Effects on walking performance and lower body strength by short message service guided training after stroke or transient ischemic attack (The STROKEWALK Study): a randomized controlled trial

Birgit Vahlberg, Erik Lundström, Staffan Eriksson, Ulf Holmbäck, Tommy Cederholm, Birgit Vahlberg, Erik Lundström, Staffan Eriksson, Ulf Holmbäck, Tommy Cederholm

Abstract

Objective: To evaluate whetherdaily mobile-phone delivered messages with training instructions during three months increase physical activity and overall mobility in patients soon after stroke or transient ischemic attack.

Design: Randomised controlled trial with intention-to-treat analyses.

Setting: University hospital. Data collection from November 2016 until December2018.

Subjects: Seventy-nine patients (mean (SD) age 63.9 (10.4) years, 29 were women) were allocated to either intervention (n = 40) or control group (n = 39). Participants had to be independent (modified Ranking Scale ⩽2) and able to perform the six-minute walking test at discharge from the hospital.

Interventions: The intervention group received standard care and daily mobile phone instructional text messages to perform regular outdoor walking and functional leg exercises. The control group received standard care; that is, primary care follow-up.

Main measures: Walking performance by six-minute walking test (m), lower body strength by five times chair-stand test (s), the short physical performance battery (0-12 points) and 10-metres walk test (m/s) were assessed at baseline and after three months.

Results: The estimated median difference in the six-minute walking test was in favour of the intervention group by 30 metres (95% CI, 55 to 1; effect size 0.64; P = 0.037) and in the chair-stand test by 0.88 seconds (95% CI, 0.02 to 1.72; effect size 0.64; P = 0.034). There were no differences between groups on the short physical performance battery or in 10-metres walking time.

Conclusions: Three months of daily mobile phone text messages with guided training instructions improved composite mobility measures; that is, walking performanceand lower body strength.

Clinical trial registry: The study is registered with ClinicalTrials.gov, number NCT02902367.

Keywords: Stroke; TIA; physical activity; rehabilitation interventions; secondary prevention.

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow chart of the study participants through the phases of the randomised controlled trial. Data were collected at Uppsala University Hospital, Sweden between November 1st, 2016 and December 18th, 2018. Individuals were randomised within one week after baseline assessment. No adverse events were reported.

References

    1. Michael KM, Allen JK, Macko RF. Reduced ambulatory activity after stroke: the role of balance, gait, and cardiovascular fitness. Arch Phys Med Rehabil 2005; 86(8): 1552–1556.
    1. English C, Healy GN, Coates A, et al. Sitting and activity time in people with stroke. Phys Ther 2016; 96(2): 193–201.
    1. Virani SS, Alonso A, Benjamin EJ, et al. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation 2020; 141(9): e139–e596.
    1. MacKay-Lyons M, Billinger SA, Eng JJ, et al. Aerobic exercise recommendations to optimize best practices in care after stroke: aerobics 2019 update. Phys Ther 2019; 100(1): 149–156.
    1. Saunders DH, Sanderson M, Hayes S, et al. Physical fitness training for stroke patients. Cochrane Database Syst Rev 2016; 24(3): CD003316.
    1. English C, Manns PJ, Tucak C, et al. Physical activity and sedentary behaviors in people with stroke living in the community: a systematic review. Phys Ther 2014; 94(2): 185–196.
    1. Danielsson A, Meirelles C, Willen C, et al. Physical activity in community-dwelling stroke survivors and a healthy population is not explained by motor function only. PM R 2014; 6(2): 139–145.
    1. Heron N, Kee F, Cardwell C, et al. Secondary prevention lifestyle interventions initiated within 90days after TIA or ‘minor’ stroke: a systematic review and meta-analysis of rehabilitation programmes. Br J Gen Pract 2017; 67(654): e57–e66.
    1. Törnbom K, Sunnerhagen KS, Danielsson A. Perceptions of physical activity and walking in an early stage after stroke or acquired brain injury. PLoS One 2017; 12(3): e0173463.
    1. Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation 2019; 139(10): e56–e528.
    1. Vahlberg B, Holmbäck U, Eriksson S, et al. Protocol and pilot study of a short message service-guided training after acute stroke/transient ischemic attack to increase walking capacity and physical activity. Prev Med Rep 2018; 11: 109–114.
    1. Nasreddine ZS, Phillips N, Chertkow H. Normative data for the Montreal Cognitive Assessment (MoCA) in a population-based sample. Neurology 2012; 78(10): 765–766.
    1. Banks JL, Marotta CA. Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke 2007; 38(3): 1091–1096.
    1. Brooks D, Solway S, Gibbons W. ATS statement on six-minute walk test. Am J Respir Crit Care Med 2003; 167(9): 1287.
    1. Goldstein LB, Samsa GP, Matchar DB, et al. Charlson index comorbidity adjustment for ischemic stroke outcome studies. Stroke 2004; 35(8): 1941–1945.
    1. Claesson M, Birgander LS, Lindahl B, et al. Women’s hearts–stress management for women with ischemic heart disease: explanatory analyses of a randomized controlled trial. J Cardiopulm Rehabil 2005; 25(2): 93–102.
    1. Rödjer L, Jonsdottir IH, Rosengren A, et al. Self-reported leisure time physical activity: a useful assessment tool in everyday health care. BMC Public Health 2012; 12: 693.
    1. Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994; 49(2): M85–M94.
    1. Jones CJ, Rikli RE, Beam WC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport 1999; 70(2): 113–119.
    1. Studenski S, Perera S, Patel K, et al. Gait speed and survival in older adults. JAMA 2011; 305(1): 50–58.
    1. Tyson S, Connell L. The psychometric properties and clinical utility of measures of walking and mobility in neurological conditions: a systematic review. Clin Rehabil 2009; 23(11): 1018–1033.
    1. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982; 14(5): 377–381.
    1. Tudor-Locke C, Bassett DR. How many steps/day are enough? Preliminary pedometer indices for public health. Sports Med 2004; 34(1): 1–8.
    1. Flansbjer UB, Holmbäck AM, Downham D, et al. Reliability of gait performance tests in men and women with hemiparesis after stroke. J Rehabil Med 2005; 37(2): 75–82.
    1. Vahlberg B, Cederholm T, Lindmark B, et al. Short-term and long-term effects of a progressive resistance and balance exercise program in individuals with chronic stroke: a randomized controlled trial. Disabil Rehabil 2017; 39(16): 1615–1622.
    1. Eng JJ, Dawson AS, Chu KS. Submaximal exercise in persons with stroke: test-retest reliability and concurrent validity with maximal oxygen consumption. Arch Phys Med Rehabil 2004; 85(1): 113–118.
    1. Hodges JL, Lehmann E.L. Estimation of location based on ranks. Ann Math Stat 1963; 34(2): 598–611.
    1. Acion L, Peterson JJ, Temple S, et al. Probabilistic index: an intuitive non-parametric approach to measuring the size of treatments effects. Stat Med 2006; 25(4): 591–602.
    1. Thilarajah S, Mentiplay BF, Bower KJ, et al. Factors associated with post-stroke physical activity: a systematic review and meta-analysis. Arch Phys Med Rehabil 2018; 99(9): 1876–1889.
    1. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation 2016; 133(4): e38–e360.
    1. Sandberg K, Kleist M, Falk L, et al. Effects of twice-weekly intense aerobic exercise in early subacute stroke: a randomized controlled trial. Arch Phys Med Rehabil 2016; 97(8): 1244–1253.
    1. Pollock A, Gray C, Culham E, et al. Interventions for improving sit-to-stand ability following stroke. Cochrane Database Syst Rev 2014; 5: CD007232.
    1. Berg K, Wood-Dauphinee S, Williams JI. The balance scale: reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med 1995; 27(1): 27–36.
    1. Franchignoni F, Horak F, Godi M, et al. Using psychometric techniques to improve the Balance Evaluation Systems Test: the mini-BESTest. J Rehabil Med 2010; 42(4): 323–331.
    1. Burridge JH, Lee ACW, Turk R, et al. Telehealth, wearable sensors, and the internet: will they improve stroke outcomes through increased intensity of therapy, motivation, and adherence to rehabilitation programs? J Neurol Phys Ther 2017; 41(Suppl. 3): S32–S38.
    1. Ramage ER, Fini NA, Lynch EA, et al. Supervised exercise delivered via telehealth in real time to manage chronic conditions in adults: a protocol for a scoping review to inform future research in stroke survivors. BMJ Open 2019; 9(3): e027416.
    1. RIKSstroke. RIKSstroke, the Swedish stroke register, (accessed October 2019).

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner