Matching Clinical Profiles with Interventions to Optimize Daily Stepping in People with Stroke.

IF 3.5 4区医学 Q1 ORTHOPEDICS

Physical Therapy Pub Date : 2025-05-13 DOI:10.1093/ptj/pzaf070

Kiersten M McCartney, Ryan T Pohlig, Allison E Miller, Elizabeth D Thompson, Darcy S Reisman

{"title":"Matching Clinical Profiles with Interventions to Optimize Daily Stepping in People with Stroke.","authors":"Kiersten M McCartney, Ryan T Pohlig, Allison E Miller, Elizabeth D Thompson, Darcy S Reisman","doi":"10.1093/ptj/pzaf070","DOIUrl":null,"url":null,"abstract":"Importance: Individualizing interventions is imperative to optimize step-activity in people with chronic stroke.Objective: The objective was to group individuals with chronic stroke into clinical profiles based on baseline characteristics and examine if these profiles preferentially benefitted from a specific intervention to improve daily step-activity.Design: This is a secondary analysis of a randomized control trial.Setting: The parent study occurred at 4 outpatient rehabilitation clinics.Participants: Participants had strokes ≥6 months prior to enrollment, were 21 to 85 years old, had walking speeds of 0.3 to1.0 m/s, and took <8000 steps-per-day.Interventions: Participants were randomized to high-intensity treadmill training (FAST), a step-activity behavioral intervention (SAM), or a combined intervention (FAST+SAM).Main outcome(s): The primary outcome was the interaction of latent class (clinical profile) and intervention group (FAST, SAM, FAST+SAM) on a change in steps-per-day. Key clinical characteristics to identify the latent classes included walking speed, walking endurance, balance self-efficacy, cognition, and area deprivation.Results: Of the 190 participants with complete pre- and post-intervention data (mean [SD] age, 64 [12] years; 93 females [48.9%]), 3 distinct profiles of people with chronic stroke were identified. Class 1 had the lowest walking capacity (speed and endurance), lowest balance self-efficacy, and highest area deprivation, and the greatest change in step-activity when enrolled in SAM (mean = 1624, 95% CI = 426 to 2821) or FAST+SAM (mean = 1150, 95% CI = 723 to 1577]). Class 2 had walking capacity, baseline steps-per-day, and self-efficacy values between Class 1 and 3, and had the greatest change in step-activity when enrolled in SAM (mean = 2002, 95% CI = 1193 to 2811). Class 3 had the highest walking capacity, highest self-efficacy, and lowest area deprivation and the greatest change in step-activity when enrolled in FAST+SAM (mean = 1532, 95% CI = 915 to 2150).Conclusions: People with chronic stroke require different interventions to optimize changes in step-activity.Relevance: Clinicians can use clinically relevant measures to personalize intervention selection to augment step-activity in people with chronic stroke.","PeriodicalId":20093,"journal":{"name":"Physical Therapy","volume":" ","pages":""},"PeriodicalIF":3.5000,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Physical Therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ptj/pzaf070","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

Abstract

Importance: Individualizing interventions is imperative to optimize step-activity in people with chronic stroke.

Objective: The objective was to group individuals with chronic stroke into clinical profiles based on baseline characteristics and examine if these profiles preferentially benefitted from a specific intervention to improve daily step-activity.

Design: This is a secondary analysis of a randomized control trial.

Setting: The parent study occurred at 4 outpatient rehabilitation clinics.

Participants: Participants had strokes ≥6 months prior to enrollment, were 21 to 85 years old, had walking speeds of 0.3 to1.0 m/s, and took <8000 steps-per-day.

Interventions: Participants were randomized to high-intensity treadmill training (FAST), a step-activity behavioral intervention (SAM), or a combined intervention (FAST+SAM).

Main outcome(s): The primary outcome was the interaction of latent class (clinical profile) and intervention group (FAST, SAM, FAST+SAM) on a change in steps-per-day. Key clinical characteristics to identify the latent classes included walking speed, walking endurance, balance self-efficacy, cognition, and area deprivation.

Results: Of the 190 participants with complete pre- and post-intervention data (mean [SD] age, 64 [12] years; 93 females [48.9%]), 3 distinct profiles of people with chronic stroke were identified. Class 1 had the lowest walking capacity (speed and endurance), lowest balance self-efficacy, and highest area deprivation, and the greatest change in step-activity when enrolled in SAM (mean = 1624, 95% CI = 426 to 2821) or FAST+SAM (mean = 1150, 95% CI = 723 to 1577]). Class 2 had walking capacity, baseline steps-per-day, and self-efficacy values between Class 1 and 3, and had the greatest change in step-activity when enrolled in SAM (mean = 2002, 95% CI = 1193 to 2811). Class 3 had the highest walking capacity, highest self-efficacy, and lowest area deprivation and the greatest change in step-activity when enrolled in FAST+SAM (mean = 1532, 95% CI = 915 to 2150).

Conclusions: People with chronic stroke require different interventions to optimize changes in step-activity.

Relevance: Clinicians can use clinically relevant measures to personalize intervention selection to augment step-activity in people with chronic stroke.

查看原文本刊更多论文

将临床资料与干预措施相匹配以优化中风患者的日常步行。

重要性：个体化干预是优化慢性卒中患者阶梯活动的必要条件。目的：目的是根据基线特征将慢性卒中患者分组到临床概况中，并检查这些概况是否优先受益于改善日常步活动的特定干预。设计：这是一项随机对照试验的二次分析。背景：本研究在4个门诊康复诊所进行。参与者：参与者在入组前6个月中风，年龄在21 - 85岁，步行速度在0.3 - 1.0 m/s，并采取干预措施：参与者随机分为高强度跑步机训练（FAST），步进活动行为干预（SAM）或联合干预（FAST+SAM）。主要结局：主要结局是潜在类别（临床概况）和干预组（FAST， SAM, FAST+SAM）对每日步数变化的相互作用。识别潜在类别的关键临床特征包括步行速度、步行耐力、平衡自我效能、认知和区域剥夺。结果：在190名具有完整干预前后数据的参与者中(平均[SD]年龄为64岁；93名女性[48.9%])，确定了慢性卒中患者的3种不同特征。第1类患者的步行能力（速度和耐力）最低，平衡自我效能最低，区域剥夺程度最高，步距活动变化最大（平均= 1624,95% CI = 426 ~ 2821）或FAST+SAM（平均= 1150,95% CI = 723 ~ 1577）。第2类患者的步行能力、每日基线步数和自我效能值介于第1类和第3类之间，并且在参加SAM时步数活动变化最大（平均值= 2002,95% CI = 1193至2811）。当参加FAST+SAM时，第3类具有最高的步行能力，最高的自我效能，最低的区域剥夺和最大的步行活动变化（平均值= 1532,95% CI = 915至2150）。结论：慢性脑卒中患者需要不同的干预措施来优化步活动的改变。相关性：临床医生可以使用临床相关的措施来个性化干预选择，以增加慢性卒中患者的步活动。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Physical Therapy Multiple-

CiteScore

7.10

自引率

0.00%

发文量

187

审稿时长

4-8 weeks

期刊介绍： Physical Therapy (PTJ) engages and inspires an international readership on topics related to physical therapy. As the leading international journal for research in physical therapy and related fields, PTJ publishes innovative and highly relevant content for both clinicians and scientists and uses a variety of interactive approaches to communicate that content, with the expressed purpose of improving patient care. PTJ"s circulation in 2008 is more than 72,000. Its 2007 impact factor was 2.152. The mean time from submission to first decision is 58 days. Time from acceptance to publication online is less than or equal to 3 months and from acceptance to publication in print is less than or equal to 5 months.