Comparing the physical activity of stroke survivors in high-income countries and low to middle-income countries.

BACKGROUND: Low physical activity levels in people with stroke may contribute to higher risk of cardiovascular disease morbidity and mortality. Differences in economic status, culture and the built environment may influence the applicability of interventions developed in high income countries (HIC) for stroke survivors in low to middle-income countries (LMIC). PURPOSE: To compare physical activity levels of stroke survivors in HIC and LMIC and to explore the influence of lower limb impairment on physical activity levels. METHODS AND MATERIALS: An exploratory secondary analysis of observational data on physical activity levels of stroke survivors from Australia (HIC) and India (LMIC). Physical activity variables (step count, light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA)) were measured by accelerometery. Comparisons of physical activity levels between (a) Australian and Indian stroke survivors and (b) participants with and without lower limb impairments were performed using independent t-tests or Mann-Whitney U tests. RESULTS: There were no significant differences in physical activity levels between (i) Australian and Indian stroke survivors (step count mean difference 201 steps [-1375 to 974], LPA mean difference -24 min [-22 to 69], MVPA mean difference 2 min [-8 to 3]), and (ii) stroke survivors with and without lower limb impairments in either country. CONCLUSION: Stroke survivors were highly inactive in both countries. Despite differences in economic status, cultural influences and the built environment, the physical activity of stroke survivors in Australia and India did not differ. People with and without lower limb impairment also had similar physical activity levels.

Ultrasound is a reliable measure of muscle thickness in acute stroke patients, for some, but not all anatomical sites: a study of the intra-rater reliability of muscle thickness measures in acute stroke patients.

This prospective, blinded study investigates the test retest reliability of measures of muscle thickness made by one sonographer across two cohort groups (n = 29) of people hospitalised with acute stroke. Reliability was assessed in cohort one (n = 14) for measurements made bilaterally at the anterior and posterior upper arms, the anterior and posterior thighs (total of eight measurements) and in cohort two (n = 15), for measurements made bilaterally at the lateral forearms, the anterior abdominal wall and the anterior and lower legs (total of eight measurements). Reliability estimates varied between measurement sites; intraclass correlation coefficients (ICCs) ranged from -0.26 (lateral forearm, paretic side) to 0.95 (anterior thigh, nonparetic side), percent mean differences ranged from 0.42% (posterior upper arm, nonparetic side) to 14.68% (anterior lower limb, nonparetic side) and method error ranged from 1.08 (abdomen, nonparetic side) to 9.69 mm (posterior lower limb, nonparetic side). Only four measurement sites (anterior upper arm, posterior upper arm, abdomen and anterior thigh) were within the acceptable ranges (ICC 0.60 to 1.00, mean percent difference range 0%-5% and method error range 0-5 mm) and considered reliable to use for measures of muscle thickness in people hospitalised with acute stroke.

Circuit class therapy versus individual physiotherapy sessions during inpatient stroke rehabilitation: a controlled trial.

OBJECTIVE: To compare the effectiveness of circuit class therapy and individual physiotherapy (PT) sessions in improving walking ability and functional balance for people recovering from stroke. DESIGN: Nonrandomized, single-blind controlled trial. SETTING: Medical rehabilitation ward of a rehabilitation hospital. PARTICIPANTS: Sixty-eight persons receiving inpatient rehabilitation after a stroke. INTERVENTIONS: Subjects received group circuit class therapy or individual treatment sessions as the sole method of PT service delivery for the duration of their inpatient stay. MAIN OUTCOME MEASURES: Five-meter walk test (5MWT), two-minute walk test (2MWT), and the Berg Balance Scale (BBS) measured 4 weeks after admission. Secondary outcome measures included the Iowa Level of Assistance Scale, Motor Assessment Scale upper-limb items, and patient satisfaction. Measures were taken on admission and 4 weeks later. RESULTS: Subjects in both groups showed significant improvements between admission and week 4 in all primary outcome measures. There were no significant between group differences in the primary outcome measures at week 4 (5MWT mean difference, .07m/s; 2MWT mean difference, 1.8m; BBS mean difference, 3.9 points). A significantly higher proportion of subjects in the circuit class therapy group were able to walk independently at discharge (P=.01) and were satisfied with the amount of therapy received (P=.007). CONCLUSIONS: Circuit class therapy appeared as effective as individual PT sessions for this sample of subjects receiving inpatient rehabilitation poststroke. Favorable results for circuit classes in terms of increased walking independence and patient satisfaction suggest this model of service delivery warrants further investigation.