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Cottrell K, Chapman HM. Acquired brain injury (ABI) survivors' experience of occupation and activity during their inpatient stay: a scoping review. Disabil Rehabil 2023:1-25. [PMID: 37982380 DOI: 10.1080/09638288.2023.2281601] [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: 05/17/2023] [Accepted: 11/02/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE This review aimed to characterise and map: (1) what type of evidence and what dominant study characteristics are available regarding acquired brain injury (ABI) survivors' experience of occupation and activity in hospital? (2) How are occupation and activity conceptualised in the literature? (3) How are ABI survivors experiencing occupation and activity while in hospital? (4) What factors create barriers or opportunities for engagement in occupations or activity in hospital? (5) Are there any knowledge gaps identified? MATERIALS AND METHODS A scoping review was conducted examining literature published between 2017 and 2022. Relevant studies were systematically retrieved from electronic databases. RESULTS Thirty-four publications were included. There were more quantitative studies (n = 18). Much of the research has been conducted outside of the UK. The populations studied were principally stroke (n = 22). The concept of activity rather than occupation predominates. Patients spend their time alone and inactive. Structural and contextual barriers for engaging in activity are identified. Qualitative study designs exclude ABI survivors with communication or cognitive impairment. CONCLUSIONS There is a paucity of research with ABI survivors in hospitals in the UK. Alternative methodological approaches such as ethnography would ensure those with communication or cognitive impairment are not excluded from research. Implications for rehabilitationRehabilitation professionals, especially occupational therapists, need to lead acquired brain injury (ABI) research in acute hospital settings in the UK.Conceptualisation of meaningful activity and occupation needs a clearer focus in ABI research.Qualitative studies frequently exclude participants with cognitive or communication impairments so methodologies that are more inclusive and representative of brain injury survivors are needed.
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Affiliation(s)
| | - Hazel M Chapman
- Faculty of Health, Medicine and Society, University of Chester, Chester, UK
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Atama T, Leclair L, Pooyania S, Barclay R. Stroke Survivors and their Physiotherapists' Perceptions of Recovery: A Multiple Methods Approach. Physiother Can 2023; 75:377-386. [PMID: 38037584 PMCID: PMC10686302 DOI: 10.3138/ptc-2021-0068] [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: 07/01/2021] [Revised: 01/07/2022] [Accepted: 01/07/2022] [Indexed: 12/02/2023]
Abstract
Purpose This multiple-methods study examined perceptions of recovery among stroke survivors and their physiotherapists at discharge from an in-patient rehabilitation program. Method The Functional Independence Measure (FIM) and Chedoke McMaster Stroke Assessment Activity Inventory scores were collected from chart review and the following outcome measures were completed by interview: Stroke Impact Scale (SIS) global recovery, Hospital Anxiety Depression Scale, and Montreal Cognitive Assessment. Physiotherapists also completed the SIS global recovery for each participant. Spearman and Pearson correlations between SIS recovery and observed measures were completed. The stroke survivors had a short interview about their perception of recovery and what recovery meant to them, and their physiotherapists answered two written questions about each participant's recovery. Responses were coded and categorized based on the International Classification of Functioning. Results A total of 31 stroke survivors with a mean age of 66.6 years (SD 10.7) and six physiotherapists participated. Nineteen stroke survivors were interviewed. The stroke survivors' SIS recovery scores correlated with FIM-motor change (rs = 0.36 p = 0.04) and the SIS-recovery scores reported by the physiotherapists (r = 0.51; p < 0.01). In relation to the factors related to recovery, the physiotherapists' focus was therapeutic mainly considering motor recovery while the stroke survivors' responses were broad, including being able to achieve recovery goals and nutrition. However, both perceived recovery to include functional activities. Conclusions SIS global recovery question helps to measure the overall perceived percentage of recovery. However, the complete picture of recovery is only possible with the stroke survivors' and physiotherapists' perceptions of recovery and what recovery means to them.
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Affiliation(s)
- Tolu Atama
- From the:
From the: Department of Physiotherapy, Health Sciences Centre, Shared Health, Winnipeg, Manitoba, Canada
| | - Leanne Leclair
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sepideh Pooyania
- Section of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruth Barclay
- Department of Physical Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Mazzeo M, Hernan G, Veerubhotla A. Usability and ease of use of long-term remote monitoring of physical activity for individuals with acquired brain injury in community: a qualitative analysis. Front Neurosci 2023; 17:1220581. [PMID: 37781244 PMCID: PMC10534037 DOI: 10.3389/fnins.2023.1220581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/23/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Objective and continuous monitoring of physical activity over the long-term in the community is perhaps the most important step in the paradigm shift toward evidence-based practice and personalized therapy for successful community integration. With the advancement in technology, physical activity monitors have become the go-to tools for objective and continuous monitoring of everyday physical activity in the community. While these devices are widely used in many patient populations, their use in individuals with acquired brain injury is slowly gaining traction. The first step before using activity monitors in this population is to understand the patient perspective on usability and ease of use of physical activity monitors at different wear locations. However, there are no studies that have looked at the feasibility and patient perspectives on long-term utilization of activity monitors in individuals with acquired brain injury. Methods This pilot study aims to fill this gap and understand patient-reported aspects of the feasibility of using physical activity monitors for long-term use in community-dwelling individuals with acquired brain injury. Results This pilot study found that patients with acquired brain injury faced challenges specific to their functional limitations and that the activity monitors worn on the waist or wrist may be better suited in this population. Discussion The unique wear location-specific challenges faced by individuals with ABI need to be taken into account when selecting wearable activity monitors for long term use in this population.
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Affiliation(s)
| | | | - Akhila Veerubhotla
- Department of Rehabilitation Medicine, New York University - Grossman School of Medicine, New York, NY, United States
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Abdullahi A, Wong TWL, Ng SSM. Variation in the rate of recovery in motor function between the upper and lower limbs in patients with stroke: some proposed hypotheses and their implications for research and practice. Front Neurol 2023; 14:1225924. [PMID: 37602245 PMCID: PMC10435271 DOI: 10.3389/fneur.2023.1225924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Background Stroke results in impairment of motor function of both the upper and lower limbs. However, although it is debatable, motor function of the lower limb is believed to recover faster than that of the upper limb. The aim of this paper is to propose some hypotheses to explain the reasons for that, and discuss their implications for research and practice. Method We searched PubMED, Web of Science, Scopus, Embase and CENTRAL using the key words, stroke, cerebrovascular accident, upper extremity, lower extremity, and motor recovery for relevant literature. Result The search generated a total of 2,551 hits. However, out of this number, 51 duplicates were removed. Following review of the relevant literature, we proposed four hypotheses: natural instinct for walking hypothesis, bipedal locomotion hypothesis, central pattern generators (CPGs) hypothesis and role of spasticity hypothesis on the subject matter. Conclusion We opine that, what may eventually account for the difference, is the frequency of use of the affected limb or intensity of the rehabilitation intervention. This is because, from the above hypotheses, the lower limb seems to be used more frequently. When limbs are used frequently, this will result in use-dependent plasticity and eventual recovery. Thus, rehabilitation techniques that involve high repetitive tasks practice such as robotic rehabilitation, Wii gaming and constraint induced movement therapy should be used during upper limb rehabilitation.
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Yoshida T, Otaka Y, Kitamura S, Ushizawa K, Kumagai M, Yaeda J, Osu R. Influence of motivation on rehabilitation outcomes after subacute stroke in convalescent rehabilitation wards. Front Neurol 2023; 14:1185813. [PMID: 37521301 PMCID: PMC10375291 DOI: 10.3389/fneur.2023.1185813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Background The motivation for rehabilitation is important in encouraging stroke patients to participate in rehabilitation; however, its relationship with outcomes is not well known. In addition, changes in patient motivation during hospitalization have not been examined. Aim To examine the relationship between motivation and rehabilitation outcomes for subacute stroke patients and to investigate the changes in motivation. Design Prospective cohort study. Setting Subacute rehabilitation hospital. Population The study enrolled a consecutive sample of patients (n = 201) with stroke admitted to a subacute rehabilitation ward from October 2017 to March 2019. Methods The functional independence measure and motivation in stroke patients for rehabilitation scale was evaluated at admission; at one, two, and three months after admission; and at discharge. The effectiveness and efficiency of the functional independence measure were calculated as rehabilitation outcomes. The effect of motivation on outcomes and the change in motivation in stroke patients for rehabilitation scale scores over time were analyzed using a linear mixed model. Results The median (interquartile range) converted motivation in stroke patients for rehabilitation scale scores (converted to a range of 0-100) at admission; one, two, and three months after admission; and discharge was 86 (76-95), 83 (77-94), 81 (74-95), 81 (71-93), and 84 (75-95), respectively. The median (interquartile range) of effectiveness and efficiency of the functional independence measure from admission to discharge was 0.82 (0.68-0.91) and 0.41 (0.30-0.59), respectively. Motivation in stroke patients for rehabilitation scale scores were not significantly associated with the effectiveness and efficiency of the functional independence measure (p > 0.05). Motivation in stroke patients for rehabilitation scale scores were significantly lower at two (β = -3.1, 95% confidence interval [-5.3, -0.9], p = 0.005) and three (β = -4.4, 95% confidence interval [-7.3, -1.6], p = 0.002) months after admission than at admission. Conclusion Motivation might not directly affect rehabilitation outcomes assessed by the functional independence measure. Furthermore, many participants remained highly motivated, although their motivation decreased at one or three months after admission. Clinical rehabilitation impact Assumptions that rehabilitation is ineffective because of low motivation may not be correct. To examine the influence on outcomes, both motivation and daily activities should be considered.
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Affiliation(s)
- Taiki Yoshida
- Tokyo Bay Rehabilitation Hospital, Department of Rehabilitation Medicine, Chiba, Japan
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Yohei Otaka
- Tokyo Bay Rehabilitation Hospital, Department of Rehabilitation Medicine, Chiba, Japan
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Aichi, Japan
| | - Shin Kitamura
- Tokyo Bay Rehabilitation Hospital, Department of Rehabilitation Medicine, Chiba, Japan
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Kazuki Ushizawa
- Tokyo Bay Rehabilitation Hospital, Department of Rehabilitation Medicine, Chiba, Japan
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Aichi, Japan
| | - Masashi Kumagai
- Tokyo Bay Rehabilitation Hospital, Department of Rehabilitation Medicine, Chiba, Japan
| | - Jun Yaeda
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tokyo, Japan
| | - Rieko Osu
- Faculty of Human Sciences, Waseda University, Saitama, Japan
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Oyake K, Yamauchi K, Inoue S, Sue K, Ota H, Ikuta J, Ema T, Ochiai T, Hasui M, Hirata Y, Hida A, Yamamoto K, Kawai Y, Shiba K, Atsumi A, Nagafusa T, Tanaka S. A multicenter explanatory survey of patients' and clinicians' perceptions of motivational factors in rehabilitation. COMMUNICATIONS MEDICINE 2023; 3:78. [PMID: 37280319 DOI: 10.1038/s43856-023-00308-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 05/22/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Patient motivation is an important determinant of rehabilitation outcomes. Differences in patients' and clinicians' perceptions of motivational factors can potentially hinder patient-centered care. Therefore, we aimed to compare patients' and clinicians' perceptions of the most important factors in motivating patients for rehabilitation. METHODS This multicenter explanatory survey research was conducted from January to March 2022. In 13 hospitals with an intensive inpatient rehabilitation ward, 479 patients with neurological or orthopedic disorders undergoing inpatient rehabilitation and 401 clinicians, including physicians, physical therapists, occupational therapists, and speech-language-hearing therapists, were purposively selected using inclusion criteria. The participants were asked to choose the most important factor motivating patients for rehabilitation from a list of potential motivational factors. RESULTS Here we show that realization of recovery, goal setting, and practice related to the patient's experience and lifestyle are the three factors most frequently selected as most important by patients and clinicians. Only five factors are rated as most important by 5% of clinicians, whereas nine factors are selected by 5% of patients. Of these nine motivational factors, medical information (p < 0.001; phi = -0.14; 95% confidence interval = -0.20 to -0.07) and control of task difficulty (p = 0.011; phi = -0.09; 95% confidence interval = -0.16 to -0.02) are selected by a significantly higher proportion of patients than clinicians. CONCLUSIONS These results suggest that when determining motivational strategies, rehabilitation clinicians should consider individual patient preferences in addition to using the core motivational factors supported by both parties.
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Affiliation(s)
- Kazuaki Oyake
- Department of Physical Therapy, School of Health Sciences, Shinshu University, Nagano, Japan
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Katsuya Yamauchi
- Department of Rehabilitation Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Seigo Inoue
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Keita Sue
- Department of Rehabilitation, JA Nagano Kouseiren Kakeyu-Misayama Rehabilitation Center Kakeyu Hospital, Nagano, Japan
| | - Hironobu Ota
- Rehabilitation Center, Aichi Medical University Medical Center, Aichi, Japan
| | - Junichi Ikuta
- Division of Occupational Therapy, Department of Rehabilitation, Nakaizu Rehabilitation Center, Shizuoka, Japan
| | - Toshiki Ema
- Department of Rehabilitation, Suzukake Central Hospital, Shizuoka, Japan
| | - Tomohiko Ochiai
- Rehabilitation Center, Juzen Memorial Hospital, Shizuoka, Japan
| | - Makoto Hasui
- Department of Rehabilitation Medicine, JA Shizuoka Kohseiren Enshu Hospital, Shizuoka, Japan
| | - Yuya Hirata
- Department of Rehabilitation, Suzukake Healthcare Hospital, Shizuoka, Japan
| | - Ayaka Hida
- Department of Rehabilitation Medicine, Kakegawa Higashi Hospital, Shizuoka, Japan
| | - Kenta Yamamoto
- Department of Rehabilitation, Toyoda Eisei Hospital, Shizuoka, Japan
| | - Yoshihiro Kawai
- Department of Rehabilitation, Tenryu Suzukake Hospital, Shizuoka, Japan
| | - Kiyoto Shiba
- Department of Rehabilitation Medicine, Hamakita Sakuradai Hospital, Shizuoka, Japan
| | - Akihito Atsumi
- Department of Rehabilitation, Hamamatsu-Kita Hospital, Shizuoka, Japan
| | - Tetsuyuki Nagafusa
- Department of Rehabilitation Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Satoshi Tanaka
- Laboratory of Psychology, Hamamatsu University School of Medicine, Shizuoka, Japan.
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Honado AS, Atigossou OLG, Daneault JF, Roy JS, Batcho CS. Relationships between overall physical activity and step counts in able-bodied adults and stroke survivors in developing countries: a cross-sectional study. Disabil Rehabil 2023; 45:997-1004. [PMID: 35260007 DOI: 10.1080/09638288.2022.2046189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate how step counts relate to overall physical activity (PA) in able-bodied adults and stroke survivors in developing countries. MATERIALS AND METHODS Sixty able-bodied adults (mean age: 48.8 ± 11.7 years old) and 60 stroke survivors (mean age: 56.7 ± 10.4 years old) were recruited in Benin (West-Africa). Step counts were collected for 7 consecutive days using the Garmin Forerunner 15 activity tracker. Then, participants completed the adapted French version of the International Physical Activity Questionnaire (IPAQ-AF) to report their PA over the same period. Spearman's rank correlation coefficients (ρ) were calculated between IPAQ-AF scores and the mean steps per day. RESULTS Very high correlations were observed between IPAQ-AF total scores and step counts, in able-bodied adults (ρ = 0.94; p < 0.001), and in stroke survivors (ρ = 0.91; p < 0.001). IPAQ-AF leisure-time presented negligible correlation with step counts in able-bodied adults. No activity was reported in occupation and intense domains in stroke survivors. CONCLUSION There is a strong relationship between overall PA and step counts in able-bodied adults and stroke survivors in Benin. Step counts appear to be an indicator of PA levels in developing countries, suggesting walking as a potential exercise to improve PA levels in stroke survivors.Implications for RehabilitationStep counts could serve as an indicator of physical activity levels in stroke survivors in developing countries.Walking may be suggested as exercise to improve physical activity levels in stroke survivors in developing countries.In Africa French speaking countries, the IPAQ-AF could be used to assess physical activity in stroke survivors and findings might guide programs to promote an active lifestyle as needed.
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Affiliation(s)
- Aristide S Honado
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale (CIUSSS-CN), Institut de Réadaptation en Déficience Physique de Québec (IRDPQ), Quebec City, QC, Canada
- Centre Hospitalier Universitaire Départemental de l'Ouémé-Plateau, Porto-Novo, Bénin
| | - Orthelo Léonel Gbètoho Atigossou
- Centre Hospitalier Universitaire Départemental de l'Ouémé-Plateau, Porto-Novo, Bénin
- École Supérieure de Kinésithérapie, Faculté des Sciences de la Santé, Université d'Abomey - Calavi, Cotonou, Bénin
| | | | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale (CIUSSS-CN), Institut de Réadaptation en Déficience Physique de Québec (IRDPQ), Quebec City, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Charles Sèbiyo Batcho
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale (CIUSSS-CN), Institut de Réadaptation en Déficience Physique de Québec (IRDPQ), Quebec City, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
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Cross-cultural adaptation and validation of the Motivation in Stroke Patients for Rehabilitation Scale in Chinese hospitalized older adults with stroke. Geriatr Nurs 2023; 50:188-193. [PMID: 36791543 DOI: 10.1016/j.gerinurse.2023.01.008] [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: 12/02/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 02/15/2023]
Abstract
OBJECTS To translate, cross-culturally adapt, and validate the Motivation in Stroke Patients for Rehabilitation Scale (MORE) questionnaire in Chinese hospitalized older adults with stroke. METHODS The Chinese version of the MORE was produced following Brislin's guidelines. The psychometric properties of the MORE were evaluated among 420 eligible patients. RESULTS The Cronbach's alpha coefficient of the Chinese version of the MORE scale was 0.983, and the content validity index (S-CVI) was 0.94, with good reliability. Exploratory factor analysis showed a single-factor structure that explained 78.01% of the total variance, and the confirmatory factor analysis model had a good fit index (X2/df=2.97; NFI =0.93; CFI=0.96; TFI=0.95; IFI=0.96). CONCLUSION The MORE presented acceptable validity and reliability and could be used in Chinese hospitalized older adults with stroke.
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Honado AS, Atigossou OLG, Roy JS, Daneault JF, Batcho CS. Relationships between Self-Efficacy and Post-Stroke Activity Limitations, Locomotor Ability, Physical Activity, and Community Reintegration in Sub-Saharan Africa: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2286. [PMID: 36767651 PMCID: PMC9915935 DOI: 10.3390/ijerph20032286] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Stroke self-efficacy is under-investigated in sub-Saharan Africa. In particular, studies focusing on the relationship between self-efficacy and post-stroke functional outcomes are scarce. This cross-sectional study aimed to explore the association between self-efficacy and post-stroke activity limitations, locomotor ability, physical activity, and community reintegration in Benin, a sub-Saharan African country. To achieve this purpose, a selection of stroke patients was made from the admission registers of the physiotherapy clinics (rehabilitation units) of three reference hospitals in Benin from January to April 2018. Stroke patients who were still continuing their rehabilitation sessions were informed by direct contact. Those who had already finished their sessions were informed by telephone. Sixty stroke patients of those contacted gave their consent and were recruited for this study. The sample consisted of 44 men and 16 women with a mean age of 56.7 ± 10.4 years. Activity limitations, locomotor ability, physical activity, community reintegration, and self-efficacy were self-reported using ACTIVLIM-Stroke, Abiloco-Benin, the Africa francophone version of the International Physical Activity Questionnaire (IPAQ-AF), the Reintegration to Normal Living Index (RNLI), and a French version of the Stroke Self-efficacy Questionnaire (SSEQ-F), respectively. Spearman's rank correlation coefficients (ρ) were calculated to characterize the relationship between self-efficacy and activity limitations, locomotor ability, physical activity, and community reintegration. According to the results, self-efficacy showed a moderate correlation with physical activity (ρ = 0.65; p < 0.001) and high correlations with activity limitations (ρ = 0.81; p < 0.001), locomotor ability (ρ = 0.72; p < 0.001), and community reintegration (ρ = -0.84; p < 0.001). Thus, self-efficacy emerges as an important factor associated with the functional recovery of stroke patients in sub-Saharan Africa.
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Affiliation(s)
- Aristide S. Honado
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale (CIUSSS-CN), Institut de Réadaptation en Déficience Physique de Québec (IRDPQ), 525 Wilfrid-Hamel, Quebec City, QC G1M 2S8, Canada
- Centre Hospitalier Universitaire Départemental de l’Ouémé-Plateau, Porto-Novo 01 BP 52, Benin
| | - Orthelo Léonel Gbètoho Atigossou
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale (CIUSSS-CN), Institut de Réadaptation en Déficience Physique de Québec (IRDPQ), 525 Wilfrid-Hamel, Quebec City, QC G1M 2S8, Canada
- École Supérieure de Kinésithérapie, Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou 01 BP 188, Benin
- Department of Rehabilitation, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Quebec City, QC G1V 0A6, Canada
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale (CIUSSS-CN), Institut de Réadaptation en Déficience Physique de Québec (IRDPQ), 525 Wilfrid-Hamel, Quebec City, QC G1M 2S8, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Quebec City, QC G1V 0A6, Canada
| | - Jean-François Daneault
- Department of Rehabilitation and Movement Sciences, Rutgers University, Newark, NJ 07107, USA
| | - Charles Sèbiyo Batcho
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale (CIUSSS-CN), Institut de Réadaptation en Déficience Physique de Québec (IRDPQ), 525 Wilfrid-Hamel, Quebec City, QC G1M 2S8, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Quebec City, QC G1V 0A6, Canada
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Tohanean N, Tucan P, Vanta OM, Abrudan C, Pintea S, Gherman B, Burz A, Banica A, Vaida C, Neguran DA, Ordog A, Tarnita D, Pisla D. The Efficacity of the NeuroAssist Robotic System for Motor Rehabilitation of the Upper Limb-Promising Results from a Pilot Study. J Clin Med 2023; 12:jcm12020425. [PMID: 36675354 PMCID: PMC9866490 DOI: 10.3390/jcm12020425] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/27/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
The research aimed to evaluate the efficacy of the NeuroAssist, a parallel robotic system comprised of three robotic modules equipped with human-robot interaction capabilities, an internal sensor system for torque monitoring, and an external sensor system for real-time patient monitoring for the motor rehabilitation of the shoulder, elbow, and wrist. The study enrolled 10 consecutive patients with right upper limb paresis caused by stroke, traumatic spinal cord disease, or multiple sclerosis admitted to the Neurology I Department of Cluj-Napoca Emergency County Hospital. The patients were evaluated clinically and electrophysiologically before (T1) and after the intervention (T2). The intervention consisted of five consecutive daily sessions of 30-45 min each of 30 passive repetitive movements performed with the robot. There were significant differences (Wilcoxon signed-rank test) between baseline and end-point clinical parameters, specifically for the Barthel Index (53.00 ± 37.72 vs. 60.50 ± 36.39, p = 0.016) and Activities of Daily Living Index (4.70 ± 3.43 vs. 5.50 ± 3.80, p = 0.038). The goniometric parameters improved: shoulder flexion (70.00 ± 56.61 vs. 80.00 ± 63.59, p = 0.026); wrist flexion/extension (34.00 ± 28.75 vs. 42.50 ± 33.7, p = 0.042)/(30.00 ± 22.97 vs. 41.00 ± 30.62, p = 0.042); ulnar deviation (23.50 ± 19.44 vs. 33.50 ± 24.15, p = 0.027); and radial deviation (17.50 ± 18.14 vs. 27.00 ± 24.85, p = 0.027). There was a difference in muscle activation of the extensor digitorum communis muscle (1.00 ± 0.94 vs. 1.40 ± 1.17, p = 0.046). The optimized and dependable NeuroAssist Robotic System improved shoulder and wrist range of motion and functional scores, regardless of the cause of the motor deficit. However, further investigations are necessary to establish its definite role in motor recovery.
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Affiliation(s)
- Nicoleta Tohanean
- Neurology I Department, Cluj-Napoca Emergency Clinical County Hospital, 400012 Cluj-Napoca, Romania
- Neurology Department, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania
| | - Paul Tucan
- CESTER, Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
| | - Oana-Maria Vanta
- Neurology I Department, Cluj-Napoca Emergency Clinical County Hospital, 400012 Cluj-Napoca, Romania
- Neurology Department, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania
- Correspondence: (O.-M.V.); (A.B.); (A.B.)
| | - Cristian Abrudan
- Neurology Department, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania
- Neurosurgery Department, Cluj-Napoca Emergency Clinical County Hospital, 400349 Cluj-Napoca, Romania
| | - Sebastian Pintea
- Department of Psychology, Babes-Bolyai University, 400029 Cluj-Napoca, Romania
| | - Bogdan Gherman
- CESTER, Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
| | - Alin Burz
- CESTER, Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
- Correspondence: (O.-M.V.); (A.B.); (A.B.)
| | - Alexandru Banica
- CESTER, Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
- Correspondence: (O.-M.V.); (A.B.); (A.B.)
| | - Calin Vaida
- CESTER, Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
| | - Deborah Alice Neguran
- Neurology I Department, Cluj-Napoca Emergency Clinical County Hospital, 400012 Cluj-Napoca, Romania
| | - Andreea Ordog
- Neurology I Department, Cluj-Napoca Emergency Clinical County Hospital, 400012 Cluj-Napoca, Romania
| | - Daniela Tarnita
- Faculty of Mechanics, University of Craiova, 200512 Craiova, Romania
| | - Doina Pisla
- CESTER, Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
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11
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Calder A, Sole G, Mulligan H. Co-Design of an Educational Resource with Female Partners of Male Stroke Survivors to Support Physical Activity Participation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16856. [PMID: 36554747 PMCID: PMC9779113 DOI: 10.3390/ijerph192416856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
Many male stroke survivors find it challenging to meet the recommended physical activity (PA) guidelines for health benefits. The spouse/partner is an important source of self-management for stroke survivor PA participation; however, they feel unsupported by health professionals. This study aimed to co-design an educational resource prototype to guide and empower female partners in supporting male stroke survivors' participation in PA. We used a participatory action research (PAR) methodology. Thirteen support persons of male stroke survivors from Canterbury, New Zealand participated in four PAR cycles. The data were collected using individual interviews and focus groups and analyzed inductively using the general inductive approach. Three themes were reflected in the data and informed the prototype content: (1) managing an unwanted and challenging new life, (2) inconsistent access to meaningful information, and (3) considerations for successful stroke survivor PA participation. If partners are to be an essential source in supporting stroke survivors' self-management of PA, they require resources that are meaningful and credible to enhance their confidence and self-efficacy. Further research is needed to explore the acceptability and usability of the educational resource with a wider audience and evaluate the co-design process. An inclusive and collaborative approach where support persons were valued for their expertise was essential in co-designing a meaningful resource intended to support stroke survivors and support persons' self-management of their PA.
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12
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Nagaraja N, Kraus AR, Rose DK, Olasoji EB, Khanna AY, Simpkins AN, Wilson CA, Dickens RR, Shushrutha Hedna V, Geis C, Youn T, Musalo MM. Benefits of an interdisciplinary stroke clinic: addressing a gap in physical therapy at post-stroke neurology follow-up. Disabil Rehabil 2022; 44:8509-8514. [PMID: 34871115 DOI: 10.1080/09638288.2021.2008527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE An interdisciplinary stroke clinic (ISC) can improve communication and identify people post-stroke who have not reached their full recovery potential. We describe the characteristics of participants who underwent physical therapy (PT) evaluation in addition to their outpatient neurology evaluation and identify the association of assessment scales that predicted referral for additional rehabilitation. METHODS Participants' post-stroke seen in the ISC were included in the study. The PT evaluation included the Berg Balance Scale (BBS), Ten-Meter Walk Test (10MWT), Six-Minute Walk Test (6MWT), and Short Form-Stroke Impact Scale (SF-SIS). Multivariable logistic regression analysis was performed to identify factors associated with referral for additional rehabilitation. RESULTS The study consisted of 148 participants with a mean age of 63 (SD ± 15) years; 58% were women and 76% were Whites. Additional rehabilitation was recommended for 59% of participants. In multivariate analysis, reduced speed on comfortable 10MWT (OR = 0.06; 95%CI = 0.01-0.51) and lower SF-SIS score (OR = 0.76; 95%CI = 0.66-0.87) were significantly associated with referral for additional PT or occupational therapy. CONCLUSION A significant number of post-acute stroke survivors were found to be appropriate for additional rehabilitation when assessed clinically by a neurologic physical therapist in an ISC. The measures that most closely correlated with this in-person clinical evaluation were 10MWT and SF-SIS.IMPLICATIONS FOR REHABILITATIONAn interdisciplinary stroke clinic can improve communication and identify people post-stroke who have not reached their full recovery potential.In a pilot study, a significant number of post-acute stroke survivors were found to be appropriate for additional rehabilitation when assessed clinically by a neurologic physical therapist in an interdisciplinary stroke clinic.Reduced speed on comfortable Ten-Meter Walk Test and lower Short Form-Stroke Impact Scale scores were associated with referral for additional rehabilitation.
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Affiliation(s)
- Nandakumar Nagaraja
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Alison R Kraus
- University of Florida Health Rehabilitation, Neuromedicine Hospital, Gainesville, FL, USA.,Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Dorian K Rose
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.,Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA
| | - Esther B Olasoji
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Anna Y Khanna
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Alexis N Simpkins
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Christina A Wilson
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Rondalyn R Dickens
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Carolyn Geis
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA.,Department of Physical Medicine and Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA
| | - Teddy Youn
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Michelle M Musalo
- University of Florida Health Rehabilitation, Neuromedicine Hospital, Gainesville, FL, USA
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13
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Wiley E, Noguchi KS, Moncion K, D’Isabella N, Shkredova DA, Fang H, Richardson J, MacDermid JC, Rodrigues L, Roig M, Tang A. The association between global cognitive function and walking capacity in individuals with broad ranges of cognitive and physical function: Are there sex differences? FRONTIERS IN REHABILITATION SCIENCES 2022; 3:960437. [PMID: 36188989 PMCID: PMC9510638 DOI: 10.3389/fresc.2022.960437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022]
Abstract
IntroductionCognitive function is known to be associated with physical function, where greater walking capacity has been shown to have moderate to strong correlations with global cognitive function and other various domains of cognition in older adults with and without chronic conditions. Biological sex may moderate the relationship between cognitive and physical function, but whether sex differences exist in this association has not been examined in an aging population. The purpose of this study was to examine the associations between global cognitive function (Montreal Cognitive Assessment; MoCA), walking capacity (6-Minute Walk Test distance; 6 MWT) and sex in an aging population with broad ranges of cognitive and physical function.MethodsParticipants were assessed for global cognitive function (MoCA) and walking capacity (6 MWT). Multivariable regression analyses were performed to examine the interaction of sex in the association between MoCA and 6 MWT. First, we presented the unadjusted model (Model 1), then the model adjusted for age, history of stroke, and height (Model 2). To determine if there were sex-based differences in the association between global cognitive function and walking capacity, we included sex and an interaction term between sex*6 MWT distance in Models 3 and 4.ResultsTwenty-three females and 36 males were included in the multivariable regression analyses, respectively. Our sample represented broad ranges of cognitive and physical function levels, where MoCA scores ranged from 13 to 30, and 6 MWT distances from 203 to 750 m. 6 MWT distance was associated with MoCA in models unadjusted (R2 = 0.17; F(1,56) = 11.4; p < 0.01) and adjusted for age, stroke history, and height (R2 = 0.20; F(4,53) = 3.2; p = 0.02). No interaction with sex was found, but a main effect of sex was observed (R2 = 0.26; F(5,21) = 3.72; p = 0.03). When adjusting for age, height and history of stroke, males MoCA scores were 2.9 ± 1.3 less than the mean MoCA scores for females.DiscussionOur findings confirm the positive relationship between cognitive and physical function in older adults. Notably, we also observed superior performance in global cognition among females that was consistent across a broad spectrum of walking capacity.
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Affiliation(s)
- Elise Wiley
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Kenneth S. Noguchi
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Kevin Moncion
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Natalie D’Isabella
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Daria A. Shkredova
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia, Kelowna, BC, Canada
| | - Hanna Fang
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Joy C. MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- School of Physical Therapy, Western University, London, ON, Canada
| | - Lynden Rodrigues
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation, Laval, QC, Canada
- School of Physical / Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Marc Roig
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation, Laval, QC, Canada
- School of Physical / Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- Correspondence: Ada Tang
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14
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Roaldsen KS, Walter C, Gäverth J, Dohrn IM. Between commitment and avoidance - working age stroke survivors' perceptions of physical activity and sedentary behaviour: a qualitative study. BMC Neurol 2022; 22:183. [PMID: 35581567 PMCID: PMC9112597 DOI: 10.1186/s12883-022-02704-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background It is critical for stroke survivors in working age to develop skills and confidence for long-term self-management of physical activity and exercise training to maintain a healthy lifestyle and decrease the risk of recurrent stroke and other cardiovascular diseases. Still, knowledge is scarce about concerns and experiences of physical activity and sedentary behaviour after stroke in working age, and further qualitative studies are required. The aim of this study was to explore and describe perceptions of physical activity and sedentary behaviour in stroke survivors under 65 years who are living with disability. Methods A qualitative design with individual semi-structured interviews was selected to generate rich data. Ten informants aged 36–61 years were interviewed 0.5–25 years after their stroke. The interviews were analysed with qualitative content analysis, with an inductive and interpretive approach. Results A two-sided contradictory relationship to physical activity and sedentary behaviour was identified. The overarching theme found was “Physical activity and sedentary behaviour – between commitment and avoidance”, comprising three main themes; “Physical activity – medicine for body and mind”, “Physical activity reminds of limitations”, and “Sedentary behaviour – risk, rest, and alternative”. The informants perceived physical activity as medicine, important for both physical and mental functioning, but also as a constant reminder of having a body that no longer functions as it used to. These mixed perceptions and feelings influenced the informants’ behaviours related to physical activity and sedentary behaviour, and both commitment and avoidance were clear strategies. Conclusions Working age stroke survivors expressed a clear positive perception of the importance of physical activity for health. However, physical activity was also described as a strong reminder of limitations which paradoxically could lead to sedentary behaviour. To support a physically active lifestyle post stroke, effective interventions as well as health promotion, counselling and patient education are imperative. These should be delivered by appropriately skilled health care professionals.
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Affiliation(s)
- Kirsti S Roaldsen
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-141 83 Huddinge, Stockholm, Sweden.,Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Charlotte Walter
- Neurocampus, Stockholm, Sweden.,Research and Development Unit, Aleris Rehab Station Stockholm/Spinalis, Stockholm, Sweden
| | - Johan Gäverth
- Unit of Occupational and Physical Therapy, Södersjukhuset, Stockholm, Sweden
| | - Ing-Mari Dohrn
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-141 83 Huddinge, Stockholm, Sweden.
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15
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Yoshida T, Otaka Y, Kitamura S, Ushizawa K, Kumagai M, Kurihara Y, Yaeda J, Osu R. Development and validation of new evaluation scale for measuring stroke patients’ motivation for rehabilitation in rehabilitation wards. PLoS One 2022; 17:e0265214. [PMID: 35298513 PMCID: PMC8929594 DOI: 10.1371/journal.pone.0265214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/24/2022] [Indexed: 11/18/2022] Open
Abstract
Objective
This study aimed to develop the Motivation in stroke patients for rehabilitation scale (MORE scale), following the Consensus-based standards for the selection of health measurement instruments (COSMIN).
Method
Study participants included rehabilitation professionals working at the convalescent rehabilitation hospital and stroke patients admitted to the hospital. The original MORE scale was developed from an item pool, which was created through discussions of nine rehabilitation professionals. After the content validity of the scale was verified using the Delphi method with 61 rehabilitation professionals and 22 stroke patients, the scale’s validity and reliability were examined for 201 stroke patients. The construct validity of the scale was investigated using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and item response theory analysis. Cronbach’s alpha confirmed its internal consistency. Regarding convergent, discriminant, and criterion validity, Spearman’s rho was calculated between the MORE scale and the Apathy Scale (AS), Self-rating Depression Scale (SDS), and Visual Analogue Scale (VAS), which rates the subjective feelings of motivation.
Results
Using the Delphi method, 17 items were incorporated into the MORE scale. According to EFA and CFA, a one-factor model was suggested. All MORE scale items demonstrated satisfactory item response, with item slopes ranging from 0.811 to 2.142, and item difficulty parameters ranging from -3.203 to 0.522. Cronbach’s alpha was 0.948. Regarding test-retest reliability, a moderate correlation was found between scores at the beginning and one month after hospitalization (rho = 0.612. p < 0.001). The MORE scale showed significant correlation with AS (rho = -0.536, p < 0.001), SDS (rho = -0.347, p < 0.001), and VAS (rho = 0.536, p < 0.001), confirming the convergent, discriminant, and criterion validity, respectively.
Conclusions
The MORE scale was verified as a valid and reliable scale for evaluating stroke patients’ motivation for rehabilitation.
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Affiliation(s)
- Taiki Yoshida
- Tokyo Bay Rehabilitation Hospital, Chiba, Japan
- Graduate School of Human Sciences, Waseda University, Saitama, Japan
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Yohei Otaka
- Tokyo Bay Rehabilitation Hospital, Chiba, Japan
- Department of Rehabilitation Medicine Ⅰ, Fujita Health University School of Medicine, Aichi, Japan
- * E-mail:
| | - Shin Kitamura
- Tokyo Bay Rehabilitation Hospital, Chiba, Japan
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Kazuki Ushizawa
- Tokyo Bay Rehabilitation Hospital, Chiba, Japan
- Department of Rehabilitation Medicine Ⅰ, Fujita Health University School of Medicine, Aichi, Japan
| | | | - Yuto Kurihara
- Graduate School of Human Sciences, Waseda University, Saitama, Japan
| | - Jun Yaeda
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tokyo, Japan
| | - Rieko Osu
- Faculty of Human Sciences, Waseda University, Saitama, Japan
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16
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Pérez-Rodríguez M, Gutiérrez-Suárez A, Barakat R, Pérez-Tejero J. Benefits of physical exercise programs toward people with acquired brain injury: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e28601. [PMID: 35119003 PMCID: PMC8812640 DOI: 10.1097/md.0000000000028601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/29/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Exercise has proven to be a tool improving health related quality of life in people with acquired brain injury (ABI) as part of multidisciplinary team during the subacute and chronic phase. While intervention studies and revisions have been increased in recent years, there is no consensus about the type, frequency and variables of control in exercise interventions. Besides, this collective need programs that respond to different functional levels, given the heterogeneity of people with ABI, not only because of the etiology, but also because of the severity differences over their deficits. The aim of this systematic review and meta-analysis is to summarize the evidence regarding the relationship between exercise and health related quality of life in subacute and chronic phase. METHODS A protocol of systematic review and meta-analysis will examine the benefits of physical exercise (PE) toward people with ABI will be conducted. A comprehensive search will be conducted in the following electronic databases: MEDLINE, The Cochrane Library, CINAHL, SportDiscus, and Web of Science from inception to July 2020. Independent review authors will evaluate the title and abstract for each trial and disagreements will be solved by discussion with a third author if necessary. Standard pairwise meta-analysis, including heterogeneity analysis, subgroup analysis, and sensitivity analysis, will be performed using the Stata software. The quality evaluation of this study will be completed using the Cochrane collaboration risk of bias tool and the risk of bias assessment will be conducted by the World Health Organization grading of recommendations, assessment, development, and evaluation. The review will be reported in accordance to the preferred reporting items for systematic reviews and meta-analyses statement. RESULTS AND CONCLUSSION This systematic review and meta-analysis protocol will provide an overview regarding the benefits of PE on functioning, social participation and quality of life toward people with ABI. The variability of outcomes across PE from the selected studies will provide important information for future trial designs. Results of the proposed review will inform practice and the design of future clinical trials. This study will summarize all the selected trials aimed at estimating the effectiveness of applying physical activity programs to ABI users.Systematic review registration number: PROSPERO CRD42020191779.
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Affiliation(s)
- Marta Pérez-Rodríguez
- Department of Health and Human Performance, Universidad Politécnica de Madrid, Spain
| | - Andrea Gutiérrez-Suárez
- Department of Physiotherapy, Medicine and Biomedical Sciences, Faculty of Physiotherapy, Universidad de A Coruña, A Coruña, Spain
| | - Ruben Barakat
- Department of Social Sciences applied to Physical Activity Sport and Leisure, Universidad Politécnica de Madrid, Spain
| | - Javier Pérez-Tejero
- Department of Health and Human Performance, Universidad Politécnica de Madrid, Spain
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17
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Mills SJ, Mackintosh S, McDonnell MN. Improving physical mobility is critical for wellbeing in people with severe impairment after an acquired brain injury: a qualitative study. Brain Inj 2022; 36:232-238. [PMID: 35084283 DOI: 10.1080/02699052.2022.2033836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVES 1) Understand the experience, and personal significance, of mobility skills for people with severe mobility impairment after brain injury 2) Determine how these evolve over time. DESIGN Longitudinal qualitative study. PARTICIPANTS Ten adults, unable to walk at 8 weeks post-injury. METHODS Participants were interviewed up to three times, at three-month intervals. Semi-structured interviews were transcribed and coded independently by two researchers, then themes developed. Codes were then reviewed longitudinally. RESULTS Initial analysis derived six themes: I lost everything overnight; It feels frustrating; Walking is absolutely the most important; I need help; I'm making progress; I can start doing things that I used to be able to do. Participants described overwhelming losses, with loss of mobility affecting many aspects of life. All participants described progress other than walking that was critical for their wellbeing, including assisted standing and transfers without a lifter. Themes from longitudinal analyses: My losses softened by progress; Walking means freedom; Control helps adjustment happen; Challenges keep coming. Over time, participants valued greater control within their lives and progress with mobility was key. CONCLUSION Participants saw mobility as crucial to recovering control of life. Mobility achievements other than independent walking matter to individuals after brain injury.
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Affiliation(s)
- Simon J Mills
- Centre for Orthopaedic & Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.,South Australian Brain Injury Rehabilitation Service, Hampstead Rehabilitation Centre, Adelaide, Australia.,UniSA: Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Shylie Mackintosh
- UniSA: Allied Health and Human Performance, University of South Australia, Adelaide, Australia
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18
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Menezes KKP, Avelino PR, Costa GA, Viana JB, Gomes WL, Nascimento LR. Telephone-based assessment of walking confidence in older people. Int J Rehabil Res 2021; 44:282-284. [PMID: 34034288 DOI: 10.1097/mrr.0000000000000472] [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: 11/26/2022]
Abstract
To validate the telephone-based application of the modified Gait Efficacy Scale (mGES) for the assessment of walking confidence in older people. Participants answered the mGES-Brazil on two randomized occasions, face-to-face and by telephone. The mean difference (MD) between the interviews was reported. Intraclass correlation coefficient (ICC3,1) was used to investigate the levels of agreement between the two occasions for total mGES-Brazil scores and for the individual items. A total of 78 individuals were included. There was no significant difference in the MD obtained between applications of the mGES (1 point, 95% confidence interval -6 to 7). A very high level of agreement was found between the mGES total scores during face-to-face and telephone applications (ICC = 0.98; 95% CI 0.97-0.99). All items, except one (item 3), had a very high agreement between the two applications. The mGES showed to be reliable to be applied for telephone assessments of walking confidence in older people.
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Affiliation(s)
- Kênia K P Menezes
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte
- Department of Physical Therapy, Fundação Comunitária de Ensino Superior de Itabira, Itabira
| | - Patrick R Avelino
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte
- Department of Physical Therapy, Faculdade de Santa Luzia, Santa Luzia, Brazil
| | - Gabriela Azevedo Costa
- Department of Physical Therapy, Fundação Comunitária de Ensino Superior de Itabira, Itabira
| | | | - Wanda Lucia Gomes
- Department of Physical Therapy, Fundação Comunitária de Ensino Superior de Itabira, Itabira
| | - Lucas R Nascimento
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte
- Center of Health Sciences, Department of Physical Therapy, Universidade Federal do Espírito Santo, Vitória
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19
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Avelino PR, Nascimento LR, Menezes KK, Alvarenga MTM, Faria Fortini I, Teixeira-Salmela LF. Test-retest reliability and measurement error of the modified gait efficacy scale in individuals with stroke. Physiother Theory Pract 2021; 38:2956-2961. [PMID: 34294003 DOI: 10.1080/09593985.2021.1952669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the test-retest reliability and measurement error of the Brazilian version of the modified Gait Efficacy scale (mGES-Brazil) in individuals who have had stroke. METHODS The mGES-Brazil was applied on two occasions, five to seven days apart, in a research laboratory setting. Test-retest reliability and measurement error, which included the standard error of measurement (SEM), smallest detectable change (SDC), and analysis of the limits of agreement by the Bland-Altman plots, were examined. RESULTS Fifty individuals who have had stroke (18 men), with a mean age of 64 ± 11 years, were evaluated. All individual items showed good reliability (Intra-class Correlation Coefficient - ICC2,1 > 0.90). The ICC was 0.98 (95% CI 0.97 to 0.99) and the Bland and Altman plots revealed no systematic changes in the mean test-retest scores. The SEM (SEM%) was 3 (5%), within the recommended values, while the SDC was 8 points. CONCLUSION The mGES-Brazil demonstrated to be reliable to be applied within clinical and research contexts for the assessment of changes in walking confidence of individuals who have had stroke. Changes in mGES scores ≥8 points reflect real changes.
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Affiliation(s)
- Patrick R Avelino
- NeuroGroup, Department of Physical Therapy, Universidade Federal De Minas Gerais, Avenida Antônio Carlos, Belo Horizonte, Minas Gerais, Brazil
| | - Lucas R Nascimento
- NeuroGroup, Department of Physical Therapy, Universidade Federal De Minas Gerais, Avenida Antônio Carlos, Belo Horizonte, Minas Gerais, Brazil.,Center of Health Sciences, Discipline of Physical Therapy, Universidade Federal Do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Kênia Kp Menezes
- NeuroGroup, Department of Physical Therapy, Universidade Federal De Minas Gerais, Avenida Antônio Carlos, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Tereza Mota Alvarenga
- NeuroGroup, Department of Physical Therapy, Universidade Federal De Minas Gerais, Avenida Antônio Carlos, Belo Horizonte, Minas Gerais, Brazil
| | - Iza Faria Fortini
- Department of Occupational Therapy, Universidade Federal De Minas Gerais, Avenida Antônio Carlos, 6627 - Campus Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Luci F Teixeira-Salmela
- NeuroGroup, Department of Physical Therapy, Universidade Federal De Minas Gerais, Avenida Antônio Carlos, Belo Horizonte, Minas Gerais, Brazil
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20
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Yoshida T, Otaka Y, Osu R, Kumagai M, Kitamura S, Yaeda J. Motivation for Rehabilitation in Patients With Subacute Stroke: A Qualitative Study. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:664758. [PMID: 36188821 PMCID: PMC9397769 DOI: 10.3389/fresc.2021.664758] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/26/2021] [Indexed: 11/26/2022]
Abstract
Background: Motivation is essential for patients with subacute stroke undergoing intensive rehabilitation. Although it is known that motivation induces behavioral changes toward rehabilitation, detailed description has been lacking. Motivation can be intrinsic or extrinsic; however, it is unclear which type of factors mainly motivates patients' daily rehabilitation. Purpose: This study aimed to examine the factors influencing patients' motivation and to explore the behavioral changes induced by motivation, especially age-related differences. Method: Twenty participants (mean age 65.8 years [standard deviation 13.7]) who had a subacute stroke and underwent rehabilitation at a convalescent hospital were recruited using convenience sampling. Semi-structured interviews were conducted by an occupational therapist with an interview topic guide regarding factors influencing motivation and how it affects behavioral change. Interviews were recorded, transcribed to text, and analyzed by three occupational therapists using thematic analysis. The participants were divided into two groups: aged patients (aged ≥ 65 years) and middle-aged patients (aged < 65 years), and data were analyzed according to the groups. This study was conducted according to the consolidated criteria for reporting qualitative research. Results: Seven core categories were identified as factors influencing patients' motivation: patients' goals, experiences of success and failure, physical condition and cognitive function, resilience, influence of rehabilitation professionals, relationships between patients, and patients' supporters. The first four and last three core categories were further classified as personal and social-relationship factors, respectively. The categories related to intrinsic motivation such as enjoyment of rehabilitation itself were not derived. In both age-groups, motivation affected the frequency of self-training and activity in daily lives. In some aged patients, however, high motivation restrained their self-training to conserve their physical strength for rehabilitation by professionals. Some aged patients do not express their high motivation through their facial expressions and conversations compared to middle-aged patients; therefore, motivation is not always observable in aged patients. Conclusions: Interventions tailored to extrinsic factors are important for maintaining patients' motivation. Observational evaluation may lead to mislabeling of their motivation, especially for aged patients. Rehabilitation professionals should use validated evaluation scales or patients' narratives to assess patients' motivation.
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Affiliation(s)
- Taiki Yoshida
- Tokyo Bay Rehabilitation Hospital, Narashino, Japan
- Graduate School of Human Sciences, Waseda University, Tokorozawa, Japan
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Yohei Otaka
- Tokyo Bay Rehabilitation Hospital, Narashino, Japan
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Toyoake, Japan
- *Correspondence: Yohei Otaka
| | - Rieko Osu
- Faculty of Human Sciences, Waseda University, Tokorozawa, Japan
| | | | - Shin Kitamura
- Tokyo Bay Rehabilitation Hospital, Narashino, Japan
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Jun Yaeda
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tokyo, Japan
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Ambulatory activity in stroke survivors associated with functional outcome and quality of life: an observational cohort study. Ann Phys Rehabil Med 2021; 65:101540. [PMID: 33984539 DOI: 10.1016/j.rehab.2021.101540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 02/19/2021] [Accepted: 04/05/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Physical activity is beneficial in stroke prevention and recovery. Understanding activity dynamics and its effect on outcome after stroke is important to improve recommendations and develop interventions. OBJECTIVES We examined serial changes in daily ambulatory activity (AA) averaged over 1 week in people with subacute to chronic stroke and its association with functional outcome (modified Rankin scale [mRS]) and quality of life (EQ-5D-3L). METHODS This observational study examined AA in stroke survivors with no to moderate disability (US National Institute of Stroke Scale [NIHSS] score) who were mostly community dwelling and had cryptogenic stroke based on data from the Continuous Cardiac Monitoring to Assess Atrial Fibrillation After Cryptogenic Stroke study. The participants underwent long-term AA monitoring by accelerometric activity data obtained from an insertable cardiac monitor without receiving any specific encouragement regarding physical activity. We analysed AA changes and assessed the association between baseline AA and mRS/EQ-5D-3L scores. A small group of participants had follow-up data for 2 years, which allowed for analysing long-term serial changes. RESULTS We included 186 participants (mean [SD] age 61.3 [11.2] years, 67% male, mean 39 [28] days after stroke). AA increased during the subacute phase in individuals with mild (NIHSS score 1-4, p<0.001) and moderate (NIHSS score 5-10, p=0.013) disability but not in the non-impaired group. Baseline AA was inversely associated with NIHSS score (p<0.001) and was associated with mRS score (p=0.001) and weakly correlated with EQ-5D-3L score at 6 months (p=0.032, r=0.22). For the 45 participants with follow-up data (mean age 64.5 [9.7] years, 80% male, mean 34 [21] days after stroke), AA remained stable. CONCLUSION AA increased in stroke survivors with impairments but remained stable in those whose symptoms had resolved. AA during the early subacute period was associated with mRS and EQ-5D-3L scores at 6 months. Insertable cardiac monitoring offers a feasible method for monitoring activity over prolonged periods in people after stroke. Its increased use may offer an opportunity to overcome the limited reliability and validity of many existing measures. TRIAL REGISTRATION ClinicalTrials.gov (NCT00924638).
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Vahlberg B, Lundström E, Eriksson S, Holmbäck U, Cederholm T. Effects on walking performance and lower body strength by short message service guided training after stroke or transient ischemic attack (The STROKEWALK Study): a randomized controlled trial. Clin Rehabil 2021; 35:276-287. [PMID: 32942914 PMCID: PMC7874373 DOI: 10.1177/0269215520954346] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 08/11/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate whetherdaily mobile-phone delivered messages with training instructions during three months increase physical activity and overall mobility in patients soon after stroke or transient ischemic attack. DESIGN Randomised controlled trial with intention-to-treat analyses. SETTING University hospital. Data collection from November 2016 until December2018. SUBJECTS Seventy-nine patients (mean (SD) age 63.9 (10.4) years, 29 were women) were allocated to either intervention (n = 40) or control group (n = 39). Participants had to be independent (modified Ranking Scale ⩽2) and able to perform the six-minute walking test at discharge from the hospital. INTERVENTIONS The intervention group received standard care and daily mobile phone instructional text messages to perform regular outdoor walking and functional leg exercises. The control group received standard care; that is, primary care follow-up. MAIN MEASURES Walking performance by six-minute walking test (m), lower body strength by five times chair-stand test (s), the short physical performance battery (0-12 points) and 10-metres walk test (m/s) were assessed at baseline and after three months. RESULTS The estimated median difference in the six-minute walking test was in favour of the intervention group by 30 metres (95% CI, 55 to 1; effect size 0.64; P = 0.037) and in the chair-stand test by 0.88 seconds (95% CI, 0.02 to 1.72; effect size 0.64; P = 0.034). There were no differences between groups on the short physical performance battery or in 10-metres walking time. CONCLUSIONS Three months of daily mobile phone text messages with guided training instructions improved composite mobility measures; that is, walking performanceand lower body strength. CLINICAL TRIAL REGISTRY The study is registered with ClinicalTrials.gov, number NCT02902367.
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Affiliation(s)
- Birgit Vahlberg
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Erik Lundström
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Staffan Eriksson
- Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research, Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Sweden
| | - Ulf Holmbäck
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
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23
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Simpson DB, Jose K, English C, Gall SL, Breslin M, Callisaya ML. "Factors influencing sedentary time and physical activity early after stroke: a qualitative study". Disabil Rehabil 2021; 44:3501-3509. [PMID: 33399023 DOI: 10.1080/09638288.2020.1867656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE We aimed to understand from the perspective of stroke survivors and their carers (1) factors contributing to sedentary time and physical activity during inpatient rehabilitation and the transition home, and (2) actual and perceived opportunities to reduce sedentary time and increase physical activity. MATERIAL AND METHODS Qualitative study with 7 stroke survivor/carer dyads and 8 stroke survivors. Semi-structured interviews were conducted 2-4 weeks after hospital discharge, audio recorded and transcribed prior to thematic analysis. RESULTS Stroke survivors were mean age 69 [SD15] years (53% male). Carers were mean age 62 [SD15] years (86% were female). Five themes were identified: (1) Education and guidance about physical activity and sedentary behaviour after stroke is important to build understanding of recovery and secondary prevention, (2) Stroke survivors need clear communication about safety and risk, (3) Return to life participation supports motivation for and engagement in physical activity, 4) Social and professional influences and 5) Opportunities to be physically active. CONCLUSION Stroke survivors and their carers need a clearer understanding of the role of physical activity and risks of sedentary time during stroke recovery. Physical activity enablers included consistent communication, building confidence and skills to self-manage activity before discharge.Implications for RehabilitationInpatient rehabilitation and early after discharge may be an important time-point to support stroke survivors to establish long term physical activity behaviours before contact with healthcare professionals reduces.To reduce sedentary behaviour, people need to understand the health benefits of breaking up sedentary time and people who need physical support to stand up will need greater support from health professionals.Being able to imagine a future post-stroke self is important motivation to get up and move. Rehabilitation should help develop a person's vision of their post-stroke self.Managing potential risks in hospital without overly restricting physical activity is important and requires consistent communication from the multi-disciplinary team.Building a person's confidence and skills to self-manage physical activity in the community prior to discharge home may be another key enabler for activity.
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Affiliation(s)
- Dawn B Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Kim Jose
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Institute for the Study of Social Change, University of Tasmania, Hobart, Australia
| | - Coralie English
- School of Health Sciences, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, University of Newcastle Priority Research Centre for Stroke and Brain Injury, Newcastle, Australia
| | - Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Michele L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
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24
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Andreasen SC, Wright TR, Crenshaw JR, Reisman DS, Knarr BA. Relationships of Linear and Non-linear Measurements of Post-stroke Walking Activity and Their Relationship to Weather. Front Sports Act Living 2020; 2:551542. [PMID: 33345115 PMCID: PMC7739597 DOI: 10.3389/fspor.2020.551542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/22/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Stroke survivors are more sedentary than the general public. Previous research on stroke activity focuses on linear quantities. Non-linear measures, such as Jensen-Shannon Divergence and Lempel-Ziv Complexity, may help explain when and how stroke survivors move so that interventions to increase activity may be designed more effectively. Objectives: Our objective was to understand what factors affect a stroke survivor's physical activity, including weather, by characterizing activity by step counts, structure, and complexity. Methods: A custom MATLAB code was used to analyze clinical trial (NCT02835313, https://clinicaltrials.gov/ct2/show/NCT02835313) data presented as minute by minute step counts. Six days of data were analyzed for 142 participants to determine the regularity of activity structure across days and complexity patterns of varied cadences. The effect of steps on structure and complexity, the season's effect on steps, structure, and complexity, and the presence of precipitation's effect on steps and complexity were all analyzed. Results: Step counts and regularity were linearly related (p < 0.001). Steps and complexity were quadratically related (r2 = 0.70 for mean values, 0.64 for daily values). Season affected complexity between spring and winter (p = 0. 019). Season had no effect on steps or structure. Precipitation had no effect on steps or complexity. Conclusions: Stroke survivors with high step counts are active at similar times each day and have higher activity complexities as measured through patterns of movement at different intensity levels. Non-linear measures, such as Jensen-Shannon Divergence and Lempel-Ziv Complexity, are valuable in describing a person's activity. Weather affects our activity parameters in terms of complexity between spring and winter.
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Affiliation(s)
- Sydney C Andreasen
- Department of Biomechanics, Biomechanics Research Building, University of Nebraska at Omaha, Omaha, NE, United States
| | - Tamara R Wright
- Clinical Research Laboratory, Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - Jeremy R Crenshaw
- Falls and Mobility Laboratory, Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Darcy S Reisman
- Neuromotor Behavior Lab, Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - Brian A Knarr
- Department of Biomechanics, Biomechanics Research Building, University of Nebraska at Omaha, Omaha, NE, United States
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Farr B, Olver J, Fedele B, McKenzie D. Co-Located or Freestanding Multi-Trauma Orthopedic Rehabilitation. PM R 2020; 13:153-158. [PMID: 32306518 DOI: 10.1002/pmrj.12383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 04/01/2020] [Accepted: 04/09/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Multi-trauma rehabilitation is delivered in a variety of hospital settings. However, it is unclear whether the proximity of rehabilitation to acute services has an effect on rehabilitation outcomes. OBJECTIVE To evaluate whether the primary outcomes of an inpatient multi-trauma rehabilitation program (functional outcome and length of rehabilitation stay) are impacted when rehabilitation is delivered in a unit co-located in an acute hospital compared with a unit located in a freestanding hospital. To also compare these outcomes at a national level using data provided by the Australasian Rehabilitation Outcomes Centre (AROC). DESIGN Observational, retrospective audit study. SETTING An inpatient, orthopedic, multi-trauma rehabilitation unit that re-located from an acute co-located facility to a freestanding facility. PATIENTS Patients following multi-trauma injury admitted to the co-located rehabilitation unit (n = 216) or after its relocation to the freestanding rehabilitation unit (n = 186). METHODS Data were audited from the patients' hospital medical records including demographics, injury characteristics, and rehabilitation outcome measures (Functional Independence Measure [FIM] and length of rehabilitation stay). OUTCOME MEASURES The primary outcome variables were motor FIM change (change in function between admission and discharge), FIM efficiency (functional gain per inpatient day), and length of rehabilitation stay. RESULTS There were no statistically significant differences between the two settings in terms of motor FIM change (adjusted for admission motor FIM score) and motor FIM efficiency. In general, there was no statistically significant difference in length of rehabilitation stay between settings (median: 26 vs 27 days). At a national level, the majority of facilities offering inpatient multi-trauma rehabilitation are co-located. Nationally, freestanding units resulted in a slightly greater motor FIM change (difference between median changes adjusted for baseline = -.5, 95% confidence interval [CI] = -2.5, -0.6, P = .0012). CONCLUSIONS There were no differences observed in outcomes between multidisciplinary rehabilitation programs in either setting. Optimizing the individual components of a rehabilitation program and improving staff skill sets should be a focus going forward.
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Affiliation(s)
- Babak Farr
- Epworth HealthCare, Melbourne, Australia.,Chronic Pain Service, Austin Health, Melbourne, Australia.,Department of Anaestheisa and Pain management, Western Health, Melbourne, Australia
| | - John Olver
- Epworth HealthCare, Melbourne, Australia.,Department of Rehabilitation, Epworth Monash Rehabilitation Medicine Unit (EMReM), Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Bianca Fedele
- Epworth HealthCare, Melbourne, Australia.,Department of Rehabilitation, Epworth Monash Rehabilitation Medicine Unit (EMReM), Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Dean McKenzie
- Epworth HealthCare, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Whitney DG, Dutt-Mazumder A, Peterson MD, Krishnan C. Fall risk in stroke survivors: Effects of stroke plus dementia and reduced motor functional capacity. J Neurol Sci 2019; 401:95-100. [PMID: 31075685 DOI: 10.1016/j.jns.2019.04.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite extensive research on falls among individuals with stroke, little is known regarding the impact of neurological conditions with comorbid diagnoses and motor functional capacity on the risk of falls in these individuals. Hence, the purpose of this study was to determine the fall risk and the contribution of reduced motor functional capacity to fall risk in individuals with stroke, dementia, and stroke plus dementia. METHODS Data from the National Health and Aging Trends Study (NHATS), a nationally-representative sample of Medicare beneficiaries, were analyzed for this cross-sectional study. The odds of self-reported falls within the past month in three subgroups of neurological conditions [stroke (n = 751), dementia (n = 369), and stroke plus dementia (n = 141)] were evaluated with a reference group of individuals with no stroke/dementia [i.e., controls (n = 6337)] using logistic regression models. RESULTS The prevalence of a recent fall was significantly higher (P < .05) in the three neurological disorder groups compared with controls. After adjusting for sociodemographics, mobility device use, and other comorbidities (i.e., chronic disease, vision impairment, and major surgery), the odds of a recent fall were significantly elevated in individuals with stroke (odds ratio [OR] = 1.45), dementia (OR = 2.45), and stroke plus dementia (OR = 2.64) compared with controls. After further adjustment for the lower motor functional capacity, the elevated odds in individuals with stroke were attenuated (OR = 1.16); however, the odds remained significantly elevated in individuals with dementia (OR = 1.67) and stroke plus dementia (OR = 1.82). CONCLUSION Findings indicate that the odds for falls in stroke survivors are elevated in the presence of comorbid dementia. Further, lower motor functional capacity accounted for increased likelihood of a fall in individuals with stroke, but it was not sufficient to account for the increased likelihood of a fall in individuals with dementia or stroke plus dementia. Thus, interventions focusing on secondary prevention of dementia and improving motor functional capacity may reduce fall risk in individuals with stroke.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Aviroop Dutt-Mazumder
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA; Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Michigan Robotics Institute, University of Michigan, Ann Arbor, MI, USA; School of Kinesiology, University of Michigan, Ann Arbor, MI, USA.
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The long-term effects of an implantable drop foot stimulator on gait in hemiparetic patients. PLoS One 2019; 14:e0214991. [PMID: 30995268 PMCID: PMC6469760 DOI: 10.1371/journal.pone.0214991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 03/26/2019] [Indexed: 12/30/2022] Open
Abstract
Drop foot is a frequent abnormality in gait after central nervous system lesions. Different treatment strategies are available to functionally restore dorsal extension during swing phase in gait. Orthoses as well as surface and implantable devices for electrical stimulation of the peroneal nerve may be used in patients who do not regain good dorsal extension. While several studies investigated the effects of implanted systems on walking speed and gait endurance, only a few studies have focussed on the system’s impact on kinematics and long-term outcomes. Therefore, our aim was to further investigate the effects of the implanted system ActiGait on gait kinematics and spatiotemporal parameters for the first time with a 1-year follow-up period. 10 patients were implanted with an ActiGait stimulator, with 8 patients completing baseline and follow-up assessments. Assessments included a 10-m walking test, video-based gait analysis and a Visual Analogue Scale (VAS) for health status. At baseline, gait analysis was performed without any assistive device as well as with surface electrical stimulation. At follow-up patients walked with the ActiGait system switched off and on. The maximum dorsal extension of the ankle at initial contact increased significantly between baseline without stimulation and follow-up with ActiGait (p = 0.018). While the spatio-temporal parameters did not seem to change much with the use of ActiGait in convenient walking speed, patients did walk faster when using surface stimulation or ActiGait compared to no stimulation at the 10-m walking test at their fastest possible walking speed. Patients rated their health better at the 1-year follow-up. In summary, a global improvement in gait kinematics compared to no stimulation was observed and the long-term safety of the device could be confirmed.
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Hanna E, Janssen H, Crowfoot G, Mason G, Vyslysel G, Sweetapple A, Callister R, English C. Participation, Fear of Falling, and Upper Limb Impairment are Associated with High Sitting Time in People with Stroke. Occup Ther Health Care 2019; 33:181-196. [PMID: 30890006 DOI: 10.1080/07380577.2019.1587675] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The purpose of this cross-sectional, exploratory study was to explore associations between sitting time and (1) participation, (2) fear of falling, and (3) upper limb impairment after stroke. High sitting time was associated with less participation in meaningful activities involving standing or walking (ρ = -0.519, p = 0.023). A greater fear of falling (ρ = 0.579, p = 0.012) and having an impaired upper limb (mean difference 18.7%, 95% CI: 5.3-32.1, p = 0.012) were associated with greater sitting time. Providing support for stroke survivors to participate in meaningful activities while reducing sitting time is an important consideration when planning occupational therapy interventions, particularly for individuals with an arm impairment and/or those with a fear of falling.
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Affiliation(s)
- Ella Hanna
- a School of Health Sciences , University of Newcastle , Newcastle , Australia
| | - Heidi Janssen
- a School of Health Sciences , University of Newcastle , Newcastle , Australia.,b Community Stroke Team and Hunter Stroke Service , Community and Aged Care Services-Greater Newcastle Cluster , Newcastle , Australia.,c NHMRC Centre for Research Excellence in Stroke Recovery and Rehabilitation , Newcastle , Australia.,d Priority Research Centre for Stroke and Brain Injury , University of Newcastle , Newcastle , Australia
| | - Gary Crowfoot
- a School of Health Sciences , University of Newcastle , Newcastle , Australia.,d Priority Research Centre for Stroke and Brain Injury , University of Newcastle , Newcastle , Australia.,e Centre for Research Excellence in Stroke Recovery and Rehabilitation , Florey Institute of Neuroscience and Hunter Medical Research Institute , Australia
| | - Gillian Mason
- c NHMRC Centre for Research Excellence in Stroke Recovery and Rehabilitation , Newcastle , Australia.,d Priority Research Centre for Stroke and Brain Injury , University of Newcastle , Newcastle , Australia
| | - Glade Vyslysel
- f Westlakes Community Rehabilitation Team , Community and Aged Care Services-Greater Newcastle Cluster , Newcastle , Australia
| | - Anne Sweetapple
- g Community Stroke Team , Community and Aged Care Services-Greater Newcastle Cluster , Newcastle , Australia
| | - Robin Callister
- h School of Biomedical Science and Pharmacy , University of Newcastle , Newcastle , Australia.,i Priority Research Centre for Physical Activity and Nutrition , University of Newcastle , Newcastle , Australia
| | - Coralie English
- a School of Health Sciences , University of Newcastle , Newcastle , Australia.,c NHMRC Centre for Research Excellence in Stroke Recovery and Rehabilitation , Newcastle , Australia.,d Priority Research Centre for Stroke and Brain Injury , University of Newcastle , Newcastle , Australia
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Törnbom K, Danielsson A. Experiences of treadmill walking with non-immersive virtual reality after stroke or acquired brain injury - A qualitative study. PLoS One 2018; 13:e0209214. [PMID: 30550607 PMCID: PMC6294388 DOI: 10.1371/journal.pone.0209214] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/30/2018] [Indexed: 02/05/2023] Open
Abstract
Objectives It is well known that physical activity levels for persons after stroke or acquired brain injuries do not reach existing recommendations. Walking training is highly important since the ability to walk is considered to be a meaningful occupation for most people, and is often reduced after a brain injury. This suggests a need to innovate stroke rehabilitation, so that forms of walking training that are user-friendly and enjoyable can be provided. Method An interview study was carried out with persons after stroke (n = 8), or acquired brain injury (n = 2) at a rehabilitation unit at Sahlgrenska University Hospital. We used a semi-structured interview guide to investigate experiences and thoughts about walking on a treadmill with non-immersive virtual reality feedback. The contents were analyzed through an inductive approach, using qualitative content analysis. Results The virtual reality experience was perceived as enjoyable, exciting, and challenging. Participants stressed that the visual and auditory feedback increased their motivation to walk on a treadmill. However, for some participants, the virtual reality experience was too challenging, and extreme tiredness or fatigue were reported after the walking session. Conclusions Participants’ thoughts and experiences indicated that the Virtual Reality walking system could serve as a complement to more traditional forms of walking training. Early after a brain injury, virtual reality could be a way to train the ability to handle individually adapted multisensory input while walking. Obvious benefits were that participants perceived it as engaging and exciting.
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Affiliation(s)
- Karin Törnbom
- Research group for Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Anna Danielsson
- Research group for Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Unit of physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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English C, Janssen H, Crowfoot G, Bourne J, Callister R, Dunn A, Oldmeadow C, Ong LK, Palazzi K, Patterson A, Spratt NJ, Walker FR, Dunstan DW, Bernhardt J. Frequent, short bouts of light-intensity exercises while standing decreases systolic blood pressure: Breaking Up Sitting Time after Stroke (BUST-Stroke) trial. Int J Stroke 2018; 13:932-940. [DOI: 10.1177/1747493018798535] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Stroke survivors sit for long periods each day. Uninterrupted sitting is associated with increased risk of cardiovascular disease. Breaking up uninterrupted sitting with frequent, short bouts of light-intensity physical activity has an immediate positive effect on blood pressure and plasma clotting factors in healthy, overweight, and type 2 diabetic populations. Aim We examined the effect of frequent, short bouts of light-intensity physical activity on blood pressure and plasma fibrinogen in stroke survivors. Methods Prespecified secondary analyses from a three-armed randomized, within-participant, crossover trial. Participants were 19 stroke survivors (nine female, aged 68 years old, 90% able to walk independently). The experimental conditions were sitting for 8 h uninterrupted, sitting with 3 min bouts of light-intensity exercise while standing every 30 min, or sitting with 3 min of walking every 30 min. Blood pressure was measured every 30 min over 8 h and plasma fibrinogen at the beginning, middle, and end of each day. Intention-to-treat analyses were performed using linear mixed models including fixed effects for condition, period, and order, and a random intercept for participant to account for repeated measures and missing data. Results Sitting with 3 min bouts of light-intensity exercise while standing every 30 min decreased systolic blood pressure by 3.5 mmHg (95% CI 1.7–5.4) compared with sitting for 8 h uninterrupted. For participants not taking antihypertensive medications, sitting with 3 min of walking every 30 min decreased systolic blood pressure by 5.0 mmHg (95% CI −7.9 to 2.0) and sitting with 3 min bouts light-intensity exercise while standing every 30 min decreased systolic blood pressure by 4.2 mmHg (95% CI −7.2 to −1.3) compared with sitting for 8 h uninterrupted. There was no effect of condition on diastolic blood pressure (p = 0.45) or plasma fibrinogen levels (p = 0.91). Conclusion Frequent, short bouts of light-intensity physical activity decreases systolic blood pressure in stroke survivors. However, before translation into clinical practice, the optimal duration and timing of physical activity bouts needs to be determined. Clinical trial registration Australian and New Zealand Clinical Trials Registry http://www.anzctr.org.au ANZTR12615001189516.
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Affiliation(s)
- Coralie English
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
- Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melboure, Australia
| | - Heidi Janssen
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
- Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melboure, Australia
- Hunter Stroke Service, Hunter New England Local Health District, Newcastle, Australia
| | - Gary Crowfoot
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
- Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melboure, Australia
| | - Josephine Bourne
- School of Biomedical Sciences and Pharmacy, and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, Australia
| | - Robin Callister
- School of Biomedical Sciences and Pharmacy, and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, Australia
| | - Ashlee Dunn
- School of Biomedical Sciences and Pharmacy, and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, Australia
| | - Christopher Oldmeadow
- Clinical Research Design, Information Technology and Statistical Support (CReDITSS), Hunter Medical Research Institute, Newcastle, Australia
| | - Lin K Ong
- School of Biomedical Sciences and Pharmacy and the Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
| | - Kerrin Palazzi
- Clinical Research Design, Information Technology and Statistical Support (CReDITSS), Hunter Medical Research Institute, Newcastle, Australia
| | - Amanda Patterson
- School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Neil J Spratt
- Department of Neurology, John Hunter Hospital, Hunter New England Local Health District, Newcastle, Australia
| | - FR Walker
- Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melboure, Australia
- School of Biomedical Sciences and Pharmacy and the Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
| | - David W Dunstan
- Physical Activity, Baker Heart and Diabetes Institute, Melbourne, Australia
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Julie Bernhardt
- Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melboure, Australia
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