Practical Ways to Measure Walking Intensity During Daily Inpatient Physical Therapy in Individuals Post-Stroke.

Research Report
Population: Adult

Tara D Klassen, PT, MSc, Instructor/PhD Student, University of British Columbia

Jennifer Semrau, PhD, Post-Doctoral Fellow, University of Calgary

Sean Dukelow, MD, PhD, Associate Professor, University of Calgary

Janice Eng, PhD, PT/OT, Professor, University of British Columbia

Keywords: Plasticity, Gait, Recovery, Stroke

PURPOSE: A top priority in stroke rehabilitation is determining the appropriate exercise intensity and dose to promote optimal recovery. The success of this endeavor strongly depends on identifying practical ways to accurately measure daily exercise intensity and dose in busy clinical environments. This is a current challenge in monitoring walking recovery post-stroke, particularly in the early phase when inpatient rehabilitation occurs. Clinicians in this demanding clinical setting require a monitoring method that is easy to administer and is also sensitive to the wide variability of walking abilities that may present. To explore practical solutions to this challenge, this study investigated the use of two devices to monitor walking intensity during daily inpatient physical therapy sessions for individuals post-stroke.
SUBJECTS: Twenty individuals admitted to inpatient rehabilitation within four weeks post-stroke were recruited for this study. The participants were part of a larger, multi-site, randomized clinical trial investigating the feasibility and effectiveness of higher intensity exercise in the early phase post-stroke.
METHODS: Two measurement devices, which provide instantaneous and continuous feedback, were used: the Fitbit One to measure step count, and the Alpha Mio strapless heart rate monitor to measure heart rate. Participants also wore the Step Watch Activity Monitor (SAM), the gold standard in stroke rehabilitation research for step count measurement, as a means of validating the Fitbit One. Devices were put on each participant at the beginning of the physical therapy session and removed at the end, for a total of 10 sessions. Correlation analysis compared the relationship of the step count measure on the Fitbit One to the SAM and the relationship of the heart rate monitor data to the step count data.
RESULTS: Preliminary findings indicate a positive correlation between the Fitbit One and the SAM in measuring step count across a wide range of post-stroke walking disability. The relationship between cardiovascular intensity (measured by the heart rate monitor) and step count appears to be more complex. As higher cardiovascular intensity training may require more frequent rest breaks, there is the potential that fewer steps may be completed compared to a lower cardiovascular intensive training session when a patient may walk continuously for longer periods of time and achieve an equivalent, if not greater, number of steps. This finding demonstrates the importance of measuring both heart rate and step count to assess walking intensity.
CONCLUSIONS: The Fitbit One and Alpha Mio watch are two commercially available devices that may fill the gap of clinically practical, readily available devices to measure walking intensity in individuals post-stroke during inpatient rehabilitation.
CLINICAL RELEVANCE: This study provides preliminary evidence for the use of two monitors, the Fitbit One and the Alpha Mio watch, to practically measure post-stroke walking intensity in the clinical inpatient rehabilitation setting.

Klassen, Tara D, PT, MSc; Semrau, Jennifer A, PhD; Dukelow, Sean P, MD, PhD; Eng, Janice J, PhD, PT/OT. Practical Ways to Measure Walking Intensity During Daily Inpatient Physical Therapy in Individuals Post-Stroke.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online.