Using Wireless-technology for Feedback of Daily Walking Activity Post-stroke
Regaining independent walking is the top priority for individuals recovering from stroke. Thus, physical rehabilitation post-stroke should focus on improving walking function and endurance. However, the amount of walking completed by individuals with stroke attending rehabilitation is far below that required for independent community ambulation. There has been increased interest in accelerometer-based monitoring of walking post-stroke. Walking monitoring could be integrated within the goal-setting process for those with ambulation goals in rehabilitation. The purpose of this study is to determine the effect of accelerometer-based feedback of daily walking activity during rehabilitation on the frequency and duration of walking post-stroke.
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Treatment
|Official Title:||Using Wireless Technology in Clinical Practice: Does Feedback of Daily Walking Activity Improve Walking Outcomes of Individuals Receiving Rehabilitation Post-stroke?|
- Change in walking activity from admission to discharge from rehabilitation [ Time Frame: Admission and discharge from in-patient rehabilitation (approx. 4-6 weeks) ] [ Designated as safety issue: No ]Total daily walking acitivty, measured by number of steps per day, total duration of walking activity, total distance walked, and frequency of 'long' walking bouts (>5 minutes in duration).
- Change in control of walking [ Time Frame: Admission and discharge from in-patient rehabilitation (approx. 4-6 weeks) ] [ Designated as safety issue: No ]Self-selected walking speed and symmetry of spatio-temporal characteristics of walking
- Change in self-efficacy [ Time Frame: Admission and discharge from in-patient rehabilitation (approx. 4-6 weeks) ] [ Designated as safety issue: No ]Stroke self-efficacy questionnaire
- Goal attainment [ Time Frame: Discharge from in-patient rehabilitation (4-6 weeks), discharge from out-patient rehabilitation (10-16 weeks) ] [ Designated as safety issue: No ]Rehabilitation goals are classified as 'achieved', 'partially achieved', 'not completed' or 'discontinued'.
- Community integration [ Time Frame: Discharge from out-patient rehabilitation (10-16 weeks) and 3-month follow-up ] [ Designated as safety issue: No ]Community integration questionnaire
- Satisfaction with progress towards rehabilitation goals [ Time Frame: Discharge from in-patient rehabilitation (4-6 weeks) and discharge from out-patient rehabilitation (10-16 weeks) ] [ Designated as safety issue: No ]Participants will be asked to rate satisfaction with progress towards goals on a 10-point scale
- Barriers to walking [ Time Frame: Monitored throughout participants' enrolment (0-28 weeks) ] [ Designated as safety issue: No ]Open-ended question regarding participants' perceived barriers to walking.
- Falls [ Time Frame: Monitored throughout participants' enrolment (0-28 weeks) ] [ Designated as safety issue: Yes ]Increased walking activity might increase the risk for falls. Falls experienced throughout the study will be recorded to determine if there are more falls in the experimental group.
|Study Start Date:||October 2012|
|Estimated Study Completion Date:||June 2014|
|Primary Completion Date:||January 2014 (Final data collection date for primary outcome measure)|
Experimental: Feedback group
For participants assigned to the feedback group, physiotherapists will receive a summary of patients' walking activity for the previous week as a tool to guide goal planning. Physiotherapists will use the information as a 'homework checker' to determine if patients are complying with an assigned walking program. In the case of non-compliance, the physiotherapist will discuss a coping strategy for better integrating walking activity into the patients' day. In the event that the patient is meeting their specific sub-goals for walking activity, the physiotherapist will re-evaluate these sub-goals and suggest more challenging goals.
Behavioral: Feedback of daily walking activity
Participants will wear accelerometers every weekday during in-patient rehabilitation to monitor walking activity. Feedback of daily walking activity will be provided to the patients' treating physiotherapists to assist with goal-planning around walking.
No Intervention: No-feedback group
For participants assigned to the control group, physiotherapists will not receive accelerometer-based feedback of daily walking activity. However, physiotherapists will still discuss the achievement of walking goals with their patients. This is usual care around goal planning.
|Toronto Rehabilitation Institute|
|Toronto, Ontario, Canada, M5G 2A2|
|Principal Investigator:||Avril Mansfield, PhD||Toronto Rehabilitation Institute|