Csilla Manoczki, MD
International Stroke Conference 2021
March 17–19, 2021
Handlery R, Regan EW, Stewart JC, Pellegrini C, Monroe C, Hainline G, Handlery K, Fritz SL. Predictors of Daily Steps at 1-Year Poststroke: A Secondary Analysis of a Randomized Controlled Trial. Stroke. 2021.
With wearable technologies becoming widely available, daily step count can be easily measured and utilized to track the patient’s physical activity in the home environment. Understanding which factors contribute to achieving a higher daily step count can help with tailoring interventions in the individual’s rehabilitation process.
A previous study showed that achieving a step count of at least 6000 steps a day decreases the risk of future cardiovascular events in patients after stroke; hence, the authors selected 6000 steps as target at 1 year post stroke with the potential of improved long-term health outcomes.
The aims of this study were: 1) to identify the modifiable and non-modifiable factors at 2 months post-stroke that best predict daily step counts at 1 year post-stroke, and 2) the daily step count at 2 months that corresponds to achieving ³6000 steps/day at 1 year post stroke.
Data from the LEAPS (Locomotor Experience Applied Post Stroke) trial was used for secondary analysis. The LEAPS trial was a single blinded, three arm, randomized control study that investigated the effects of three interventions on walking speed (body weight–supported treadmill training early at 2 months, or late at 6 months post-stroke; and a progressive supervised home exercise program). Each intervention consisted of 36 sessions of 90 minutes’ duration exercise program over 12-16 weeks. Inclusion criteria for the LEAPS trial were: diagnosis of first stroke (ischemic or hemorrhagic), able to walk at least 3 meters with or without help of another person and have a self-selected walking speed of <0.80m/s.
206 patients’ data from the LEAPS trial were eligible for analysis (mean age: 63, male: 57.3%, baseline NIHSS: 6). Of the 18 candidate predictors investigated, a significant association (p<=0.001) was found in the following 9 modifiable factors: daily step count at 2 months, self-selected and self-paced walking speed, walking endurance, cardiorespiratory fitness, lower extremity impairment, participant reported mobility, balance and balance confidence. The only non-modifiable factor with significant association was initial stroke severity as per NIHHS score.
In the final model, the strongest predictors were balance and daily step count at 2 months, accounting for 38% of variance in daily steps at 1 year post-stroke. Participants who took ³1632 steps at 2 months were 1.86 times more likely to achieve ³6000/day at 1 year post stroke.
Although all participants improved their daily step count, interestingly, only 27.6% of them were able to obtain at least 6000 steps a day at 1 year post stroke. A reason for this might be that the LEAPS trial’s primary aim was to improve walking speed rather than walking activity.
The results show that a distinct focus on balance and daily walking activity in the early rehabilitation after stroke improves long-term physical activity, and reaching preliminary target of 1632 daily steps at 2 months may lead to better long-term prognosis with reduction of future cardiovascular events. The combination of a structured exercise program and a behavioral intervention, such as setting daily step goals, can be of additional benefit.