Article

Walking-related disability is the most frequent reason for inpatient
stroke rehabilitation. Task-related practice is a critical component for
improving patient outcomes. OBJECTIVE: To test the feasibility of providing
quantitative feedback about daily walking performance and motivating greater
skills practice via remote sensing. METHODS: In this phase III randomized, single
blind clinical trial, patients participated in conventional therapies while
wearing wireless sensors (triaxial accelerometers) at both ankles.
Activity-recognition algorithms calculated the speed, distance, and duration of
walking bouts. Three times a week, therapists provided either feedback about
performance on a 10-meter walk (speed only) or walking speed feedback plus a
review of walking activity recorded by the sensors (augmented). Primary outcomes
at discharge included total daily walking time, derived from the sensors, and a
timed 15-meter walk. RESULTS: Sixteen rehabilitation centers in 11 countries
enrolled 135 participants over 15 months. Sensors recorded more than 1800 days of
therapy, 37 000 individual walking bouts, and 2.5 million steps. No significant
differences were found between the 2 feedback groups in daily walking time (15.1
+/- 13.1 vs 16.6 +/- 14.3 minutes, P = .54) or 15-meter walking speed (0.93 +/-
0.47 vs 0.91 +/- 0.53 m/s, P = .96). Remarkably, 30% of participants decreased
their total daily walking time over their rehabilitation stay. CONCLUSIONS: In
this first trial of remote monitoring of inpatient stroke rehabilitation,
augmented feedback beyond speed alone did not increase the time spent practicing
or improve walking outcomes. Remarkably modest time was spent walking. Wireless
sensing, however, allowed clinicians to audit skills practice and provided ground
truth regarding changes in clinically important, mobility-related activities.
CI - (c) The Author(s) 2014.

Langue : ANGLAIS