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Disparities in research publications are common in the physiotherapy and rehabilitation fields. (1) A small proportion of published research arises from low-income and middle-income countries (LMICs), (1,2) home to 85% [...]

Background. What contributes to free-living walking after stroke is poorly understood. Studying the characteristics of walking may provide further details that guide interventions. Objective. The objectives of this study were to examine how the walking characteristics of bouts per day, median steps per bout, maximum steps per bout, and time spent walking differ in individuals with various walking speeds, walking endurance, and daily steps and to identify cutoffs for differentiating ambulators who were active versus inactive. Design. This study involved a cross-sectional analysis of data from the Locomotor Experience Applied Post-Stroke trial. Methods. Participants were categorized by walking speed, walking endurance (via the 6-minute walk test), and daily steps (via 2 consecutive days of objective activity monitoring). Differences in walking characteristics were assessed. Linear regression determined which characteristics predicted daily step counts. Receiver operating characteristic curves and areas under the curve were used to determine which variable was most accurate in classifying individuals who were active (>5500 daily steps). Results. This study included 252 participants with chronic stroke. Regardless of categorization by walking speed, walking endurance, or daily steps, household ambulators had significantly fewer bouts per day, steps per bout, and maximum steps per bout and spent less time walking compared with community ambulators. The areas under the curve for maximum steps per bout and bouts per day were 0.91 (95% confidence interval = 0.88 to 0.95) and 0.83 (95% confidence interval = 0.78 to 0.88), respectively, with cutoffs of 648 steps and 53 bouts being used to differentiate active and inactive ambulation. Limitations. Activity monitoring occurred for only 2 days. Conclusions. Walking characteristics differed based on walking speed, walking endurance, and daily steps. Differences in daily steps between household and community ambulators were largely due to shorter and fewer walking bouts. Assessing and targeting walking bouts may prove useful for increasing stepping after stroke., Stroke is the leading cause of long-term disability in the United States (1) and can negatively impact the ability to walk at home or in the community. For many of [...]

Background. Advances in sensor technologies and signal processing techniques provide a method to accurately measure walking activity in the home and community. Activity monitors geared toward consumer or patient use may be an alternative to more expensive monitors designed for research to measure stepping activity. Objective. The objective of this study was to examine the accuracy of 2 consumer/patient activity monitors, the Fitbit Ultra and the Nike + Fuelband, in identifying stepping activity in people with stroke and traumatic brain injury (TBI). Secondarily, the study sought to compare the accuracy of these 2 activity monitors with that of the StepWatch Activity Monitor (SAM) and a pedometer, the Yamax Digi-Walker SW-701 pedometer (YDWP). Design. A cross-sectional design was used for this study. Method. People with chronic stroke and TBI wore the 4 activity monitors while they performed the Two-Minute Walk Test (2MWT), during which they were videotaped. Activity monitor estimated steps taken were compared with actual steps taken counted from videotape. Accuracy and agreement between activity monitor estimated steps and actual steps were examined using intraclass correlation coefficients (ICC [2,1]) and the Bland-Altman method. Results. The SAM demonstrated the greatest accuracy (ICC [2,1] = .97, mean difference between actual steps and SAM estimated steps = 4.7 steps) followed by the Fitbit Ultra (ICC [2,1] = .73, mean difference between actual steps and Fitbit Ultra estimated steps = -9.7 steps), the YDWP CICC [2,1] = .42, mean difference between actual steps and YDWP estimated steps = - 28.8 steps), and the Nike + Fuelband (ICC [2,1] = .20, mean difference between actual steps and Nike+ Fuelband estimated steps = -66.2 steps). Limitations. Walking activity was measured over a short distance in a closed environment, and participants were high functioning ambulators, with a mean gait speed of 0.93 m/s. Conclusions. The Fitbit Ultra may be a low-cost alternative to measure the stepping activity in level, predictable environments of people with stroke and TBI who can walk at speeds ≥ 0.58 m/s., The recovery of walking ability is a primary goal for many people with stroke, traumatic brain injury (TBI), and other neurological disorders. (1-4) The clinical gold standard for measuring walking [...]

Background. The upper-extremity portion of the Fugl-Meyer Scale (UE-FM) is one of the most established and commonly used outcome measures in stroke rehabilitative trials. Empirical work is needed to determine the amount of change in UE-FM scores that can be regarded as important and clinically meaningful for health professionals, patients, and other stakeholders. Objective. This study used anchor-based methods to estimate the clinically important difference (CID) for the UE-FM in people with minimal to moderate impairment due to chronic stroke. Method. one hundred forty-six individuals with stable, mild to moderate upper-extremity (UE) hemiparesis were administered the UE-FM before and after an intervention targeting their affected UEs. The treating therapists rated each participant's perceived amount of UE motor recovery on a global rating of change (GROC) scale evaluating several facets of UE movement (grasp, release, move the affected UE, perform 5 important functional tasks with the affected UE, overall UE function). Estimated CID of the UE-FM scores was calculated using receiver operating characteristic (ROC) curve with the GROC scores as the anchor. Results, The ROC curve analysis revealed that change in UE-FM scores during the intervention period distinguished participants who experienced clinically important improvement from those that did not based on the therapists' GROC scores. The area under the curve ranged from 0.61 to 0.70 for the different facets of UE movement. Conclusions. The estimated CID of the UE-FM scores ranged from 4.25 to 7.25 points, depending on the different facets of UE movement., The Fugl-Meyer Scale is an established, often-used measure of upper-extremity impairment after stroke. Its reliability and validity are widely known. This study provides clinicians with information on the smallest amount [...]