Steps, duration and intensity of usual walking practice during subacute rehabilitation after stroke: an observational study

Abstract

Background: Duration of therapy time is an inadequate indicator of stroke rehabilitation. Steps, duration, and intensity of active therapy time may provide a better indicator of practice.

Objective: This study quantified usual walking practice in terms of steps, duration and intensity of active therapy time, and distance walked during physical therapy sessions in people with sub-acute stroke undertaking inpatient rehabilitation and to examine whether usual walking practice differed depending on walking ability.

Methods: A prospective observational study was conducted across two metropolitan rehabilitation units in Australia. Twenty-four stroke survivors were observed over three physical therapy sessions. Walking ability was categorized as unassisted or assisted based on Item 5 of the Motor Assessment Scale. Walking practice was categorized as basic or advanced. Steps, duration, intensity and distance walked were measured during physical therapy sessions.

Results: Overall, participants took 560 steps (SD 309) over 13 min (SD 6) at an intensity of steps 44 steps/min (SD 17) and walked 222 m (SD 143) in physical therapy. Unassisted walkers (n = 6, 25%) undertook more (or trended towards more) practice of advanced walking than assisted walkers in terms of steps (MD 254 steps, 95% CI 48–462), duration (MD 5 min, 95% CI 0–10), intensity (MD 18 steps/min, 95% CI −8 to 44) and distance (MD 112 m, 95% CI −12 to 236).

Conclusion: Stroke survivors undergoing inpatient rehabilitation spent approximately 20% of physical therapy actively engaged in walking practice. Those able to walk without assistance took more steps for longer, at a higher intensity.