Accelerometer and global positioning system measurement of recovery of community ambulation across the first 6 months after stroke: an exploratory prospective study

Objective: To characterize community ambulation and determine if it changes across the first 6 months after discharge from hospital after stroke

Additional Saturday occupational therapy for adults receiving inpatient physiotherapy rehabilitation : A prospective cohort study

Background The first aim of this study was to investigate the impact of providing an additional four hours of Saturday occupational therapy to patients receiving Saturday physiotherapy in an inpatient setting on length of stay, functional independence, gait and balance. The second aim was to conduct an economic evaluation to determine if the introduction of a Saturday occupational therapy service in addition to physiotherapy resulted in a net cost savings for the rehabilitation facility. Methods A prospective cohort study with a historical control was conducted in an Australian private mixed rehabilitation unit from 2015–2017. Clinical outcomes included the Functional Independence Measure (Motor, Cognitive, Total), gait speed (10 Meter Walk test) and five balance measures (Timed Up and Go test, Step test, Functional Reach, Feet Together Eyes Closed and the Balance Outcome Measure of Elder Rehabilitation). Economic outcomes were rehabilitation unit length of stay and additional treatment costs. Results A total of 366 patients were admitted to the rehabilitation unit over two 20-week periods. The prospective cohort (receiving Saturday occupational therapy and physiotherapy) had 192 participants and the historical control group (receiving Saturday physiotherapy only) had 174 participants. On admission, intervention group participants had higher cognitive (p < 0.01) and total (p < 0.01) Functional Independence Measure scores. Participation in weekend therapy by the intervention group was 11% higher, attending more sessions (p < 0.01) for a greater length of time (p < 0.01) compared to the historical control group. After controlling for differences in admission Functional Independence Measure scores, rehabilitation length of stay was estimated to be reduced by 1.39 (p = 0.08) days. The economic evaluation identified potential cost savings of AUD1,536 per patient. The largest potential savings were attributed to neurological patients AUD4,854. Traumatic and elective orthopaedic patients realised potential patient related cost savings per admission of AUD2,668 and AUD2,180, respectively. Conclusions Implementation of four hours of Saturday occupational therapy in addition to physiotherapy results in a more efficient service, enabling a greater amount of therapy to be provided on a Saturday over a shorter length of stay. Provision of multidisciplinary Saturday rehabilitation is potentially cost reducing for the treating hospital

Does the use of store-and-forward telehealth systems improve outcomes for clinicians managing diabetic foot ulcers? A pilot study

Diabetic foot ulcers are one of the most hospitalised diabetes complications and contribute to many leg amputations.\ud Trained diabetic foot teams and specialists managing diabetic foot ulcers have demonstrated reductions in amputations and hospitalisation by up to 90%. Few such teams exist in Australia. Thus, access is limited for all geographical populations and may somewhat explain the high rates of hospitalisation.\ud Aim: This pilot study aims to analyse if local clinicians managing diabetic foot complications report improved access to diabetic foot specialists and outcomes with the introduction of a telehealth store-and-forward system.\ud Method: A store-and-forward telehealth system was implemented in six different Queensland locations between August 2009 and February 2010. Sites were offered ad hoc and/or fortnightly telehealth access to a diabetic foot speciality service. A survey was sent six months following commencement of the trial to the 14 eligible clinicians involved in the trial to gauge clinical perception of the telehealth system.\ud Results: Eight participants returned the surveys. The majority of responding clinicians reported that the telehealth system was easy to use (100%), improved their access to diabetic foot speciality services (75%), improved upskilling of local diabetes service staff (100%), and improved patient outcomes (100%).\ud Conclusion: This pilot study suggests that clinicians found the use of a telehealth store-and-forward system very useful in improving access to speciality services, clinical skills and patient outcomes. This study supports the recommendation that telehealth systems should be made available for diabetic foot ulcer management

Identifying factors associated with sedentary time after stroke. Secondary analysis of pooled data from nine primary studies.

<p><b>Background</b>: High levels of sedentary time increases the risk of cardiovascular disease, including recurrent stroke.</p> <p><b>Objective</b>: This study aimed to identify factors associated with high sedentary time in community-dwelling people with stroke.</p> <p><b>Methods</b>: For this data pooling study, authors of published and ongoing trials that collected sedentary time data, using the activPAL monitor, in community-dwelling people with stroke were invited to contribute their raw data. The data was reprocessed, algorithms were created to identify sleep-wake time and determine the percentage of waking hours spent sedentary. We explored demographic and stroke-related factors associated with total sedentary time and time in uninterrupted sedentary bouts using unique, both univariable and multivariable, regression analyses.</p> <p><b>Results</b>: The 274 included participants were from Australia, Canada, and the United Kingdom, and spent, on average, 69% (SD 12.4) of their waking hours sedentary. Of the demographic and stroke-related factors, slower walking speeds were significantly and independently associated with a higher percentage of waking hours spent sedentary (p = 0.001) and uninterrupted sedentary bouts of <i>>30</i> and <i>>60 min</i> (p = 0.001 and p = 0.004, respectively). Regression models explained 11–19% of the variance in total sedentary time and time in prolonged sedentary bouts.</p> <p><b>Conclusion</b>: We found that variability in sedentary time of people with stroke was largely unaccounted for by demographic and stroke-related variables. Behavioral and environmental factors are likely to play an important role in sedentary behavior after stroke. Further work is required to develop and test effective interventions to address sedentary behavior after stroke.</p

Validation and reliability of the Modified Elderly Mobility Scale

Objective: To establish concurrent validity, interrater and test-retest reliability of the Modified Elderly Mobility Scale (MEMS). Methods: Ninety elderly patients were scored on the MEMS. To establish concurrent validity, 75 patients MEMS scores were compared to Functional Independence Measure (FIM) scores using Spearman's correlation. Videotaped patient performances were used to establish interrater and test-retest reliability using percentage absolute agreement and intraclass correlation coefficients (ICCs). Results: The total MEMS score demonstrated a significant association with the motor (r = 0.725) and total FIM scores (r = 0.718). Absolute agreement for interrater reliability was greater than 93% for all test items, with 97 and 98% for the two new measures, respectively. Test-retest reliability demonstrated similar high levels of absolute agreement and had ICCs ranging from 0.870 to 1.0. Conclusions: The MEMS is a quick, valid and reliable test of motor function of elderly patients with a spread of functional levels

Which impairments, activity limitations and personal factors at hospital discharge predict walking activity across the first 6 months poststroke?

Purpose: To determine which impairments, activity limitations and personal factors at hospital discharge poststroke predict volume, frequency, and intensity of walking activity 1, 3, and 6 months later. Materials and Methods: Prospective longitudinal observational study. Thirty-six people with stroke (71 SD 14 years, 69% male) were recruited at hospital discharge and predictors including fatigue, mood, executive function, walking speed, walking endurance, age, prestroke activity, self-efficacy, and perceived stroke recovery and health were collected. At 1, 3, and 6 months follow-up, participants wore an ActivPAL™ accelerometer to collect measures of walking activity. Results: At 1 month, walking endurance predicted all walking activity (R2 > 0.29, p < 0.01). At 3 months, walking endurance and prestroke activity predicted activity volume and intensity (R2 = 0.46–0.61, p < 0.001), and prestroke activity predicted activity frequency (R2 = 0.31, p = 0.004). At 6 months, age-predicted activity volume and frequency (R2 = 0.34–0.35, p < 0.003), while prestroke activity, discharge walking endurance, and executive function together predicted activity intensity (R2 = 0.79, p < 0.001). Conclusion: Walking endurance contributes to walking activity outcomes across the first 6 months following hospital discharge poststroke. After 1 month of discharge, factors other than poststroke changes also contribute to activity outcomes, and should be considered when targeting poststroke physical activity

Higher-intensity treadmill walking during rehabilitation after stroke in feasible and not detrimental to walking pattern or quality: A pilot randomized trial

Objective: To determine whether higher-intensity treadmill walking during rehabilitation in those newly able to walk after stroke is feasible, is detrimental to walking or is beneficial. Design: A single-blind, randomized trial. Setting: Two rehabilitation units. Participants: Thirty people with first stroke. Interventions: Experimental group received 30 minutes of higher-intensity treadmill walking, three times per week for six weeks, in addition to usual physiotherapy. Control group received usual physiotherapy only. Main outcome measures: Feasibility was measured by examining compliance and adverse events. Detriment to walking was measured by examining pattern and quality. Benefit to walking was measured as capacity using six-minute walk test and speed, at baseline (Week 0), immediately after (Week 6) and at three months (Week 18). Results: Overall compliance was 89%, with no adverse events reported. There was no between-group difference in walking pattern and quality. By Week 6, the experimental group improved walking capacity by 62 m (95% confidence interval (CI) 10 to 114), comfortable walking speed by 0.18 m/s (95% CI 0.07 to 0.29) and fast walking speed by 0.18 m/s (95% CI 0.03 to 0.35) more than the control group. By Week 18, the experimental group was still walking 0.26 m/s (95% CI 0.12 to 0.41) faster than the control group. Conclusions: Higher-intensity treadmill walking during rehabilitation after stroke is feasible and not detrimental to walking pattern and quality in those newly able to walk. 94 participants are required to detect a between-group difference of 75 m on six-minute walk test (α 0.05, β 0.90) in future trials

Activity level of hospital medical inpatients: An observational study

Objectives: To determine the activity level of people admitted for an acute hospital medical admission and to describe the location of and people present at the activity. Design: Prospective observational behavioral mapping study. Participants: 102 patients admitted to general medical wards. Intervention: Participants were observed 1 min every 10 min during a working day from 8.30 am to 4.30 pm. Outcome measures: Highest level of activity was recorded; location, activity and person/s attending the participant. Results: Data from 76 participants were analyzed; mean age 67 (SD 19) years, 38 (50%) male. Participants were observed for 450 min. They spent 394 (88%) min in their rooms, 18 (4%) min in the bathroom and 27 (6%) min off the ward. Of the time in their rooms, participants spent a median 315 (IQR 205–398) min lying in bed, 10 (IQR 0–38) min sitting on or out of bed and 1 (IQR 0–20) min standing or walking. Participants spent a median 115 (IQR 70–158) min doing nothing, 80 (IQR 43–160) min resting or sleeping and 75 (IQR 40–168) min talking, reading or watching television. Participants were alone 280 (IQR 230–340) min and with one person 90 (IQR 50–130) min. Participants were with staff a median 120 (IQR 73–180) min; nurses 35 (IQR 20–60) min, medical staff 10 (IQR 0–18) min and allied health staff 10 (IQR 0–20) min. Conclusion: People admitted to general medical wards are inactive during hospital stay; spending the majority of the working day in their rooms, in bed and alone