Use of Accelerometer-Based Feedback of Walking Activity for Appraising Progress With Walking-Related Goals in Inpatient Stroke Rehabilitation

These researchers need to go back to the drawing board and figure out what intervention will make walking better.
http://nnr.sagepub.com/content/29/9/847?etoc

A Randomized Controlled Trial

1. Avril Mansfield, PhD1,2,3,4
2. Jennifer S. Wong1,3
3. Jessica Bryce1
4. Karen Brunton1,3
5. Elizabeth L. Inness, MSc1,3
6. Svetlana Knorr, PhD1
7. Simon Jones, MSc1
8. Babak Taati, PhD1,2,3
9. William E. McIlroy, PhD1,2,3,4,5

1. ¹Toronto Rehabilitation Institute—University Health Network, Toronto, Ontario, Canada
2. ²Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, Ontario, Canada
3. ³University of Toronto, Toronto, Ontario, Canada
4. ⁴Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
5. ⁵University of Waterloo, Waterloo, Ontario, Canada

1. Avril Mansfield, Toronto Rehabilitation Institute, Room 11-117, 550 University Ave, Toronto, Ontario, Canada M5G 2A2. Email: Avril.Mansfield@uhn.ca

Abstract

Background. Regaining independent ambulation is important to those with stroke. Increased walking practice during “down time” in rehabilitation could improve walking function for individuals with stroke.  

Objective. To determine the effect of providing physiotherapists with accelerometer-based feedback on patient activity and walking-related goals during inpatient stroke rehabilitation.  

Methods. Participants with stroke wore accelerometers around both ankles every weekday during inpatient rehabilitation. Participants were randomly assigned to receive daily feedback about walking activity via their physiotherapists (n = 29) or to receive no feedback (n = 28). Changes in measures of daily walking (walking time, number of steps, average cadence, longest bout duration, and number of “long” walking bouts) and changes in gait control and function assessed in-laboratory were compared between groups. 

Results. There was no significant increase in walking time, number of steps, longest bout duration, or number of long walking bouts for the feedback group compared with the control group (P values > .20). However, individuals who received feedback significantly increased cadence of daily walking more than the control group (P = .013). From the in-laboratory gait assessment, individuals who received feedback had a greater increase in walking speed and decrease in step time variability than the control group (P values < .030).  

Conclusion. Feedback did not increase the amount of walking completed by individuals with stroke. However, there was a significant increase in cadence, indicating that intensity of daily walking was greater for those who received feedback than the control group. Additionally, more intense daily walking activity appeared to translate to greater improvements in walking speed.