1
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Hung SH, Tierney C, Klassen TD, Schneeberg A, Bayley MT, Dukelow SP, Hill MD, Krassioukov A, Pooyania S, Poulin MJ, Yao J, Eng JJ. Blood pressure trajectory of inpatient stroke rehabilitation patients from the Determining Optimal Post-Stroke Exercise (DOSE) trial over the first 12 months post-stroke. Front Neurol 2023; 14:1245881. [PMID: 37794879 PMCID: PMC10546336 DOI: 10.3389/fneur.2023.1245881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/28/2023] [Indexed: 10/06/2023] Open
Abstract
Background High blood pressure (BP) is the primary risk factor for recurrent strokes. Despite established clinical guidelines, some stroke survivors exhibit uncontrolled BP over the first 12 months post-stroke. Furthermore, research on BP trajectories in stroke survivors admitted to inpatient rehabilitation hospitals is limited. Exercise is recommended to reduce BP after stroke. However, the effect of high repetition gait training at aerobic intensities (>40% heart rate reserve; HRR) during inpatient rehabilitation on BP is unclear. We aimed to determine the effect of an aerobic gait training intervention on BP trajectory over the first 12 months post-stroke. Methods This is a secondary analysis of the Determining Optimal Post-Stroke Exercise (DOSE) trial. Participants with stroke admitted to inpatient rehabilitation hospitals were recruited and randomized to usual care (n = 24), DOSE1 (n = 25; >2,000 steps, 40-60% HRR for >30 min/session, 20 sessions over 4 weeks), or DOSE2 (n = 25; additional DOSE1 session/day) groups. Resting BP [systolic (SBP) and diastolic (DBP)] was measured at baseline (inpatient rehabilitation admission), post-intervention (near inpatient discharge), 6- and 12-month post-stroke. Linear mixed-effects models were used to examine the effects of group and time (weeks post-stroke) on SBP, DBP and hypertension (≥140/90 mmHg; ≥130/80 mmHg, if diabetic), controlling for age, stroke type, and baseline history of hypertension. Results No effect of intervention group on SBP, DBP, or hypertension was observed. BP increased from baseline to 12-month post-stroke for SBP (from [mean ± standard deviation] 121.8 ± 15.0 to 131.8 ± 17.8 mmHg) and for DBP (74.4 ± 9.8 to 78.5 ± 10.1 mmHg). The proportion of hypertensive participants increased from 20.8% (n = 15/72) to 32.8% (n = 19/58). These increases in BP were statistically significant: an effect [estimation (95%CI), value of p] of time was observed on SBP [0.19 (0.12-0.26) mmHg/week, p < 0.001], DBP [0.09 (0.05-0.14) mmHg/week, p < 0.001], and hypertension [OR (95%CI): 1.03 (1.01-1.05), p = 0.010]. A baseline history of hypertension was associated with higher SBP by 13.45 (8.73-18.17) mmHg, higher DBP by 5.57 (2.02-9.12) mmHg, and 42.22 (6.60-270.08) times the odds of being hypertensive at each timepoint, compared to those without. Conclusion Blood pressure increased after inpatient rehabilitation over the first 12 months post-stroke, especially among those with a history of hypertension. The 4-week aerobic gait training intervention did not influence this trajectory.
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Affiliation(s)
- Stanley H. Hung
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Rehabilitation Research Program, Center for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | | | - Tara D. Klassen
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Amy Schneeberg
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Mark T. Bayley
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sean P. Dukelow
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Michael D. Hill
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Andrei Krassioukov
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sepideh Pooyania
- Division of Physical Medicine and Rehabilitation, University of Manitoba, Winnipeg, MB, Canada
| | - Marc J. Poulin
- Department of Physiology and Pharmacology and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Jennifer Yao
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Janice J. Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Rehabilitation Research Program, Center for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
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2
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Peters S, Lohse KR, Klassen TD, Liu-Ambrose T, Dukelow SP, Bayley MT, Hill MD, Pooyania S, Yao J, Eng JJ. Higher intensity walking improves global cognition during inpatient rehabilitation: a secondary analysis of a randomized control trial. Front Neurol 2023; 14:1023488. [PMID: 37360352 PMCID: PMC10289188 DOI: 10.3389/fneur.2023.1023488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Cognitive deficits are common poststroke. Cognitive rehabilitation is typically used to improve cognitive deficits. It is unknown whether higher doses of exercise to promote motor recovery influence cognitive outcomes. Our recent trial, Determining Optimal Post-Stroke Exercise (DOSE), shows more than double the steps and aerobic minutes can be achieved during inpatient rehabilitation versus usual care, and translates to improved long-term walking outcomes. Thus, the secondary analysis aim was to determine the effect of the DOSE protocol on cognitive outcomes over 1-year poststroke. The DOSE protocol progressively increased step number and aerobic minutes during inpatient stroke rehabilitation over 20 sessions. The Montreal Cognitive Assessment (MoCA), Digit Symbol Substitution Test (DSST), and Trail Making Test B were completed at baseline, post-intervention, and 6- and 12-months poststroke, administered using standardized guidelines. Using the DOSE data, we used mixed-effect spline regression to model participants' trajectories of cognitive recovery, controlling for relevant covariates. Participants (Usual Care n = 25, DOSE n = 50) were 56.7(11.7) years old, and 27(10) days post stroke. For the MoCA, there were statistically significant Group × Trajectory(p = 0.019), and Group × ΔTrajectory (p = 0.018) interactions with a substantial clinically meaningful difference, from +5.44 points/month improvement of the DOSE group compared to +1.59 points/month improvement with Usual Care during the 4-week intervention. The DSST and Trails B improved over time but were not different between groups. Taking advantage of this early difference may lend support to continued efforts to increase intensity, during and after discharge from inpatient rehabilitation, to improve cognition. Clinical trial registration: www.clinicaltrials.gov, NCT01915368.
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Affiliation(s)
- Sue Peters
- School of Physical Therapy, University of Western Ontario, London, ON, Canada
| | - Keith R. Lohse
- Program in Physical Therapy and Department of Neurology, Washington University School of Medicine, Saint Louis, MO, United States
| | - Tara D. Klassen
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver, BC, Canada
| | - Sean P. Dukelow
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Mark T. Bayley
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Michael D. Hill
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Sepideh Pooyania
- Division of Physical Medicine and Rehabilitation, University of Manitoba, Winnipeg, MB, Canada
| | - Jennifer Yao
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada
| | - Janice J. Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver, BC, Canada
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3
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Peters S, Lim SB, Bayley MT, Best K, Connell LA, Corriveau H, Donkers SJ, Dukelow SP, Klassen TD, Milot MH, Sakakibara BM, Sheehy L, Wong H, Yao J, Eng JJ. Implementation of increased physical therapy intensity for improving walking after stroke: Walk 'n watch protocol for a multisite stepped-wedge cluster-randomized controlled trial. Int J Stroke 2023; 18:117-122. [PMID: 36129364 PMCID: PMC9806455 DOI: 10.1177/17474930221129982] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
RATIONALE Clinical practice guidelines support structured, progressive protocols for improving walking after stroke. Yet, practice is slow to change, evidenced by the little amount of walking activity in stroke rehabilitation units. Our recent study (n = 75) found that a structured, progressive protocol integrated with typical daily physical therapy improved walking and quality-of-life measures over usual care. Research therapists progressed the intensity of exercise by using heart rate and step counters worn by the participants with stroke during therapy. To have the greatest impact, our next step is to undertake an implementation trial to change practice across stroke units where we enable the entire unit to use the protocol as part of standard of care. AIMS What is the effect of introducing structured, progressive exercise (termed the Walk 'n Watch protocol) to the standard of care on the primary outcome of walking in adult participants with stroke over the hospital inpatient rehabilitation period? Secondary outcomes will be evaluated and include quality of life. METHODS AND SAMPLE SIZE ESTIMATES This national, multisite clinical trial will randomize 12 sites using a stepped-wedge design where each site will be randomized to deliver Usual Care initially for 4, 8, 12, or 16 months (three sites for each duration). Then, each site will switch to the Walk 'n Watch phase for the remaining duration of a total 20-month enrolment period. Each participant will be exposed to either Usual Care or Walk 'n Watch. The trial will enroll a total of 195 participants with stroke to achieve a power of 80% with a Type I error rate of 5%, allowing for 20% dropout. Participants will be medically stable adults post-stroke and able to take five steps with a maximum physical assistance from one therapist. The Walk 'n Watch protocol focuses on completing a minimum of 30 min of weight-bearing, walking-related activities (at the physical therapists' discretion) that progressively increase in intensity informed by activity trackers measuring heart rate and step number. STUDY OUTCOME(S) The primary outcome will be the change in walking endurance, measured by the 6-Minute Walk Test, from baseline (T1) to 4 weeks (T2). This change will be compared across Usual Care and Walk 'n Watch phases using a linear mixed-effects model. Additional physical, cognitive, and quality of life outcomes will be measured at T1, T2, and 12 months post-stroke (T3) by a blinded assessor. DISCUSSION The implementation of stepped-wedge cluster-randomized trial enables the protocol to be tested under real-world conditions, involving all clinicians on the unit. It will result in all sites and all clinicians on the unit to gain expertise in protocol delivery. Hence, a deliberate outcome of the trial is facilitating changes in best practice to improve outcomes for participants with stroke in the trial and for the many participants with stroke admitted after the trial ends.
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Affiliation(s)
- Sue Peters
- School of Physical Therapy, University
of Western Ontario, London, ON, Canada,Rehabilitation Research Program, G.F.
Strong Rehabilitation Centre and Department of Physical Therapy, University of
British Columbia, Vancouver, BC, Canada
| | - Shannon B Lim
- Rehabilitation Research Program, G.F.
Strong Rehabilitation Centre and Department of Physical Therapy, University of
British Columbia, Vancouver, BC, Canada
| | - Mark T Bayley
- Division of Physical Medicine and
Rehabilitation, University of Toronto and KITE Research Institute University Health
Network, Toronto, ON, Canada
| | - Krista Best
- Intégré Universitaire de Santé et de
Services Sociaux de La Capitale-Nationale and Department of Rehabilitation,
Université Laval, Quebec, QC, Canada
| | - Louise A Connell
- Allied Health Research Unit, University
of Central Lancashire, Preston, UK,Rakehead Rehabilitation Centre, Burnley
General Teaching Hospital, East Lancashire Hospitals NHS Trust, Burnley, UK
| | - Hélène Corriveau
- School of Rehabilitation, Faculté de
médecine et des sciences de la santé and Research Center on Aging, Université de
Sherbrooke, Sherbrooke, QC, Canada
| | - Sarah J Donkers
- School of Rehabilitation Science,
College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences,
University of Calgary, Calgary, AB, Canada
| | - Tara D Klassen
- Rehabilitation Research Program, G.F.
Strong Rehabilitation Centre and Department of Physical Therapy, University of
British Columbia, Vancouver, BC, Canada
| | - Marie-Hélène Milot
- School of Rehabilitation, Faculté de
médecine et des sciences de la santé and Research Center on Aging, Université de
Sherbrooke, Sherbrooke, QC, Canada
| | - Brodie M Sakakibara
- Department of Occupational Science
and Occupational Therapy, University of British Columbia, Vancouver, BC,
Canada,Centre for Chronic Disease Prevention
and Management, University of British Columbia, Kelowna, BC, Canada
| | - Lisa Sheehy
- Bruyère Research Institute, Ottawa,
ON, Canada
| | - Hubert Wong
- School of Population and Public
Health, University of British Columbia and Centre for Health Evaluation &
Outcomes Sciences, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Jennifer Yao
- Division of Physical Medicine and
Rehabilitation, University of British Columbia and G.F. Strong Rehabilitation
Centre, Vancouver, BC, Canada
| | - Janice J Eng
- Rehabilitation Research Program, G.F.
Strong Rehabilitation Centre and Department of Physical Therapy, University of
British Columbia, Vancouver, BC, Canada,Janice J Eng, Rehabilitation Research
Program, G.F. Strong Rehabilitation Centre and Department of Physical Therapy,
University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC V6T 1Z3,
Canada.
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4
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Fishbook BN, Brinton CD, Siever J, Klassen TD, Sakakibara BM. Cardiometabolic multimorbidity and activity limitation: a cross-sectional study of adults using the Canadian Longitudinal Study on Aging data. Fam Pract 2022; 39:455-463. [PMID: 34644392 DOI: 10.1093/fampra/cmab129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cardiometabolic multimorbidity (CM) is the diagnosis of 2 or more cardiometabolic conditions. Multimorbidity and individual cardiometabolic conditions have been associated with activity limitation, a common form of disability, but few studies have investigated the association between CM and activity limitation. OBJECTIVES To estimate the prevalence of activity limitation among Canadians with CM and to quantify the association between CM and activity limitation. METHODS Using data from the Canadian Longitudinal Study on Aging, we conducted a cross-sectional analysis of activity limitation among Canadians aged 45-85 (n = 50,777; weighted n = 13,118,474). CM was defined as the diagnosis of 2 or more of diabetes/prediabetes, myocardial infarction, and stroke, and activity limitation was evaluated using the Older Americans Resources and Services scale. Descriptive statistics and logistic and multinomial logistic regression analyses were conducted to determine the association between CM and activity limitation. RESULTS The estimated prevalence of activity limitation among participants living with CM was 27.4% compared with 7.5% with no cardiometabolic conditions. Activity limitation increased in prevalence and severity with the number of cardiometabolic conditions. People with CM had increased odds of activity limitation compared with those without any cardiometabolic conditions (adjusted relative risk ratio = 3.99, 95% confidence interval [3.35-4.75]), and the odds increased with each additional condition. Stroke survivors had greater odds of activity limitation than those without a history of stroke and the same number of cardiometabolic conditions. CONCLUSION Activity limitation is common among Canadians living with CM. Odds of activity limitation increase with each additional cardiometabolic condition, especially for stroke survivors.
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Affiliation(s)
- Brayden N Fishbook
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, BC, Canada
| | - Christopher D Brinton
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, BC, Canada.,Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, Kelowna, BC, Canada
| | - Jodi Siever
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, BC, Canada
| | - Tara D Klassen
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Brodie M Sakakibara
- Southern Medical Program, Faculty of Medicine, University of British Columbia, Kelowna, BC, Canada.,Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, Kelowna, BC, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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5
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Musselman KE, Walden K, Noonan VK, Jervis-Rademeyer H, Thorogood N, Bouyer L, Chan B, Donkers S, Ho C, Jeji T, Kaiser A, Klassen TD, Zariffa J, Grant C, Masani K, Zbogar D, Athanasopoulous P. Development of priorities for a Canadian strategy to advance activity-based therapies after spinal cord injury. Spinal Cord 2021; 59:874-884. [PMID: 34099881 PMCID: PMC8338546 DOI: 10.1038/s41393-021-00644-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 11/12/2022]
Abstract
Study Design Participatory design. Objectives Activity-based therapies (ABT) have physical and psychosocial benefits for individuals with spinal cord injury (SCI). A Canadian ABT summit was held to: (1) identify methods used in stroke rehabilitation that may be appropriate for SCI; (2) understand the current state of ABT activities in Canada; and (3) identify priorities for ABT research and care for the next five years. Setting Stakeholder-engaged meeting at a tertiary rehabilitation hospital. Methods Thirty-nine stakeholders, including individuals with SCI, frontline clinicians, healthcare administrators, researchers, funders and health policy experts, attended. Two participants were note-takers. Priority identification occurred through input from stakeholder groups, followed by individual voting. Conventional content analysis was used to synthesize the information in the meeting notes. Results The strengths of ABT in stroke rehabilitation included clear and clinically feasible definitions, measurements and interventions, and recognized requirements for implementation (e.g. behavior change, partnerships). Knowledge gaps concerning ABT activities in Canada were identified for acute and community settings, non-traumatic populations, and the interventions, equipment and standardized measures (i.e. upper limb, activity levels) used. Five priorities for ABT across the continuum of care were identified: (1) Identify current ABT activities; (2) Create a network to facilitate dialog; (3) Track engagement in ABT activities; (4) Develop and implement best practice recommendations; and (5) Study optimal timing, methods, and dose of ABT. Working groups were formed to address priorities 1–3. Conclusions The priorities will guide SCI research and care activities in Canada over the next five years. Sponsorship Praxis Spinal Cord Institute.
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Affiliation(s)
- Kristin E Musselman
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada. .,KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada. .,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
| | | | | | - Hope Jervis-Rademeyer
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | | | - Laurent Bouyer
- Department of Rehabilitation, Laval University, Quebec City, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
| | - Brian Chan
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sarah Donkers
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada
| | - Chester Ho
- Department of Medicine, University of Alberta, Edmonton, AB, Canada.,Physical Medicine and Rehabilitation, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Tara Jeji
- Ontario Neurotrauma Foundation, Toronto, ON, Canada
| | - Anita Kaiser
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Canadian Spinal Research Organization, Toronto, ON, Canada
| | - Tara D Klassen
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.,GF Strong Rehabilitation Centre, Vancouver, BC, Canada
| | - José Zariffa
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Christopher Grant
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Foothills Medical Centre, Calgary, AB, Canada
| | - Kei Masani
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Dominik Zbogar
- Spinal Cord Injury Rehabilitation Evidence, Vancouver, BC, Canada
| | - Peter Athanasopoulous
- Spinal Cord Injury Ontario, Toronto, ON, Canada.,SCI Solutions Alliance, Toronto, ON, Canada
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6
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Klassen TD, Dukelow SP, Bayley MT, Benavente O, Hill MD, Krassioukov A, Liu-Ambrose T, Pooyania S, Poulin MJ, Schneeberg A, Yao J, Eng JJ. Higher Doses Improve Walking Recovery During Stroke Inpatient Rehabilitation. Stroke 2020; 51:2639-2648. [PMID: 32811378 DOI: 10.1161/strokeaha.120.029245] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We investigated the effect of higher therapeutic exercise doses on walking during inpatient rehabilitation, typically commencing 1 to 4 weeks poststroke. METHODS This phase II, blinded-assessor, randomized controlled trial recruited from 6 Canadian inpatient rehabilitation units, between 2014 and 2018. Subjects (n=75; 25/group) were randomized into: control (usual care) physical therapy: typically, 1 hour, 5 days/week; Determining Optimal Post-Stroke Exercise (DOSE1): 1 hour, 5 days/week, more than double the intensity of Control (based on aerobic minutes and walking steps); and DOSE2: 2 hours, 5 days/week, more than quadruple the intensity of Control, each for 4 weeks duration. The primary outcome, walking endurance at completion of the 4-week intervention (post-evaluation), was compared across these groups using linear regression. Secondary outcomes at post-evaluation, and longitudinal outcomes at 6 and 12-month evaluations, were also analyzed. RESULTS Both DOSE1 (mean change 61 m [95% CI, 9-113], P=0.02) and DOSE2 (mean change 58 m, 6-110, P=0.03) demonstrated greater walking endurance compared with Control at the post-evaluation. Significant improvements were also observed with DOSE2 in gait speed (5-m walk), and both DOSE groups in quality of life (EQ-5D-5 L) compared with Control. Longitudinal analyses revealed that improvements in walking endurance from the DOSE intervention were retained during the 1-year follow-up period over usual care. CONCLUSIONS This study provides the first preliminary evidence that patients with stroke can improve their walking recovery and quality of life with higher doses of aerobic and stepping activity within a critical time period for neurological recovery. Furthermore, walking endurance benefits achieved from a 4-week intervention are retained over the first-year poststroke. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01915368.
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Affiliation(s)
- Tara D Klassen
- Department of Physical Therapy (T.D.K., T.L.-A., A.S., J.J.E.), University of British Columbia, Vancouver, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Hotchkiss Brain Institute (S.P.D., M.D.H.)University of Calgary, Canada
| | - Mark T Bayley
- Division of Physical Medicine and Rehabilitation, University of Toronto, Canada (M.T.B.)
| | - Oscar Benavente
- Division of Neurology (O.B.), University of British Columbia, Vancouver, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute (S.P.D., M.D.H.)University of Calgary, Canada
| | - Andrei Krassioukov
- Division of Physical Medicine and Rehabilitation (A.K., J.Y.), University of British Columbia, Vancouver, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy (T.D.K., T.L.-A., A.S., J.J.E.), University of British Columbia, Vancouver, Canada
| | - Sepideh Pooyania
- Division of Physical Medicine and Rehabilitation, University of Manitoba (S.P.)
| | - Marc J Poulin
- Department of Physiology & Pharmacology (M.J.P.) University of Calgary, Canada
| | - Amy Schneeberg
- Department of Physical Therapy (T.D.K., T.L.-A., A.S., J.J.E.), University of British Columbia, Vancouver, Canada
| | - Jennifer Yao
- Division of Physical Medicine and Rehabilitation (A.K., J.Y.), University of British Columbia, Vancouver, Canada
| | - Janice J Eng
- Department of Physical Therapy (T.D.K., T.L.-A., A.S., J.J.E.), University of British Columbia, Vancouver, Canada
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7
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Janssen J, Klassen TD, Connell LA, Eng JJ. Factors Influencing the Delivery of Intensive Rehabilitation in Stroke: Patient Perceptions Versus Rehabilitation Therapist Perceptions. Phys Ther 2019; 100:307-316. [PMID: 31711211 PMCID: PMC7246073 DOI: 10.1093/ptj/pzz159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/04/2018] [Accepted: 08/14/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite increasing evidence regarding the benefit of intensive task-specific practice and aerobic exercise in stroke rehabilitation, implementation remains difficult. The factors influencing implementation have been explored from therapists' perspectives; however, despite an increased emphasis on patient involvement in research, patients' perceptions have not yet been investigated. OBJECTIVE The study aimed to investigate factors influencing implementation of higher intensity activity in people with stroke and to compare this with therapists' perspectives. DESIGN The design was a cross-sectional qualitative study. METHODS The study used semistructured interviews with people with stroke who were part of a randomized clinical trial, the Determining Optimal post-Stroke Exercise study, which delivered a higher intensity intervention. An interview guide was developed and data analyzed using implementation frameworks. Factors emerging from interviews with people with stroke were compared and contrasted with factors perceived by rehabilitation therapists. RESULTS Ten people with stroke were interviewed before data saturation was reached. Participants had a positive attitude regarding working hard and were satisfied with the graded exercise test, high intensity intervention, and the feedback-monitoring devices. Therapists and patients had contrasting perceptions about their beliefs regarding intensive exercise and the content of the intervention, with therapists more focused on the methods and patients more focused on the personal interactions stemming from the therapeutic relationship. CONCLUSIONS People with stroke perceived no barriers regarding the implementation of higher intensity rehabilitation in practice and were positive towards working at more intense levels. Contrastingly, from the therapists' perspective, therapists' beliefs about quality of movement and issues around staffing and resources were perceived to be barriers. In addition, therapists and people with stroke perceived the contents of the intervention differently, highlighting the importance of involving patients and clinicians in the development and evaluation of rehabilitation interventions.
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Affiliation(s)
- Jessie Janssen
- J. Janssen, PhD, Allied Health Research Unit, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom; and Institute of Therapeutic Sciences, IMC University of Applied Sciences Krems, Krems an der Donau, Austria. Address all correspondence to Dr Janssen at: ,Address all correspondence to Dr Janssen at:
| | - Tara D Klassen
- T.D. Klassen, PhD, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; and Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver, British Columbia, Canada
| | - Louise A Connell
- L.A. Connell, PhD, Allied Health Research Unit, Faculty of Health and Wellbeing, University of Central Lancashire
| | - Janice J Eng
- J.J. Eng, PhD, Department of Physical Therapy, University of British Columbia and Rehabilitation Research Program, GF Strong Rehab Centre
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8
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Klassen TD, Dukelow SP, Bayley MT, Benavente O, Hill MD, Krassioukov A, Liu-Ambrose T, Pooyania S, Poulin MJ, Yao J, Eng JJ. Determining optimal poststroke exercise: Study protocol for a randomized controlled trial investigating therapeutic intensity and dose on functional recovery during stroke inpatient rehabilitation. Int J Stroke 2019; 14:80-86. [PMID: 30010509 DOI: 10.1177/1747493018785064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
RATIONALE A top priority in stroke rehabilitation research is determining the appropriate exercise dose to optimize recovery. Although more intensive rehabilitation very early after stroke may be deleterious to recovery, inpatient rehabilitation, occurring after acute care, may be a more appropriate setting to assess therapeutic dose on neurological recovery. HYPOTHESIS Individuals receiving higher intensity and dose exercise programs will yield greater improvements in walking ability over usual inpatient physical therapy care. METHODS AND DESIGN Seventy-five individuals across seven inpatient rehabilitation sites in Canada will be randomized into one of three treatment programs, each 5 days/week, for four weeks and monitored for exertion (heart rate) and repetitions (step count). STUDY OUTCOMES The primary outcome measure is the 6 min walk and secondary outcomes include functional independence, cognitive, and quality-of-life measures. Outcome data will be assessed at four time points. SUMMARY This trial will contribute to our knowledge of the therapeutic intensity and dose necessary to maximize functional recovery at a very important stage of rehabilitation and neural recovery poststroke.
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Affiliation(s)
- Tara D Klassen
- 1 Rehabilitation Sciences Graduate Program, Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- 2 Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Sean P Dukelow
- 3 Department of Clinical Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Mark T Bayley
- 4 Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada
| | - Oscar Benavente
- 5 Division of Neurology, University of British Columbia, Vancouver, Canada
| | - Michael D Hill
- 3 Department of Clinical Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
- 6 Department of Community Health Sciences, Department of Medicine, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Andrei Krassioukov
- 7 Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada
- 8 International Collaboration on Repair Discovery (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Teresa Liu-Ambrose
- 9 Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- 10 Aging, Mobility and Cognitive Neuroscience Laboratory, University of British Columbia, Vancouver, Canada
| | - Sepideh Pooyania
- 11 Division of Physical Medicine and Rehabilitation, University of Manitoba, Winnipeg, Canada
| | - Marc J Poulin
- 3 Department of Clinical Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
- 12 Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Canada
- 15 O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jennifer Yao
- 2 Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada
- 7 Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada
| | - Janice J Eng
- 2 Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada
- 9 Department of Physical Therapy, University of British Columbia, Vancouver, Canada
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Klassen TD, Semrau JA, Dukelow SP, Bayley MT, Hill MD, Eng JJ. Consumer-Based Physical Activity Monitor as a Practical Way to Measure Walking Intensity During Inpatient Stroke Rehabilitation. Stroke 2017; 48:2614-2617. [DOI: 10.1161/strokeaha.117.018175] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/05/2017] [Accepted: 07/12/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Tara D. Klassen
- From the University of British Columbia, Vancouver, Canada (T.D.K., J.J.E.); University of Calgary, Canada (J.A.S., S.P.D., M.D.H.); Hotchkiss Brain Institute, Calgary, Canada (J.A.S., S.P.D., M.D.H.); and Toronto Rehabilitation Institute, Canada (M.T.B.)
| | - Jennifer A. Semrau
- From the University of British Columbia, Vancouver, Canada (T.D.K., J.J.E.); University of Calgary, Canada (J.A.S., S.P.D., M.D.H.); Hotchkiss Brain Institute, Calgary, Canada (J.A.S., S.P.D., M.D.H.); and Toronto Rehabilitation Institute, Canada (M.T.B.)
| | - Sean P. Dukelow
- From the University of British Columbia, Vancouver, Canada (T.D.K., J.J.E.); University of Calgary, Canada (J.A.S., S.P.D., M.D.H.); Hotchkiss Brain Institute, Calgary, Canada (J.A.S., S.P.D., M.D.H.); and Toronto Rehabilitation Institute, Canada (M.T.B.)
| | - Mark T. Bayley
- From the University of British Columbia, Vancouver, Canada (T.D.K., J.J.E.); University of Calgary, Canada (J.A.S., S.P.D., M.D.H.); Hotchkiss Brain Institute, Calgary, Canada (J.A.S., S.P.D., M.D.H.); and Toronto Rehabilitation Institute, Canada (M.T.B.)
| | - Michael D. Hill
- From the University of British Columbia, Vancouver, Canada (T.D.K., J.J.E.); University of Calgary, Canada (J.A.S., S.P.D., M.D.H.); Hotchkiss Brain Institute, Calgary, Canada (J.A.S., S.P.D., M.D.H.); and Toronto Rehabilitation Institute, Canada (M.T.B.)
| | - Janice J. Eng
- From the University of British Columbia, Vancouver, Canada (T.D.K., J.J.E.); University of Calgary, Canada (J.A.S., S.P.D., M.D.H.); Hotchkiss Brain Institute, Calgary, Canada (J.A.S., S.P.D., M.D.H.); and Toronto Rehabilitation Institute, Canada (M.T.B.)
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Chen AB, Anicetti VR, Klassen TD, Berthold W, Zahn G, Wert RM, Geier MD, Jones AJ. A sensitive radioimmunoprecipitation assay for the detection of antibody to recombinant human gamma-interferon: comparison to a bioassay neutralization test. J Interferon Res 1986; 6:313-20. [PMID: 3091713 DOI: 10.1089/jir.1986.6.313] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This report describes a specific radioimmunoprecipitation (RIP) assay for the detection of antibodies to recombinant DNA (rDNA) derived human gamma-interferon (rHuIFN-gamma). The assay was shown not to detect antibodies to rHuIFN-alpha, rHuIFN-beta, human lymphotoxin, or E. coli proteins and was reproducible with intraassay and interassay coefficients of variation of 1.6 and 3%, respectively, for the log titer of a high positive control. Comparison of this assay with a standard bioassay for detection of neutralizing antibody (abrogation of the inhibitory effect of rHuIFN-gamma on EMC virus replication in A549 cells) demonstrated that the RIP assay was more sensitive for detection of HuIFN-gamma neutralizing monoclonal antibody. Nonneutralizing monoclonal antibody was detectable in the RIP assay but not in the bioassay neutralization test. Examination of polyclonal antisera (rabbit and monkey) that contained neutralizing antibodies also demonstrated the RIP system to be a more sensitive indicator of the presence of antibodies than the bioassay neutralization test. In preliminary studies of human samples (86 patients) from clinical trials using an assay precipitation system capable of detecting antibody of the IgG, IgM, IgA, and IgE classes, no antibody to rHuIFN-gamma was observed. These patients were also found negative for neutralizing antibody to rHuIFN-gamma.
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