Using Wireless-technology for Feedback of Daily Walking Activity Post-stroke

Study Overview
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Brief Summary
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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.

Official Title
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Using Wireless Technology in Clinical Practice: Does Feedback of Daily Walking Activity Improve Walking Outcomes of Individuals Receiving Rehabilitation Post-stroke?

Conditions
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Stroke

Intervention / Treatment
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* Behavioral: Feedback of daily walking activity


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: individuals with sub-acute stroke attending in-patient rehabilitation at Toronto Rehab patients who have identified improving walking function as a rehabilitation goal patients who can walk without supervision at the time of recruitment into the study

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Feedback group<br>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<br>* 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.<br>|
| No Intervention: No-feedback group<br>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. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in walking activity from admission to discharge from rehabilitation | 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). | Admission and discharge from in-patient rehabilitation (approx. 4-6 weeks) | 
| Change in control of walking | Self-selected walking speed and symmetry of spatio-temporal characteristics of walking | Admission and discharge from in-patient rehabilitation (approx. 4-6 weeks) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in self-efficacy | Stroke self-efficacy questionnaire | Admission and discharge from in-patient rehabilitation (approx. 4-6 weeks) | 
| Goal attainment | Rehabilitation goals are classified as 'achieved', 'partially achieved', 'not completed' or 'discontinued'. | Discharge from in-patient rehabilitation (4-6 weeks), discharge from out-patient rehabilitation (10-16 weeks) | 
| Community integration | Community integration questionnaire | Discharge from out-patient rehabilitation (10-16 weeks) and 3-month follow-up | 
| Satisfaction with progress towards rehabilitation goals | Participants will be asked to rate satisfaction with progress towards goals on a 10-point scale | Discharge from in-patient rehabilitation (4-6 weeks) and discharge from out-patient rehabilitation (10-16 weeks) | 
| Barriers to walking | Open-ended question regarding participants' perceived barriers to walking. | Monitored throughout participants' enrolment (0-28 weeks) | 
| Falls | 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. | Monitored throughout participants' enrolment (0-28 weeks) |