Real-world walking activity in individuals with chronic stroke
Date
2022
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
University of Delaware
Abstract
Stroke is a leading cause of disability and results in numerous impairments, including deficits in walking capacity, cognition, and self-efficacy. These deficits can negatively affect a stroke survivor’s walking activity, placing them at an increased risk for recurrent stroke. Rehabilitation clinical trials in stroke have therefore tested interventions to improve walking capacity or targeted walking activity directly and utilized step activity monitors to measure the effectiveness of these interventions. This line of work has resulted in several critical findings, including (1) the profound sedentariness of people with stroke, (2) the observation that improvements in laboratory-based measures of walking capacity do not necessarily translate to what people actually do in their real-world setting (i.e., real-world walking activity), and (3) a general lack of effectiveness of interventions that result in long-term improvements in real-world walking activity. These observations may be partly explained by a lack of understanding as to how factors associated with real-world walking activity are related and a lack of understanding of how real-world walking activity may best be measured. The overarching goal of this dissertation was to address these knowledge gaps to inform future behavioral clinical trials targeting real-world walking activity in persons with stroke. ☐ In Aim 1, we found that numerous factors are associated with real-world walking activity in persons with stroke and that several of these factors, specifically walking capacity, balance self-efficacy, cognition, and environmental factors are related. This result may explain why improvements in laboratory-based measures of walking capacity do not necessarily translate to improvements in real-world walking activity. This result also reinforces the notion that behavior change programs targeting real-world walking activity in people with stroke should be multifaceted and provides empirical targets that should be considered in such programs. ☐ In Aim 2, we found partial support for our theoretical model hypothesizing how several of the factors identified in Aim 1 are related. In particular, we found that balance self-efficacy mediates the relationship between the physical environment and real-world walking activity in people with stroke. This result provides new perspective on how clinicians may be able to overcome environmental barriers to improve real-world walking activity in their patients with stroke and represents a first critical step towards understanding the complex relationships among these factors. ☐ In Aim 3, we found that measures of activity intensity and sedentary behavior were most strongly related to systolic blood pressure in people with stroke, whereas steps/day was not. This result provides new perspective on the measurement of real-world walking activity in people with stroke and suggests the field may need to look beyond steps/day when measuring real-world walking activity in the context of physical health. ☐ The limited effectiveness of rehabilitation clinical trials targeting real-world walking activity may also be partly explained by the significant heterogeneity and limitations in study design of previous work. Therefore, the training aim of this dissertation provided opportunities to understand best practices of clinical trials research. ☐ In summary, the results of this dissertation suggest that numerous, related factors affect real-world walking activity in people with stroke and that careful consideration should be made when determining how this activity should be quantified. This knowledge can be used to inform the development of behavior change programs targeting real-world walking activity in people with stroke.
Description
Keywords
Physical activity, Rehabilitation, Sensors, Stroke, Walking