A park-based group mobility program for older adults with difficulty walking outdoors: a quantitative process evaluation of the Getting Older Adults Outdoors (GO-OUT) randomized controlled trial.

BACKGROUND: Process evaluations of randomized controlled trials (RCTs) of community exercise programs are important to help explain the results of a trial and provide evidence of the feasibility for community implementation. The objectives of this process evaluation for a multi-centre RCT of outdoor walking interventions for older adults with difficulty walking outdoors, were to determine: 1) implementation fidelity (the extent to which elements of the intervention were delivered as specified in the original protocol) and 2) participant engagement (the receipt of intervention components by the participants) in the Getting Older Adults Outdoors (GO-OUT) trial. METHODS: GO-OUT participants attended an active 1-day workshop designed to foster safe, outdoor walking skills. After the workshop, 190 people at 4 sites were randomized to an outdoor walk group (OWG) (n = 98) which met 2x/week for 10 weeks, or the weekly reminders (WR) group (n = 92) which received a phone reminder 1x/week for 10 weeks. The OWG had 5 components - warm-up, continuous distance walk, task-oriented walking activities, 2nd continuous distance walk, and cool-down. Data on implementation fidelity and participant engagement were gathered during the study through site communications, use of standardized forms, reflective notes of the OWG leaders, and accelerometry and GPS assessment of participants during 2 weeks of the OWG. RESULTS: All sites implemented the workshop according to the protocol. Participants were engaged in all 8 activity stations of the workshop. WR were provided to 96% of the participants in the WR intervention group. The 5 components of the OWG sessions were implemented in over 95% of the sessions, as outlined in the protocol. Average attendance in the OWG was not high - 15% of participants did not attend any sessions and 64% of participants in the OWG attended > 50% of the sessions. Evaluations with accelerometry and GPS during week 3 and 9 OWG sessions suggest that participants who attended were engaged and active during the OWG. CONCLUSIONS: This process evaluation helps explain the main study findings and demonstrates the flexibility required in the protocol for safe and feasible community implementation. Future research could explore the use of additional behaviour change strategies to optimize attendance for community implementation. TRIAL REGISTRATION: ClinicalTrials.gov NCT03292510 Date of registration: September 25, 2017.

Optimizing falls risk prediction for inpatient stroke rehabilitation: A secondary data analysis.

BACKGROUND: Identifying individuals at risk for falls during inpatient stroke rehabilitation can ensure timely implementation of falls prevention strategies to minimize the negative personal and health system consequences of falls. OBJECTIVES: To compare sociodemographic and clinical characteristics of fallers and non-fallers; and evaluate the ability of the Berg Balance Scale (BBS) and Morse Falls Scale (MFS) to predict falls in an inpatient stroke rehabilitation setting. METHODS: A longitudinal study involving a secondary analysis of health record data from 818 patients with stroke admitted to an urban, rehabilitation hospital was conducted. A fall was defined as having ≥1 fall during the hospital stay. Cut-points on the BBS and MFS, alone and in combination, that optimized sensitivity and specificity for predicting falls, were identified. RESULTS: Low admission BBS score and admission to a low-intensity rehabilitation program were associated with falling (p < .05). Optimal cut-points were 29 for the BBS (sensitivity: 82.4%; specificity: 57.4%) and 30 for the MFS (sensitivity: 73.2%; specificity: 31.4%) when used alone. Cut-points of 45 (BBS) and 30 (MFS) in combination optimized sensitivity (74.1%) and specificity (42.7%). CONCLUSIONS: A BBS cut-point of 29 alone appears superior to using the MFS alone or combined with the BBS to predict falls.

Consumer Wearable Devices for Activity Monitoring Among Individuals After a Stroke: A Prospective Comparison.

BACKGROUND: Activity monitoring is necessary to investigate sedentary behavior after a stroke. Consumer wearable devices are an attractive alternative to research-grade technology, but measurement properties have not been established. OBJECTIVE: The purpose of this study was to determine the accuracy of 2 wrist-worn fitness trackers: Fitbit Charge HR (FBT) and Garmin Vivosmart (GAR). METHODS: Adults attending in- or outpatient therapy for stroke (n=37) wore FBT and GAR each on 2 separate days, in addition to an X6 accelerometer and Actigraph chest strap monitor. Step counts and heart rate data were extracted, and the agreement between devices was determined using Pearson or Spearman correlation and paired t or Wilcoxon signed rank tests (one- and two-sided). Subgroup analyses were conducted. RESULTS: Step counts from FBT and GAR positively correlated with the X6 accelerometer (ρ=.78 and ρ=.65, P<.001, respectively) but were significantly lower (P<.01). For individuals using a rollator, there was no significant correlation between step counts from the X6 accelerometer and either FBT (ρ=.42, P=.12) or GAR (ρ=.30, P=.27). Heart rate from Actigraph, FBT, and GAR demonstrated responsiveness to changes in activity. Both FBT and GAR positively correlated with Actigraph for average heart rate (r=.53 and .75, P<.01, respectively) and time in target zone (ρ=.49 and .74, P<.01, respectively); these measures were not significantly different, but nonequivalence was found. CONCLUSIONS: FBT and GAR had moderate to strong correlation with best available reference measures of walking activity in individuals with subacute stroke. Accuracy appears to be lower among rollator users and varies according to heart rhythm. Consumer wearables may be a viable option for large-scale studies of physical activity.

Relationship between margin of stability and deviations in spatiotemporal gait features in healthy young adults.

Increased variability of spatio-temporal features while walking is related to increased risk of falls. It is thought that variability in foot placement and timing reflects responses to mechanical instability while walking. The purpose of this study was to determine whether 'extreme' values of step length, width and time follow transient periods of low mechanical stability during the single support phase of gait in healthy young adults. We conducted secondary analysis of a portion of an existing dataset. Eleven healthy adults walked on an instrumented treadmill. Participants were outfitted with reflective markers and completed two 1-min periods of walking at each of 3 speeds (0.8m/s, 1.2m/s, and 1.6m/s). Margins of stability were calculated relative to the anterior, posterior, lateral, and medial boundaries of the base of support, and the value at heel strike and the minimum value during the first half of each single-support phase were extracted. Step length, swing time, and step width were calculated from motion capture and ground reaction force data. Extreme values for consecutive steps were identified using Poincaré plots, and margins of stability in each direction were compared between 'normal' and 'extreme' steps. Margins of stability in both the anterior and medial direction were lower prior to long and wide steps, respectively. Margins of stability in the anterior and medial directions were lower prior to quick steps, and margins of stability in the posterior and lateral directions were lower prior to slow steps. There were either no significant differences in margin of stability between 'normal' and 'extreme' steps at heel strike, or the direction of the relationship was reversed to that observed during single support. These data suggest that spatio-temporal variability may reflect adjustments in step placement and timing to compensate for transient periods of low mechanical stability when walking.