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42022315639.
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Affiliation(s)
- Stéphanie Goncalves
- HAVAE, Limoges University, Department of Physical Activity and Sport Sciences, UR20217, F-87000, France (S.G., S.M.)
| | - Morgane Le Bourvellec
- MOVE, Poitiers University, Faculty of Sport Sciences, UR20296, F-86000, France (M.L.B.)
| | - Stéphane Mandigout
- HAVAE, Limoges University, Department of Physical Activity and Sport Sciences, UR20217, F-87000, France (S.G., S.M.)
- ILFOMER, Limoges University, F-87000, France (S.M.)
| | - Noémie C Duclos
- Bordeaux University, INSERM, BPH, U1219, Team ACTIVE, F-33000, France (N.C.D.)
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D'Amore C, Saunders S, Bhatnagar N, Griffith LE, Richardson J, Beauchamp MK. Determinants of physical activity in community-dwelling older adults: an umbrella review. Int J Behav Nutr Phys Act 2023; 20:135. [PMID: 37990225 PMCID: PMC10664504 DOI: 10.1186/s12966-023-01528-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/10/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Physical activity (PA) is critical for disease prevention and maintaining functional ability with aging. Despite this, as many as 50% of older adults in populations worldwide are considered insufficiently active. There is a recognized need to mobilize policies targeted toward modifiable determinants of healthy aging like PA. This umbrella review aimed to summarize the evidence for determinants of PA in community-dwelling older adults. METHODS A research librarian searched six databases. Systematic and scoping reviews were included if they investigated community-dwelling people with a mean age of 60 + years and examined a relationship between a determinant and any type of PA. Two independent reviewers screened and extracted data from all reviews. JBI methodology and Critical Appraisal Checklist for Systematic Reviews and Research Syntheses were followed and information on the quality of the evidence was extracted. RESULTS From 17,277 records screened,11 reviews representing > 300 unique primary papers were ultimately included. Only 6% of studies included in all reviews had longitudinal designs. Included studies used a large variety of PA measures, with 76% using only self-report, 15% using only direct measures (e.g., accelerometry), 3% using both types, and 6% with no outcome measure reported. Only four reviews provided a definition of PA and there was substantial inconsistency in the way PA was categorised. Community level influences, which only included the physical environment, were the most commonly assessed (6/11) with more than 70% of the summarized relationships demonstrating null associations. Three out of four reviews reported a positive relationship between walkability and PA in general community-dwelling older adults. There was also evidence supporting relationships between presence of social support for PA, younger age, and men having higher PA from a single systematic review. None of the included reviews assessed the quality of evidence but over 60% performed a risk of bias assessment. CONCLUSIONS Walkability, age, gender, and social support for PA were the most supported PA determinants identified. Further research should focus on interpersonal and intrapersonal influences and incorporate direct measures of PA with clear operational definitions. There is a need for longitudinal study designs to further understand determinants of PA behaviour trajectories.
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Affiliation(s)
- Cassandra D'Amore
- School Rehabilitation Science, McMaster University, 175 Longwood Rd South - Suite 310A, Hamilton, ON, L8P 0A1, Canada
| | - Stephanie Saunders
- School Rehabilitation Science, McMaster University, 175 Longwood Rd South - Suite 310A, Hamilton, ON, L8P 0A1, Canada
| | - Neera Bhatnagar
- Health Science Library, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Lauren E Griffith
- Health Research Methods, Evidence, and Impact, McMaster Univeristy, 175 Longwood Rd South - Suite 309A, Hamilton, ON, L8P 0A1, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Institute for Applied Health Sciences (IAHS) Building - Room 403, Hamilton, ON, L8S 1C7, Canada
| | - Marla K Beauchamp
- School Rehabilitation Science, McMaster University, 175 Longwood Rd South - Suite 310A, Hamilton, ON, L8P 0A1, Canada.
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Bhimani R, Xiong J, Anderson L. Fatigue Experiences in People With Stroke. Rehabil Nurs 2023; 48:200-208. [PMID: 37733016 DOI: 10.1097/rnj.0000000000000431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
PURPOSE Fatigue is a major symptom in patients with stroke. Because fatigue is an overarching multidimensional phenomenon, it is important to understand how the characteristics of fatigue change over time. The purpose of this study was to explore how fatigue characteristics change over time in patients with stroke. DESIGN This study used a mixed-method observational design. METHODS This study is a secondary analysis of data from a previous study, the results of which indicated fatigue to be a prominent symptom. Participants in that study were patients with stroke who met eligibility criteria and provided informed consent. This secondary analysis used data from numeric rating scale scores for fatigue, Functional Assessment of Chronic Illness Therapy-Fatigue Scale scores, fatigue descriptors, and participant comments about fatigue gleaned from transcribed interviews. RESULTS Twenty-two patients participated in the study. Thirteen characteristics of fatigue were evaluated. Seven characteristics showed significant improvement ( p < .05) from admission to 1 month follow-up, and six characteristics did not change significantly. CONCLUSIONS Fatigue experiences vary over time and have both physical and mental aspects to them. CLINICAL RELEVANCE TO REHABILITATION NURSING Nurses may consider providing a quiet environment for physical rest, which may allow the brain to not be distracted by multiple stimuli.
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Affiliation(s)
- Rozina Bhimani
- University of Minnesota School of Nursing, Minneapolis, MN, USA
| | - Jiayue Xiong
- University of Minnesota School of Nursing, Minneapolis, MN, USA
| | - Lisa Anderson
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA
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Pogrebnoy D, Dennett AM, Simpson DB, MacDonald-Wicks L, Patterson AJ, English C. Effects of Using Websites on Physical Activity and Diet Quality for Adults Living With Chronic Health Conditions: Systematic Review and Meta-Analysis. J Med Internet Res 2023; 25:e49357. [PMID: 37856187 PMCID: PMC10623240 DOI: 10.2196/49357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/20/2023] [Accepted: 08/09/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Adults with chronic health conditions need support to manage modifiable risk factors such as physical inactivity and poor diet. Disease-specific websites with health information on physical activity and diet quality may be effective in supporting adults in managing their chronic illnesses. OBJECTIVE The primary aim of this review was to determine whether using websites with health information can lead to improvements in physical activity levels or diet quality in adults with chronic health conditions. METHODS Randomized controlled trials evaluating the effectiveness of website use on levels of physical activity or diet quality in adults with chronic health conditions were included. MEDLINE, Embase, CINAHL, and the Physiotherapy Evidence Database were searched from the earliest available record until February 2023. Data for outcomes measuring physical activity levels; diet quality; and, where reported, self-efficacy and quality of life were independently extracted by 2 reviewers. The risk of bias was assessed using the Physiotherapy Evidence Database scale, and the overall certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Where values were presented as the same unit of measure, postintervention scores were pooled for meta-analysis to yield an overall mean difference (MD). A standardized MD (SMD) was calculated for the pooled data in which different units for the same outcome were used. Individual trial data were described in cases where the data of trials could not be pooled. RESULTS A total of 29 trials (N=6418 participants) across 8 different disease groups with intervention periods ranging from 4 weeks to 12 months were included in the analysis. There was moderate-certainty evidence that using websites with health information increased levels of moderate to vigorous physical activity (MD=39 min/wk, 95% CI 18.60-58.47), quality of life (SMD=0.36, 95% CI 0.12-0.59), and self-efficacy (SMD=0.26, 95% CI 0.05-0.48) and high-certainty evidence for reduction in processed meat consumption (MD=1.1 portions/wk, 95% CI 0.70-1.58) when compared with usual care. No differences were detected in other measures of diet quality. There was no increased benefit for website users who were offered additional support. CONCLUSIONS The use of websites for risk factor management has the potential to improve physical activity levels, quality of life, and self-efficacy as well as reduce processed meat consumption for adults living with chronic health conditions when compared with usual care. However, it remains unclear whether using websites leads to meaningful and long-lasting behavior change. TRIAL REGISTRATION PROSPERO CRD42021283168; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=283168.
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Affiliation(s)
- Dina Pogrebnoy
- School of Health Sciences, University of Newcastle, Newcastle, Australia
- Department of Physiotherapy, Western Health, St Albans, Australia
| | - Amy M Dennett
- Allied Health Clinical Research Office, Eastern Health, Melbourne, Australia
- School of Allied Health, Human Services and Sport, Latrobe University, Melbourne, Australia
| | - Dawn B Simpson
- School of Health Sciences, University of Newcastle, Newcastle, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, Australia
| | - Lesley MacDonald-Wicks
- School of Health Sciences, University of Newcastle, Newcastle, Australia
- Food and Nutrition Program, Hunter Medical Institute, Newcastle, Australia
| | - Amanda J Patterson
- School of Health Sciences, University of Newcastle, Newcastle, Australia
- Food and Nutrition Program, Hunter Medical Institute, Newcastle, Australia
| | - Coralie English
- School of Health Sciences, University of Newcastle, Newcastle, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, Australia
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Tan S, Gao Q, Cui Y, Ou Y, Huang S, Feng W. Oncologic outcomes of watch-and-wait strategy or surgery for low to intermediate rectal cancer in clinical complete remission after adjuvant chemotherapy: a systematic review and meta-analysis. Int J Colorectal Dis 2023; 38:246. [PMID: 37787779 DOI: 10.1007/s00384-023-04534-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND A watch-and-wait (WW) strategy or surgery for low to intermediate rectal cancer that has reached clinical complete remission (cCR) after neoadjuvant chemotherapy (nCRT) or total neoadjuvant therapy (TNT) has been widely used in the clinic, but both treatment strategies are controversial. OBJECTIVE The aim of this study was to compare the oncologic outcomes of a watch-and-wait strategy or a surgical approach to treat rectal cancer in complete remission and to report the evidence-based clinical advantages of the two treatment strategies. METHODS Seven national and international databases were searched for clinical trials comparing the watch-and-wait strategy with surgical treatment for oncological outcomes in patients with rectal cancer in clinical complete remission. RESULTS In terms of oncological outcomes, there was no significant difference between the watch-and-wait strategy and surgical treatment in terms of overall survival (OS) (HR = 0.92, 95% CI (0.52, 1.64), P = 0.777), and subgroup analysis showed no significant difference in 5-year disease-free survival (5-year DFS) between WW and both local excision (LE) and radical surgery (RS) (HR = 1.76, 95% CI (0.97, 3.19), P = 0.279; HR = 1.98, 95% CI (0.95, 4.13), P = 0.164), in distant metastasis rate (RR = 1.12, 95% CI (0.73, 1.72), P = 0.593), mortality rate (RR = 1.62, 95% CI (0.93, 2.84), P = 0.09), and organ preservation rate (RR = 1.05, 95% CI (0.94, 1.17), P = 0.394) which were not statistically significant and on the outcome indicators of local recurrence rate (RR = 2.09, 95% CI (1.44, 3.03), P < 0.001) and stoma rate (RR = 0.35, 95% CI (0.20, 0.61), P < 0.001). There were significant differences between the WW group and the surgical treatment group. CONCLUSION There were no differences in OS, 5-year DFS, distant metastasis, and mortality between the WW strategy group and the surgical treatment group. The WW strategy did not increase the risk of local recurrence compared with local resection but may be at greater risk of local recurrence compared with radical surgery, and the WW group was significantly better than the surgical group in terms of stoma rate; the WW strategy was evidently superior in preserving organ integrity compared to radical excision. Consequently, for patients who exhibit a profound inclination towards organ preservation and the evasion of stoma formation in the scenario of clinically complete remission of rectal cancer, the WW strategy can be contemplated as a pragmatic alternative to surgical interventions. It is, however, paramount to emphasize that the deployment of such a strategy should be meticulously undertaken within the ambit of a multidisciplinary team's management and within specialized centers dedicated to rectal cancer management.
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Affiliation(s)
- Shufa Tan
- Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Qiangqiang Gao
- Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Deputy No. 2, West Weiyang Road, Xianyang City, Shaanxi Province, 712000, China
| | - Yaping Cui
- Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Deputy No. 2, West Weiyang Road, Xianyang City, Shaanxi Province, 712000, China
| | - Yan Ou
- Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Deputy No. 2, West Weiyang Road, Xianyang City, Shaanxi Province, 712000, China
| | - Shuilan Huang
- Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Wenzhe Feng
- Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Deputy No. 2, West Weiyang Road, Xianyang City, Shaanxi Province, 712000, China.
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Farre A, Morris JH, Irvine L, Dombrowski SU, Breckenridge JP, Ozakinci G, Lebedis T, Jones C. Exploring the views and experiences of people recovering from a stroke about a new text message intervention to promote physical activity after rehabilitation-Keeping Active with Texting After Stroke: A qualitative study. Health Expect 2023; 26:2013-2022. [PMID: 37409460 PMCID: PMC10485328 DOI: 10.1111/hex.13809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/30/2023] [Accepted: 06/13/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Participating in exercise following a stroke is essential for recovery. When community-based rehabilitation services end, some people struggle to remain active. We codesigned Keeping Active with Texting After Stroke (KATS), a text message intervention to support home-based, self-directed plans to continue exercising. KATS delivers a series of automated text messages over a 12-week period from the point of discharge from National Health Service-funded therapy. The aim of this study was to explore the views and experiences of the first cohort of participants to complete the KATS intervention about the meaning, engagement, workability and worth of the intervention. METHODS We undertook a qualitative study, theoretically informed by Normalisation Process Theory. We conducted semi-structured telephone interviews with people with stroke from two Health Boards in Scotland. Data collection took place over two phases, with each participant being interviewed twice: first, halfway through intervention delivery (Week 6) and then again at the end of the intervention (Week 12). All interviews were audio-recorded, transcribed and analysed thematically. RESULTS A total of 24 interviews were conducted with 12 participants. Our findings were organised around four overarching analytical themes: (1) making sense of KATS: timing and complementarity in the rehabilitation journey; (2) engaging with KATS: connection and identification with others; (3) making KATS work: flexibility and tailorable guidance; (4) appraising the worth of KATS: encouragement and friendliness. Participants differentiated KATS from current rehabilitation practice, finding it relevant, fitting and worthwhile. Variations were reported in engagement with behaviour change techniques, but participants were able to tailor KATS use, making it work for them in different ways. CONCLUSIONS Perceived benefits went beyond promoting physical activity, including feeling supported and connected. Future research will test the effectiveness of KATS in promoting physical activity and explore any associations with relevant social and emotional secondary outcomes. PATIENT OR PUBLIC CONTRIBUTION A research funding proposal was developed in collaboration with five people with stroke and three spouses. After securing funding, six people with stroke were invited to join the project's Collaborative Working Group, alongside health professionals and stroke rehabilitation experts, to codevelop the intervention and support the feasibility study.
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Affiliation(s)
- Albert Farre
- School of Health SciencesUniversity of DundeeDundeeUK
| | | | - Linda Irvine
- School of Health SciencesUniversity of DundeeDundeeUK
| | | | | | - Gozde Ozakinci
- Division of Psychology, Faculty of Natural SciencesUniversity of StirlingStirlingUK
| | | | - Claire Jones
- Health Informatics CentreSchool of MedicineUniversity of DundeeDundeeUK
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Larsson P, Bidonde J, Olsen U, Gay CL, Lerdal A, Ursin M, Mead GE, Edvardsen E. Association of post-stroke fatigue with physical activity and physical fitness: A systematic review and meta-analysis. Int J Stroke 2023; 18:1063-1070. [PMID: 36622013 PMCID: PMC11044520 DOI: 10.1177/17474930231152132] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/03/2023] [Indexed: 01/10/2023]
Abstract
BACKGROUND It has been hypothesized that post-stroke fatigue (PSF) is associated with reduced physical activity (PA) and impaired physical fitness (fitness). Understanding associations between PSF and PA, and/or fitness could help guide the development of targeted exercise interventions to treat PSF. AIMS Our systematic review and meta-analysis aimed to investigate PSF's associations with PA and fitness. SUMMARY OF REVIEW Following a registered protocol, we included studies with cross-sectional or prospective observational designs, published in English or a Scandinavian language, which reported an association of PSF with PA and/or fitness in adult stroke survivors. We searched MEDLINE, Embase, AMED, CINAHL, PsycINFO, ClinicalTrials.gov, and World Health Organization's International Clinical Trials Registry Platform from inception to November 30, 2022. Risk of bias was assessed using Quality in Prognosis Studies. Thirty-two unique studies (total n = 4721 participants, 55% male), and three study protocols were included. We used random-effects meta-analysis to pool data for PA and fitness outcomes, and vote-counting of direction of association to synthesize data that could not be meta-analyzed. We found moderate-certainty evidence of a weak association between higher PSF and impaired fitness (meta r = -0.24; 95% confidence interval (CI) = -0.33, -0.15; n = 905, 7 studies), and very low-certainty evidence of no association between PSF and PA (meta r = -0.09; 95% CI = -0.34, 0.161; n = 430, 3 studies). Vote-counting showed a higher proportion of studies with associations between higher PSF and impaired fitness (pˆ = 0.83; 95% CI = 0.44, 0.97; p = 0.22, n = 298, 6 studies), and with associations between higher PSF and lower PA (pˆ = 0.75; 95% CI = 0.51, 0.90; p = 0.08, n = 2566, 16 studies). Very low- to moderate-certainty evidence reflects small study sample sizes, high risk of bias, and inconsistent results. CONCLUSIONS The meta-analysis showed moderate-certainty evidence of an association between higher PSF and impaired fitness. These results indicate that fitness might protect against PSF. Larger prospective studies and randomized controlled trials evaluating the effect of exercise on PSF are needed to confirm these findings.
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Affiliation(s)
- Petra Larsson
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Surgical Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Julia Bidonde
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Canada
| | - Unni Olsen
- Surgical Department, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Caryl L Gay
- Department of Family Health Care Nursing, University of California, San Francisco, CA, USA
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Anners Lerdal
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Marie Ursin
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Gillian Elizabeth Mead
- Geriatric Medicine, Division of Health Sciences, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Elisabeth Edvardsen
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Pulmonary Medicine, Oslo University Hospital, Oslo, Norway
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Shankaranarayana AM, Jagadish A, Nimmy J, Natarajan M, Janssen H, Solomon JM. Non-therapeutic strategies to promote physical activity of stroke survivors in hospital settings: A systematic review. J Bodyw Mov Ther 2023; 36:192-202. [PMID: 37949559 DOI: 10.1016/j.jbmt.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/11/2023] [Accepted: 07/04/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To systematically summarize the evidence of strategies other than therapy to promote physical activity in hospital settings. METHODS Studies testing the various strategies to promote the physical activity of stroke survivors in different hospital settings, including stroke units, hospitals and rehabilitation centres were included. Two independent reviewers screened, extracted data, and assessed the study quality. Quality assessments were performed using standardized checklists. Data synthesis was done from the selected articles and results were reported. RESULTS Of the 3396 records retrieved from database searches, 12 studies (n = 529 participants) were included. All the studies were of moderate to good quality. The strategies were grouped into five categories: i) physical environment, ii) device-based feedback, iii) self-management approaches, iv) family presence, and v) education. Physical environmental and device-based feedback were the most common strategies to promote physical activity after a stroke in a hospital setting. Strategies such as family presence and education improved physical activity levels, whereas device-based feedback showed mixed results. CONCLUSION Despite the importance of physical activity in early stroke, there is limited literature present to enhance activity levels. Physical environment and device-based feedback were the two most common strategies used in acute stroke survivors. The impact of these strategies remain suboptimal to be considered as effective intervention methods to enhance physical activity.
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Affiliation(s)
- Apoorva M Shankaranarayana
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India; Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Akhila Jagadish
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India; Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Josephine Nimmy
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Manikandan Natarajan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India; Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Heidi Janssen
- School of Health Sciences, The University of Newcastle, Australia
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India; Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
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Blokland IJ, Groot FP, Logt NHG, van Bennekom CAM, de Koning JJ, van Dieen JH, Houdijk H. Cardiorespiratory Fitness in Individuals Post-stroke: Reference Values and Determinants. Arch Phys Med Rehabil 2023; 104:1612-1619. [PMID: 37172675 DOI: 10.1016/j.apmr.2023.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/09/2023] [Accepted: 03/31/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To provide reference values of cardiorespiratory fitness for individuals post-stroke in clinical rehabilitation and to gain insight in characteristics related to cardiorespiratory fitness post stroke. DESIGN A retrospective cohort study. Reference equations of cardiopulmonary fitness corrected for age and sex for the fifth, 25th, 50th, 75th, and 95th percentile were constructed with quantile regression analysis. The relation between patient characteristics and cardiorespiratory fitness was determined by linear regression analyses adjusted for sex and age. Multivariate regression models of cardiorespiratory fitness were constructed. SETTING Clinical rehabilitation center. PARTICIPANTS Individuals post-stroke who performed a cardiopulmonary exercise test as part of clinical rehabilitation between July 2015 and May 2021 (N=405). MAIN OUTCOME MEASURES Cardiorespiratory fitness in terms of peak oxygen uptake (V˙O2peak) and oxygen uptake at ventilatory threshold (V˙O2-VT). RESULTS References equations for cardiorespiratory fitness stratified by sex and age were provided based on 405 individuals post-stroke. Median V˙O2peak was 17.8[range 8.4-39.6] mL/kg/min and median V˙O2-VT was 9.7[range 5.9-26.6] mL/kg/min. Cardiorespiratory fitness was lower in individuals who were older, women, using beta-blocker medication, and in individuals with a higher body mass index and lower motor ability. CONCLUSIONS Population specific reference values of cardiorespiratory fitness for individuals post-stroke corrected for age and sex were presented. These can give individuals post-stroke and health care providers insight in their cardiorespiratory fitness compared with their peers. Furthermore, they can be used to determine the potential necessity for cardiorespiratory fitness training as part of the rehabilitation program for an individual post-stroke to enhance their fitness, functioning and health. Especially, individuals post-stroke with more mobility limitations and beta-blocker use are at a higher risk of low cardiorespiratory fitness.
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Affiliation(s)
- Ilse J Blokland
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands; Heliomare Research and Development, Wijk aan Zee, The Netherlands.
| | | | - Nadine H G Logt
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands; Heliomare Research and Development, Wijk aan Zee, The Netherlands
| | - Coen A M van Bennekom
- Heliomare Research and Development, Wijk aan Zee, The Netherlands; Coronel Institute of Occupational Health, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Jos J de Koning
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - Jaap H van Dieen
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - Han Houdijk
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
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Kubo H, Kanai M, Nozoe M, Inamoto A, Taguchi A, Makihara A, Hosokawa D, Mitsue S, Asai T, Shimada S. Association of Malnutrition With Physical Activity Intensity in Patients With Subacute Stroke. Arch Phys Med Rehabil 2023; 104:1652-1660. [PMID: 37257550 DOI: 10.1016/j.apmr.2023.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/29/2023] [Accepted: 04/28/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To investigate the relationship between nutritional status measured by the Global Leadership Initiative on Malnutrition (GLIM) criteria and the intensity of physical activity, and to determine the association between these factors and the activities of daily living (ADLs) in patients with subacute stroke during hospitalization. DESIGN A cross-sectional study. SETTING The study was conducted in the rehabilitation unit at a neurosurgical hospital. PARTICIPANTS One hundred and twenty-eight patients with subacute stroke (N=128). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Nutritional status was assessed using GLIM criteria. Sedentary behavior (SB), light-intensity physical activity (LIPA), and moderate-to-vigorous physical activity (MVPA) were measured using an accelerometer. Multiple regression analysis was used to investigate the relationship between nutritional status and intensity of physical activity. Moreover, the association of nutritional status and physical activity intensity with ADLs was determined using multiple regression analysis and mediation analysis. RESULTS Malnutrition was associated with SB time (B = 16.241, P=.009) and LIPA time (B = -17.656, P=.002), but not MVPA time (B = -0.472, P=.776). SB time (B = -0.063, P=.009) and LIPA time (B = 0.093, P<.001) were associated with functional independence measure for motor function, while MVPA time (B = -0.080, P=.379) was not. SB time (coefficient = -10.785, P<.001) and LIPA time (coefficient = -12.054, P<.001) were significant mediators between nutrition status and ADLs. CONCLUSIONS Malnutrition was associated with a SB time and LIPA time, but not MVPA time, in patients with sub-acute stroke. SB and LIPA times were associated with ADLs and mediated between nutrition status and ADLs in these patients. The association of nutritional status on physical activity and ADLs should be considered in stroke rehabilitation.
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Affiliation(s)
- Hiroki Kubo
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan; Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan; Researcher, Kansai Medical University, Hirakata, Japan.
| | - Masashi Kanai
- Institute of Transdisciplinary Sciences for Innovation, Kanazawa University, Kanazawa, Japan
| | - Masafumi Nozoe
- Faculty of Rehabilitation, Kansai Medical University, Hirakata, Japan
| | - Asami Inamoto
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Akira Taguchi
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Ayano Makihara
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Daiki Hosokawa
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Shingo Mitsue
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Tsuyoshi Asai
- Faculty of Rehabilitation, Kansai Medical University, Hirakata, Japan
| | - Shinichi Shimada
- Department of Neurosurgery, Itami Kousei Neurosurgical Hospital, Itami, Japan
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de Vries EA, Heijenbrok-Kal MH, van Kooten F, Giurgiu M, Ribbers GM, van den Berg-Emons RJG, Bussmann JBJ. Unraveling the interplay between daily life fatigue and physical activity after subarachnoid hemorrhage: an ecological momentary assessment and accelerometry study. J Neuroeng Rehabil 2023; 20:127. [PMID: 37752550 PMCID: PMC10521384 DOI: 10.1186/s12984-023-01241-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Fatigue is one of the most commonly reported symptoms after subarachnoid hemorrhage (SAH) and is indirectly associated with physical activity (PA). Associations between fatigue and PA are primarily examined based on conventional measures (i.e. a single fatigue score or average PA levels), thereby assuming that fatigue and PA do not fluctuate over time. However, levels of fatigue and PA may not be stable and may interrelate dynamically in daily life. Insight in direct relationships between fatigue and PA in daily life, could add to the development of personalized rehabilitation strategies. Therefore we aimed to examine bidirectional relationships between momentary fatigue and PA in people with SAH. METHODS People (n = 38) with SAH who suffer from chronic fatigue were included in an observational study using Ecological Momentary Assessment (EMA) and accelerometry. Momentary fatigue was assessed on a scale from 1 to 7 (no to extreme fatigue), assessed with 10-11 prompts per day for 7 consecutive days using EMA with a mobile phone. PA was continuously measured during this 7-day period with a thigh-worn Activ8 accelerometer and expressed as total minutes of standing, walking, running and cycling in a period of 45 min before and after a momentary fatigue prompt. Multilevel mixed model analyses including random effects were conducted. RESULTS Mean age was 53.2 years (SD = 13.4), 58% female, and mean time post SAH onset was 9.5 months (SD = 2.1). Multilevel analyses with only time effects to predict fatigue and PA revealed that fatigue significantly (p < 0.001) increased over the day and PA significantly (p < 0.001) decreased. In addition, more PA was significantly associated with higher subsequent fatigue (β = 0.004, p < 0.05) and higher fatigue was significantly associated with less subsequent PA (β=-0.736, p < 0.05). Moreover, these associations significantly differed between participants (p < 0.001). CONCLUSIONS By combining EMA measures of fatigue with accelerometer-based PA we found that fatigue and PA are bidirectionally associated. In addition, these associations differ among participants. Given these different bidirectional associations, rehabilitation aimed at reducing fatigue should comprise personalized strategies to improve both fatigue and PA simultaneously, for example by combining exercise therapy with cognitive behavioral and/or energy management therapy.
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Affiliation(s)
- Elisabeth A de Vries
- Erasmus MC, Department of Rehabilitation Medicine, University Medical Center Rotterdam, Rotterdam, the Netherlands.
- Rijndam Rehabilitation, Rotterdam, the Netherlands.
| | - Majanka H Heijenbrok-Kal
- Erasmus MC, Department of Rehabilitation Medicine, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Rijndam Rehabilitation, Rotterdam, the Netherlands
| | - Fop van Kooten
- Erasmus MC, Department of Neurology, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marco Giurgiu
- Institute for Sports and Sports Science, Mental mHealth lab, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Gerard M Ribbers
- Erasmus MC, Department of Rehabilitation Medicine, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Rijndam Rehabilitation, Rotterdam, the Netherlands
| | - Rita J G van den Berg-Emons
- Erasmus MC, Department of Rehabilitation Medicine, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Johannes B J Bussmann
- Erasmus MC, Department of Rehabilitation Medicine, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Miller A, McCartney K, Wright T, Reisman D. Predictors of non-stepping time in people with chronic stroke. Top Stroke Rehabil 2023; 30:543-551. [PMID: 35993481 PMCID: PMC9943794 DOI: 10.1080/10749357.2022.2114703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/09/2022] [Accepted: 08/14/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Sedentary time is an independent construct from active time. Previous studies have examined variables associated with sedentary time to inform behavior change programs; however, these studies have lacked data sets that encompass potentially important domains. OBJECTIVES The purpose of this study was to build a more comprehensive model containing previously theorized important predictors of sedentary time and new predictors that have not been explored. We hypothesized that variables representing the domains of physical capacity, psychosocial, physical health, cognition, and environmental would be significantly related to sedentary time in individuals post-stroke. METHODS This was a cross-sectional analysis of 280 individuals with chronic stroke. An activity monitor was used to measure sedentary (i.e. non-stepping) time. Five domains (8 predictors) were entered into a sequential linear regression model: physical capacity (6-Minute Walk Test, assistive device use), psychosocial (Activities Specific Balance Confidence Scale and Patient Health Questionnaire-9), physical health (Charlson Comorbidity Index and body mass index), cognition (Montreal Cognitive Assessment), and environmental (Area Deprivation Index). RESULTS The 6-Minute Walk Test (β = -0.39, p < .001), assistive device use (β = 0.15, p = .03), Patient Health Questionnaire-9 (β = 0.16, p = .01), and body mass index (β = 0.11, p = .04) were significantly related to non-stepping time in individuals with chronic stroke. The model explained 28.5% of the variability in non-stepping time. CONCLUSIONS This work provides new perspective on which variables may need to be addressed in programs targeting sedentary time in stroke. Such programs should consider physical capacity, depressive symptoms, and physical health.
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Affiliation(s)
- Allison Miller
- Department of Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
| | - Kiersten McCartney
- Department of Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
| | - Tamara Wright
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Darcy Reisman
- Department of Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
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Wavell C, Marrocco S, Lee FJH, Momen R, Macaluso S. The SETPACE Trial: Stroke Survivors Impressions of the Education and Teaching Provided Regarding Physical Activity and Patient Confidence Regarding Exercise. Am J Phys Med Rehabil 2023; 102:810-814. [PMID: 36811549 DOI: 10.1097/phm.0000000000002213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE The aim of the study is to investigate the association between patient self-efficacy, impression of exercise education, and physical activity among stroke survivors. We hypothesized that low self-efficacy and/or poor impressions of exercise education after stroke would be associated with reduced exercise participation. DESIGN This is a cross-sectional investigation of patients' poststroke with physical activity as the primary outcome variable. Physical activity was measured with the Physical Activity Scale for Individuals with Physical Disabilities. Self-efficacy was measured with the Self-Efficacy for Exercise questionnaire. Impression of exercise education measured by the Exercise Impression Questionnaire. RESULTS There was a low but significant correlation between Self-Efficacy for Exercise questionnaire and Physical Activity Scale for Individuals with Physical Disabilities ( r (66) = 0.272, P = 0.012). There was an insignificant correlation between Exercise Impression Questionnaire and Physical Activity Scale for Individuals with Physical Disabilities ( r (66) = 0.174, P = 0.078). There was a low but significant correlation between age and Physical Activity Scale for Individuals with Physical Disabilities ( r (66) = -0.269, P = 0.013). There was no correlation between sex and Physical Activity Scale for Individuals with Physical Disabilities ( r (66) = 0.051, P = 0.339). Age, sex, Exercise Impression Questionnaire, and Self-Efficacy for Exercise questionnaire predict 17.1% of Physical Activity Scale for Individuals with Physical Disabilities variance ( R2 = 0.171). CONCLUSION Self-efficacy was the strongest predictor of physical activity participation. There was a lack of association between the impressions of exercise education and physical activity. Addressing patient confidence to complete exercise has the potential to improve exercise participation in patients after stroke.
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Affiliation(s)
- Christopher Wavell
- From the University of Western Ontario, London, Canada (CW, S Marrocco, FJ-HL, RM); Schulich School of Medicine and Dentistry, Western University, London, Canada (CW); University of Toronto, Temerty Faculty of Medicine, Toronto, Canada (CW); Lawson Health, Parkwood Institute, London, Canada (S Marrocco, S Macaluso); and Department of Physical Medicine and Rehabilitation, Western University, London, Canada (S Macaluso)
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46
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Ashizawa R, Honda H, Kameyama Y, Yoshimoto Y. Effect of Pre-Hospitalization Fall History on Physical Activity and Sedentary Behavior After the Implementation of a Behavioral Change Approach in Patients with Minor Ischemic Stroke: A Secondary Analysis of a Randomized Controlled Trial. Int J Behav Med 2023:10.1007/s12529-023-10202-0. [PMID: 37587353 DOI: 10.1007/s12529-023-10202-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND We aimed to determine whether a history of falls before admission affected physical activity levels and sedentary behavior negatively after implementing a behavior modification approach in patients with minor ischemic stroke. METHODS This study constituted a secondary analysis of an intervention trial. In the intervention study, patients with minor ischemic stroke were randomly assigned to two groups: intervention and control groups. The intervention group was encouraged to reduce sedentary behavior during hospitalization and after discharge, while the control group was encouraged to increase physical activity levels solely during hospitalization. The study included 52 patients who completed the intervention trial. The exposure factor examined was a history of falls. Upon admission, patients were queried about any falls experienced in the year preceding admission and subsequently classified into fall and non-fall groups based on their responses. The primary outcome of interest focused on changes in physical activity levels (step count, light-intensity physical activity, and moderate-to-vigorous-intensity physical activity) and sedentary behavior. Measurements were obtained at two time points: before the intervention, during hospitalization (baseline), and 3 months after discharge (post-intervention). RESULTS Only a significantly lower change in the number of steps taken in the fall group than in the non-fall group was found. CONCLUSION Those with a history of falls showed a lesser change in the number of steps taken before and after implementing a behavior change approach compared with those without a history of falls. Those with a history of falls may have engaged in activities other than walking.
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Affiliation(s)
- Ryota Ashizawa
- Department of Rehabilitation, Seirei Mikatahara General Hospital, 3453 Mikatahara-Cho, Kita-Ku, Hamamatsu-Shi, Shizuoka, 433-8558, Japan.
| | - Hiroya Honda
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Japan
- Department of Rehabilitation, Hanadaira Care Center, Hamamatsu, Japan
| | - Yuto Kameyama
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Japan
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Yoshinobu Yoshimoto
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Japan
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Thompson ED, Pohlig RT, McCartney KM, Hornby TG, Kasner SE, Raser-Schramm J, Miller AE, Henderson CE, Wright H, Wright T, Reisman DS. Increasing activity after stroke: a randomized controlled trial of highintensity walking and step activity intervention. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.11.23287111. [PMID: 37609269 PMCID: PMC10441496 DOI: 10.1101/2023.03.11.23287111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Background Physical inactivity in people with chronic stroke profoundly affects daily function and increases recurrent stroke risk and mortality, making physical activity improvements an important target of intervention. We compared the effects of a highintensity walking intervention (FAST), a step activity monitoring behavioral intervention (SAM), or a combined intervention (FAST+SAM) on physical activity (i.e., steps per day). We hypothesized the combined intervention would yield the greatest increase in steps per day. Methods This assessor-blinded multi-site randomized controlled trial was conducted at four university/hospital-based laboratories. Participants were 21-85 years old, walking without physical assistance following a single, unilateral non-cerebellar stroke of ≥6 months duration, and randomly assigned to FAST, SAM, or FAST+SAM for 12 weeks (2-3 sessions/week). FAST training consisted of walking-related activities for 40 minutes/session at 70-80% heart rate reserve, while SAM received daily feedback and goal-setting of walking activity (steps per day). Assessors and study statistician were masked to group assignment.The a priori-determined primary outcome and primary endpoint was change in steps per day from pre- to post-intervention. Adverse events (AEs) were tracked after randomization. All randomized participants were included in the intent-to-treat analysis.This study is registered at ClinicalTrials.gov, NCT02835313. Findings Participants were enrolled from July 18, 2016-November 16, 2021. Of 250 randomized participants (mean[SE] age 63[0.80], 116F/134M), 89 were assigned to FAST, 81 to SAM, and 80 to FAST+SAM. Steps per day significantly increased in both the SAM (mean[SE] 1542[267], 95%CI:1014-2069, p<0.001) and FAST+SAM groups (1307[280], 752-1861, p<0.001), but not in the FAST group (406[238], 63-876, p=0.09). There were no deaths or serious study-related AEs and all other minor AEs were similar between groups. Interpretation Only individuals with chronic stroke who completed a step activity monitoring behavioral intervention with skilled coaching and goal progression demonstrated improvements in physical activity (steps per day).
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Affiliation(s)
| | - Ryan T Pohlig
- University of Delaware, Biostatistics Core, Newark, DE, USA
| | - Kiersten M McCartney
- University of Delaware, Biomechanics and Movement Science (BIOMS) program, Newark, DE, USA
| | - T George Hornby
- Indiana University, Department of Physical Medicine and Rehabilitation, Indianapolis, IN, USA
| | - Scott E Kasner
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Allison E Miller
- Washington University School of Medicine, Program in Physical Therapy, St. Louis, MO, USA
| | - Christopher E Henderson
- Indiana University, Department of Physical Medicine and Rehabilitation, Indianapolis, IN, USA
| | - Henry Wright
- University of Delaware, Department of Physical Therapy, Newark, DE, USA
| | - Tamara Wright
- University of Delaware, Department of Physical Therapy, Newark, DE, USA
| | - Darcy S Reisman
- University of Delaware, Department of Physical Therapy, Newark, DE, USA
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48
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de Diego-Alonso C, Blasco-Abadía J, Buesa-Estéllez A, Giner-Nicolás R, López-Royo MP, Roldán-Pérez P, Doménech-García V, Bellosta-López P, Fini N. Relationship between Participation in Daily Life Activities and Physical Activity in Stroke Survivors: A Protocol for a Systematic Review and Meta-Analysis. Healthcare (Basel) 2023; 11:2167. [PMID: 37570407 PMCID: PMC10419119 DOI: 10.3390/healthcare11152167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Stroke survivors undertake low levels of physical activity and participation in daily life activities, but the correlation between these two domains still carries some degree of uncertainty. This systematic review and meta-analyses-based data synthesis will aim to describe and estimate the relationship between participation in daily life activities and physical activity in stroke survivors. Six databases (MEDLINE/PubMed, Web of Science, Scopus, PEDro, SPORTDiscus, and Rehabilitation & Sport Medicine Source) will be searched. Studies assessing participation alongside physical activity levels in adult stroke survivors in English or Spanish will be included. The study selection, assessment of the risk of bias, and data extraction will be conducted independently by two investigators. If available, correlation values between physical activity and participation outcomes will be extracted. The Hedges-Olkin method will be used for pooling correlation values between participation and physical activity measures. Subgroup analyses will be performed according to the time elapsed since the stroke (i.e., ≤6 months and >6 months). This will be the first systematic review with a meta-analysis to provide information on the relationship between physical activity and participation in stroke survivors. Findings are likely to inform the design of health prevention protocols and the development of healthy behavior change interventions.
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Affiliation(s)
- Cristina de Diego-Alonso
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Campus Universitario, Autov. A23 km 299, Villanueva de Gállego, 50830 Zaragoza, Spain; (C.d.D.-A.); (J.B.-A.); (A.B.-E.); (R.G.-N.); (M.P.L.-R.); (P.R.-P.); (V.D.-G.)
| | - Julia Blasco-Abadía
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Campus Universitario, Autov. A23 km 299, Villanueva de Gállego, 50830 Zaragoza, Spain; (C.d.D.-A.); (J.B.-A.); (A.B.-E.); (R.G.-N.); (M.P.L.-R.); (P.R.-P.); (V.D.-G.)
| | - Almudena Buesa-Estéllez
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Campus Universitario, Autov. A23 km 299, Villanueva de Gállego, 50830 Zaragoza, Spain; (C.d.D.-A.); (J.B.-A.); (A.B.-E.); (R.G.-N.); (M.P.L.-R.); (P.R.-P.); (V.D.-G.)
| | - Rafael Giner-Nicolás
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Campus Universitario, Autov. A23 km 299, Villanueva de Gállego, 50830 Zaragoza, Spain; (C.d.D.-A.); (J.B.-A.); (A.B.-E.); (R.G.-N.); (M.P.L.-R.); (P.R.-P.); (V.D.-G.)
| | - María Pilar López-Royo
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Campus Universitario, Autov. A23 km 299, Villanueva de Gállego, 50830 Zaragoza, Spain; (C.d.D.-A.); (J.B.-A.); (A.B.-E.); (R.G.-N.); (M.P.L.-R.); (P.R.-P.); (V.D.-G.)
| | - Patricia Roldán-Pérez
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Campus Universitario, Autov. A23 km 299, Villanueva de Gállego, 50830 Zaragoza, Spain; (C.d.D.-A.); (J.B.-A.); (A.B.-E.); (R.G.-N.); (M.P.L.-R.); (P.R.-P.); (V.D.-G.)
| | - Víctor Doménech-García
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Campus Universitario, Autov. A23 km 299, Villanueva de Gállego, 50830 Zaragoza, Spain; (C.d.D.-A.); (J.B.-A.); (A.B.-E.); (R.G.-N.); (M.P.L.-R.); (P.R.-P.); (V.D.-G.)
| | - Pablo Bellosta-López
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Campus Universitario, Autov. A23 km 299, Villanueva de Gállego, 50830 Zaragoza, Spain; (C.d.D.-A.); (J.B.-A.); (A.B.-E.); (R.G.-N.); (M.P.L.-R.); (P.R.-P.); (V.D.-G.)
| | - Natalie Fini
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, VIC 3052, Australia;
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Irvine L, Morris JH, Dombrowski SU, Breckenridge JP, Farre A, Ozakinci G, Lebedis T, Jones C. Keeping Active with Texting after Stroke (KATS): development of a text message intervention to promote physical activity and exercise after stroke. Pilot Feasibility Stud 2023; 9:105. [PMID: 37353847 DOI: 10.1186/s40814-023-01326-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/26/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Post-stroke physical activity reduces disability and risk of further stroke. When stroke rehabilitation ends, some people feel abandoned by services and struggle to undertake physical activities that support recovery and health. The aim of this study was to codesign a novel text message intervention to promote physical activity among people with stroke and provide support when formal rehabilitation ends. This manuscript describes the intervention development processes that will inform future pilot and feasibility studies. METHODS The planned intervention was a series of text messages to be sent in a predetermined sequence to people with stroke at the end of rehabilitation. The intervention, underpinned by behaviour change theory and using salient behaviour change techniques, would provide daily messages offering encouragement and support for the uptake and maintenance of physical activity following stroke. The intervention was codesigned by a Collaborative Working Group, comprised of people with stroke, rehabilitation therapists, representatives from stroke charities and academics. A four-step framework was used to design the intervention: formative research on physical activity post-stroke, creation of the behaviour change text message intervention, pre-testing and refinement. Formative research included a review of the scientific evidence and interviews with community-dwelling people with stroke. Data generated were used by the Collaborative Working Group to identify topics to be addressed in the intervention. These were mapped to constructs of the Health Action Process Approach, and salient behaviour change techniques to deliver the intervention were identified. The intervention was rendered into a series of text messages to be delivered over 12 weeks. The draft intervention was revised and refined through an iterative process including review by people with stroke, their spouses, rehabilitation therapists and experts in the field of stroke. The messages encourage regular physical activity but do not prescribe exercise or provide reminders to exercise at specific times. They use conversational language to encourage engagement, and some are personalised for participants. Quotes from people with stroke provide encouragement and support and model key behaviour change techniques such as goal setting and coping planning. DISCUSSION Co-design processes were critical in systematically developing this theory and evidence-based intervention. People with stroke and rehabilitation therapists provided insights into perceived barriers post-rehabilitation and identified strategies to overcome them. The structured multistep approach highlighted areas for improvement through successive rounds of review. The intervention will be tested for acceptability, feasibility and effectiveness in future studies. This co-design approach could be used for interventions for other heath behaviours and with different populations.
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Affiliation(s)
- Linda Irvine
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Jacqui H Morris
- School of Health Sciences, University of Dundee, Dundee, UK.
| | - Stephan U Dombrowski
- Faculty of Kinesiology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | | | - Albert Farre
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Gozde Ozakinci
- Faculty of Natural Sciences, Division of Psychology, University of Stirling, Stirling, UK
| | | | - Claire Jones
- School of Medicine, University of Dundee, Dundee, UK
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50
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Gutierrez-Arias R, González-Mondaca C, Marinkovic-Riffo V, Ortiz-Puebla M, Paillán-Reyes F, Seron P. Measures to ensure safety during telerehabilitation of people with stroke: A scoping review. J Telemed Telecare 2023:1357633X231181426. [PMID: 37321644 DOI: 10.1177/1357633x231181426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Measures used to prevent adverse events during the implementation of exercise sessions delivered via telerehabilitation can be varied, ranging from simple telephone monitoring to synchronous therapist-led sessions. However, this information is scattered in the literature, as evidence synthesis studies have only addressed the safety, satisfaction, and effectiveness aspects of exercise delivered via telerehabilitation. AIMS This scoping review aims to describe that measures are used to ensure safety during exercise sessions delivered to people with stroke through telerehabilitation, as reported by authors of primary studies. Secondarily, it describes the designs most frequently used to notify the effects of telerehabilitation and evidence level, the characteristics of the participants and type of stroke, and the characteristics of telerehabilitation. SUMMARY OF REVIEW A scoping review was conducted according to the Joana Briggs Institute (JBI) recommendations. A systematic search of MEDLINE (Ovid), Embase (Ovid), CENTRAL, and CINHAL was conducted from inception to August 2022, and a review of systematic review references on the topic. We included primary studies that enrolled adults with stroke who underwent exercise delivered via telerehabilitation. Two independent reviewers performed study selection and data extraction, and disagreements were resolved by consensus or a third reviewer. A qualitative analysis of the information was performed. One hundred seven primary studies (3991 participants) published between 2002 and 2022 were included. Most studies were case series (43%) and rated with an Oxford level of evidence of "4" (55.3%). Regarding randomized clinical trials, half included 53 or more participants (IQR 26.75 to 81). Most studies applied the exercises via asynchronous telerehabilitation (55.1%), of which only ten reported measures to avoid adverse events. Some of the measures included assessing the location where exercises are to be performed, only using a seated position, and using live warning systems that prevent or stop exercises when they are risky. CONCLUSIONS Reporting of measures implemented to prevent adverse events during exercise delivery via asynchronous telerehabilitation is scarce. Future primary studies should always consider reporting adverse events related to exercise delivery via telerehabilitation and strategies implemented to decrease the incidence of these unwanted safety events. REGISTRATION NUMBER INPLASY202290104.
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Affiliation(s)
- Ruvistay Gutierrez-Arias
- Departamento de Apoyo en Rehabilitación Cardiopulmonar Integral, Instituto Nacional del Tórax, Santiago, Chile
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences,Universidad Andres Bello, Santiago, Chile
| | - Camila González-Mondaca
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences,Universidad Andres Bello, Santiago, Chile
| | - Vinka Marinkovic-Riffo
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences,Universidad Andres Bello, Santiago, Chile
| | - Marietta Ortiz-Puebla
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences,Universidad Andres Bello, Santiago, Chile
| | - Fernanda Paillán-Reyes
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences,Universidad Andres Bello, Santiago, Chile
| | - Pamela Seron
- Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile
- Departamento de Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
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