Evaluating the impact of high dose inpatient rehabilitation gait training on post stroke physical activity: A secondary analysis of a randomized controlled trial

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OBJECTIVE: This secondary analysis aimed to determine if higher doses of inpatient step training affects physical activity levels 12 months post-stroke. A secondary aim sought to identify whether walking improvements during the subacute rehabilitation stage was predictive of 12-month physical activity. DESIGN: Multi-site, assessor blinded, randomized controlled trial. SETTING: Inpatient rehabilitation. PARTICIPANTS: Stroke patients (<10 weeks post-stroke) admitted to inpatient rehabilitation with lower limb hemiparesis and able to walk 5 meters with or without assistance. INTERVENTIONS: Participants admitted for subacute stroke rehabilitation were randomized to either: Control (usual therapy); DOSE 1, 4 weeks structured and progressive walking and aerobic exercise within usual therapy time (5 hours/week); or DOSE 2, 4 weeks of walking and aerobic exercises within usual therapy time, plus an additional session (2 sessions/day, 10 hours/week). MAIN OUTCOME MEASURES: The treatment effect was examined on physical activity measured by daily steps at 12 months post-stroke. Longitudinal analysis determined predictors of 12-month physical activity based on subacute period change in six-minute walk test from rehabilitation admission (∼1 month post-stroke) to 4-weeks later. RESULTS: Valid step data were available for 57 participants at 12-months. Participants were on average 54.91 ± 11.45 years, predominantly male (63%), and had impaired mobility (gait speed; 0.41 ± 0.24). There were no group effects on physical activity at 12 months after stroke. Twelve-month physical activity was relatively high (7020 steps/day) across the 3 groups. Longitudinal analysis showed a significant association between change in six-minute walk test during inpatient rehabilitation and combined 12-month physical activity post-stroke (estimated effect: 15.80, 95% Confidence Intervals: 7.06 - 24.54). CONCLUSION: Higher walking doses at inpatient rehabilitation did not impact 12-month physical activity. Longitudinal analysis found a positive association with change in distance walked and 12-month physical activity levels, with a gain of 15.8 steps 12 months post-stroke per meter walked.

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