Impact of actigraphy-based circadian rest-activity rhythms on functional outcomes in post-stroke rehabilitation.

Background/purpose: This prospective observational study investigated the relationship between circadian rest-activity rhythms and functional outcomes in subacute stroke rehabilitation.

Methods: A cohort of 70 subacute stroke patients (32.9 % female; mean age 67.1 ± 12.2 years) was assessed. Actigraphy data collected over seven days were used to calculate rest-activity rhythm indicators, including interdaily stability (IS), intradaily variability, relative amplitude, and the 10 most active and five least active continuous hours. Correlations between these indicators and functional outcomes, measured by the Barthel Index (BI) at discharge, were analyzed.

Results: Significant associations were identified between rest-activity rhythm indicators and functional outcomes. By univariate analysis, IS demonstrated positive correlations with BI scores at admission (r = 0.32, P = 0.007) and at discharge (r = 0.46, P < 0.001), whereas relative amplitude and the 10 most active continuous hours also showed positive correlations with BI scores at both time points. By multivariate analysis, after adjusting for age, sex, BI score, cognition, stroke severity at admission, and other rest-activity rhythm indicators, IS was an independent predictor of discharge BI scores (β = 0.23, P = 0.013).

Conclusion: Circadian rest-activity rhythm indicators are significantly associated with functional recovery in post-stroke patients. These findings highlight the negative impact of circadian disruptions on rehabilitation outcomes and suggest that actigraphy-derived metrics could serve as promising digital biomarkers to guide interventions and enhance outcomes.