Are age-predicted equations valid in predicting maximum heart rate in individuals after stroke?

PURPOSE: To investigate the validity of six age-predicted maximum heart rate (HRmax) equations after stroke. MATERIAL AND METHODS: Sixty individuals (54 (12) years; 64 (69) months after stroke) were included. A Cardiopulmonary Exercise Test (CPET) performed on a treadmill obtained the HRmax. The most used age-predicted equations were investigated: (1) 220-age, proposed by Fox; (2) 206.9- (0.67 × age), proposed by Gellish; (3) 208- (0.7 × age), proposed by Tanaka; (4) 216.6- (0.84 × age), proposed by Astrand; (5) 164- (0.72 × age) and (6) 200- (0.92 × age) proposed by Brawner. RESULTS: No statistically significant agreement was found between the HRmax obtained by the CPET and the one predicted by the equations 1-5 (-0.18 ≤ 95% confidence interval ≤0.79). A significant and moderate agreement was found between the HRmax obtained by the CPET and the one predicted by equation (6) (95% CI= 0.05-0.75; Intraclass Correlation Coefficient= 0.51). Bland-Altman plots showed that equations (1-4) and (6) overestimated the HRmax. Equation (6) presented the lower mean difference. CONCLUSIONS: The equations developed for non-disabled individuals (1-4) are not adequate to be used in individuals after a stroke. Equation (6) (Brawner) showed the best results to be used in individuals after stroke; however, it should be used cautiously.

Prediction equations for maximum heart rate (HR_max) are commonly used to prescribe aerobic exercise for individuals following a stroke.The equations developed for non-disabled individuals are not valid for use with individuals after stroke, leading to an overestimation of the HR_max.An age-predicted HR_max equation developed for individuals with coronary heart disease may provide outcomes that are more accurate for stroke survivors, but care should still be taken when using it.

Measurement properties of outcome measures used in neurological telerehabilitation: A systematic review using COSMIN checklist.

OBJECTIVE: To summarize the measurement properties (reliability, validity, and responsiveness) and the clinical utility of measurement tools used in telerehabilitation in individuals with neurological conditions. DESIGN: Systematic review. SUBJECTS: Individuals with neurological conditions. INTERVENTION: Not applicable. MAIN MEASURES: The methodological quality of the studies using the COSMIN Risk of Bias Checklist, the quality of the measurement properties using the criteria for good measurement properties, and the clinical utility of the measurements using the Tyson & Connell scale. RESULTS: From the 22,188 identified studies, 47 were included. Forty-three measurement tools were identified. The main modes of administration were telephone and videoconference. Studies involved mostly individuals with stroke, multiple sclerosis, and Alzheimer's disease. Criterion validity and reliability were the most investigated measurement properties. None of the tools had their responsiveness investigated. Twenty-two measurement tools have at least one measurement property evaluated as "sufficient" in a study with appropriate methodological quality ("very good" or "adequate"). Nineteen measurement tools showed adequate clinical utility. Eight measurement tools, investigated in individuals with stroke, spinal cord injury or Alzheimer's disease, all administered by telephone, were recommended. CONCLUSION: The present results can be used to assist in choosing appropriate measurement tools, both in research and clinical practice, during telerehabilitation in individuals with neurological conditions. Measurement error, content validity, structural validity, and responsiveness need to be further investigated. In addition, the measurement properties of tools used in telerehabilitation in other neurological conditions, such as Huntington's disease, should also be investigated. REGISTRATION NUMBER: CRD42021257662.

An Equation With Clinical Applicability and Adequate Validity to Predict the Maximum Oxygen Consumption of Individuals Post-stroke.

OBJECTIVE: To develop an equation with clinical applicability and adequate validity to predict the maximum oxygen consumption (V̇o2max) of individuals post-stroke. DESIGN: A cross-sectional study. SETTING: A university laboratory. PARTICIPANTS: Individuals post-stroke in the chronic phase (at least 6 months post-stroke). Step-1 (equation development): n=50, aged 55±12 years; Step-2 (validity investigation): n=20, aged 58±8 years (N=50 [step 1], N=20 [step 2]). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): Step-1 (equation development): multiple linear regression analysis was performed. DEPENDENT VARIABLE: V̇o2max (mL/kg/min) in the cardiopulmonary exercise test. INDEPENDENT VARIABLES: age (years), sex (1-women, 2-men), body mass index (BMI) (kg/m2), and distance (meters) in the Six-Minute Walk Test (6MWT) (6MWT-Equation) or in the Incremental Shuttle Walk Test (ISWT) (ISWT-Equation). Step-2 (validity investigation): agreement between the V̇o2max measured and predicted was evaluated with the intraclass correlation coefficient (ICC) with 95% confidence interval (CI) and the Bland-Altman method (α=5%). RESULTS: In step-1 (equation development), the 4 independent variables for each equation were retained (6MWT-Equation: R2=0.68, P<.001; ISWT-Equation: R2=0.58, P<.001). In step-2 (validity investigation), the 6MWT-Equation showed an ICC of 0.73 (95% CI=0.30, 0.89; P=.004) and a mean bias of 0.003 mL/kg/min; and the ISWT-Equation showed an imprecise ICC of 0.55 (95% CI=-0.12, 0.82; P=.045) and a mean bias of 0.971 mL/kg/min. 6MWT-Equation (V̇o2max=22.239+0.02 × distance in the 6MWT+4.039 × sex-0.157 × age-0.265 × BMI) showed adequate validity. CONCLUSIONS: An equation with clinical applicability and adequate validity in the investigated sample was developed to predict the V̇o2max of individuals post-stroke in the chronic phase (6MWT-Equation). Future studies with larger sample should investigate its external validity.

Measurement properties of outcome measures used in neurological telerehabilitation: A systematic review protocol.

Several measurement tools commonly used in face-to-face neurological rehabilitation have been used in telerehabilitation. However, it is not known whether these tools have adequate measurement properties and clinical utility. This systematic review aims to investigate the measurement properties and the clinical utility of measurement tools used in telerehabilitation in individuals with neurological diseases. A systematic review to investigate the measurement properties and clinical utility of measurement tools used in telerehabilitation in individuals with neurological conditions will be conducted. This systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. this systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 28 May 2021 (registration number: CRD42021257662). Electronic searches will be performed in following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE Ovid), Excerpta Medica Database (Embase Classic + Embase Ovid), Physiotherapy Evidence Database (PEDro), Scientific Electronic Library Online (Scielo), and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Two trained independent reviewers will select the studies according to the inclusion criteria, and will also extract the data, evaluate the clinical utility and methodological quality. The relevant data such as design, participants, settings, and mode of administration, measurement properties, and clinical utility will be summarized. Disagreements between reviewers will be resolved by consensus or by the decision of a third independent reviewer. Hand searches of other relevant studies will be employed. The COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist and the clinical utility scale will be used to assess the methodological quality and clinical utility of these tools, respectively. This systematic review will provide information regarding the measurement properties and the clinical utility of the measurement tools used in neurological telerehabilitation. This information will be useful to assist health professionals in choosing adequate measurement tools and planning new research studies.

Recrutamento, retenção, presença e adesão de um ensaio clínico aleatorizado para avaliar os efeitos do treino específico da tarefa em indivíduos pós-acidente vascular encefálico / Selección, retención, asistencia y adherencia de un ensayo clínico aleatorizado para evaluar los efectos del entrenamiento específico de tareas en sujetos pos-accidente cerebrovascular / Recruitment, retention, attendance, and adherence of a randomized controlled trial to evaluate the effects of task-specific training with individuals post stroke

RESUMO Indivíduos acometidos pelo acidente vascular encefálico (AVE) se beneficiam de diferentes estratégias terapêuticas que apresentam comprovação da eficácia por meio da condução de ensaios clínicos aleatorizados (ECA) bem delineados. Compreender as etapas do estudo pode auxiliar os pesquisadores na realização de futuros ensaios clínicos. Dessa forma, o objetivo deste estudo foi descrever o processo de recrutamento, retenção, presença e adesão na condução de um ECA realizado com indivíduos pós-AVE na fase crônica na cidade de Belo Horizonte (MG), Brasil, com o propósito de investigar a eficácia do treino específico da tarefa para membros superiores e inferiores na melhora do nível de atividade física e mobilidade. Nos resultados, foi observado que dos 674 potenciais participantes, não foi possível contatar 240; 384 não foram avaliados por não atenderem aos critérios de elegibilidade. Participaram da avaliação presencial 50 indivíduos e 14 não fizeram parte do estudo pelo mesmo motivo. Apenas 36 indivíduos iniciaram as intervenções (taxa de recrutamento de 5,3%). Uma taxa de retenção de 80,6% foi observada. Sete indivíduos abandonaram o estudo, principalmente por desinteresse pelas atividades. A taxa de presença foi de 80,9%, e o principal motivo para ausência nas sessões foi incompatibilidade de horário com as consultas médicas. A taxa de adesão foi de 82,7%, com 180 interrupções durante as sessões, sendo sair mais cedo o motivo mais comum. Esses resultados indicam algumas dificuldades no processo de condução do ECA com indivíduos na fase crônica do AVE envolvendo treino específico da tarefa. Apesar dessas dificuldades, a intervenção proposta pode ser considerada viável.

RESUMEN Las personas afectadas por accidente cerebrovascular (ACV) tienen a su disposición diferentes estrategias terapéuticas que muestran evidencia de eficacia a través de la realización de ensayos clínicos aleatorizados (ECA) bien diseñados. Conocer las etapas del estudio puede ayudar a los investigadores a realizar futuros ensayos clínicos. Así, el objetivo de este estudio fue describir el proceso de selección, retención, asistencia y adherencia de un ECA realizado con individuos post-ACV en fase crónica en la ciudad de Belo Horizonte (Brasil), para investigar la efectividad del entrenamiento específico de tareas para las extremidades superiores e inferiores en la mejora del nivel de actividad física y la movilidad. En los resultados se observó que, de los 674 potenciales participantes, no fue posible contactar a 240; y 384 no fueron evaluados por no cumplir con los criterios de elegibilidad. Cincuenta personas participaron en la evaluación presencial y 14 no formaron parte del estudio por la misma razón. Solo 36 personas empezaron las intervenciones (tasa de selección del 5,3%). Se observó una tasa de retención del 80,6%. Siete personas abandonaron el estudio, principalmente por falta de interés en las actividades. La tasa de asistencia fue del 80,9%, y el principal motivo de ausencia a las sesiones fue la incompatibilidad de horario con las citas médicas. La tasa de adherencia fue del 82,7%, con 180 interrupciones durante las sesiones, y la salida anticipada fue la razón más frecuente. Los resultados apuntan algunas dificultades en el proceso de realización del ECA con individuos en fase crónica del ACV con relación al entrenamiento específico de tarea. A pesar de esto, la intervención propuesta puede considerarse viable.

ABSTRACT Individuals who suffered stroke benefit from different therapeutic strategies whose efficacy has been proved by well-designed randomized controlled trials (RCTs). Understanding study steps may assist researchers in conducting future RCTs. Thus, the objective of this study was to describe the process of recruitment, retention, attendance, and adherence in conducting RCTs with individuals in the chronic phase of stroke in the municipality of Belo Horizonte/MG/Brazil, with the purpose of investigating the efficacy of specific task training for both lower and upper limbs in improving patients' physical activity and mobility. Results showed that, of the 674 potential participants, it was impossible to contact 240 individuals and 384 were excluded from our sample for failing to meet eligibility criteria. In total, 50 individuals participated in clinical evaluations and 14 were excluded from the study for the same reason. Overall, 36 individuals started the interventions, a 5.3% recruitment rate. An 80.6% retention rate was observed. In total, seven individuals left the study, mainly due to lack of interest in the activities. We found an 80.9% attendance rate, and the main reason for missing medical appointments was incompatibility with treatment schedule. We also observed an 82.7% adherence rate. Of these, 180 interrupted sessions were mainly due to patients leaving early. These results indicate some difficulties found in conducting RCTs with individuals in the chronic phase of stroke, especially regarding specific task training. Despite these difficulties, the proposed intervention can be considered feasible.

Perspectives, satisfaction, self-efficacy, and barriers to aerobic exercise reported by individuals with chronic stroke in a developing country.

PURPOSE: To describe the perspectives, satisfaction, and self-efficacy towards aerobic exercise and to investigate the barriers to aerobic exercise identified by individuals with stroke in a developing country. MATERIALS AND METHODS: A cross-sectional study was performed with 15 individuals (55 ± 12 years, 69 ± 77 months post-stroke), who received a 12-week vigorous intensity aerobic treadmill training (three 30-min sessions/week). To assess participants' perspectives, satisfaction, self-efficacy, and barriers to aerobic exercise, a standardized interview and the Short Self-Efficacy for Exercise scale were employed. RESULTS: Participants considered aerobic exercise important (100% (IQR 20%), out of 100), recognized that it improves recovery (93%) and heart health (100%) and were satisfied with the training (80%). Self-efficacy was high (4 (IQR 1), out of 5). The main barriers were lack of information (86.7%), fear of falling (80%), lack of equipment (73.3%) or support (66.7%-73.3%), cognitive (66.7%) and physical impairments (60%) and severe weather conditions (60%). Most of them preferred to exercise in groups (93%). CONCLUSIONS: Individuals with stroke in a developing country considered aerobic exercise important. However, they perceived barriers related to safety, individual ability, social support, and aerobic exercise. It is necessary to improve education of these individuals, family members, and health care professionals regarding aerobic exercises.IMPLICATIONS FOR REHABILITATIONIndividuals after stroke in developing countries consider aerobic exercise important and recognized that it improves stroke recovery and health, although they perceived barriers related to safety, individual ability, social support, and aerobic exercise itself.It is important to improve education to stroke survivors, family members and healthcare professionals in developing countries about the possibilities, risks, and benefits of aerobic exercises.Rehabilitation professionals should provide aerobic exercise for individuals after stroke in groups.Rehabilitation professionals might use cycle ergometers or partial body weight support to overcome fear of falling and facilitate implementation of aerobic exercise after stroke.

The Distance Covered in Field Tests is more Explained by Walking Capacity than by Cardiorespiratory Fitness after Stroke.

OBJECTIVES: To investigate if the distance covered in the Six-Minute Walk Test (6MWT) and in the Incremental Shuttle Walk Test (ISWT) is most strongly explained by walking capacity or cardiorespiratory fitness (CRF) measures in individuals after chronic stroke. MATERIALS AND METHODS: This is a cross-sectional study. Individuals after chronic stroke aged at least 20 years old and able to walk at least 10 minutes independently were included. The distance covered (meters) in the 6 MWT and ISWT (dependent variables), comfortable and fast gait speed obtained by the 10 m walk test (10 mWT) (walking capacity measures; independent variables) and peak oxygen consumption (VO2peak; CRF measure; independent variable) (ml.kg-1.min-1) obtained by the cardiopulmonary exercise test (CPET) were obtained. Linear regression analyses were performed (α = 5%). RESULTS: Fifty individuals (mean age of 55±12 years and mean time after stroke of 67±74 months) were included. Comfortable and fast gait speeds were the variables that most strongly explained the distance covered in the field tests: 6MWT (R² = 0.614, ß = 0.784, p < 0.001 and R² = 0.615, ß = 0.778, p < 0.001, respectively) and ISWT (R² = 0.450, ß = 0.671, p < 0.001 and R² = 0.456, ß = 0.746, p < 0.001, respectively). On the other hand, for the VO2peak, the following models were generated: 6MWT (R² = 0.280, ß = 0.530, p < 0.001) and ISWT (R² = 0.154, ß = 0.393, p = 0.005). CONCLUSIONS: The distance covered in the field tests (6MWT and ISWT) is more suitable to support inferences about the walking capacity than about the CRF of individuals after chronic stroke.

Cardiopulmonary exercise testing and aerobic treadmill training after stroke: Feasibility of a controlled trial.

PURPOSE: To investigate the feasibility and safety of a randomized controlled trial that performed cardiopulmonary exercise testing and 12 weeks of aerobic treadmill training in individuals in the chronic phase after stroke. METHODS: The following data were recorded: number of individuals contacted to participate, that attended in the evaluation session, and that were included (recruited) in the study; retention, attendance and adherence rates; reasons for exclusion, withdrawal, non-attendance and non-completing exercise; adverse events. RESULTS: From 230 individuals that were contacted, 39 (17%) attended the evaluation session and 22 (9.6%) were recruited in the study, 11 in each group (control and experimental). The main source of recruitment was other research projects (43.5%). The main reason for exclusion was unavailability (22%). Six out of 39 individuals (15.4%) that attended in the evaluation session were not able to perform the cardiopulmonary exercise testing. All subjects included showed a respiratory exchange ratio ≥1.0 (considered as maximal effort in the CPET). Retention rate was 81% and the main reason of withdrawal was unavailability (75%). The overall attendance rate was 88% and the main reason for non-attendance was illness/sickness (20.8%). The adherence rate was 99% and the reasons for non-completing sessions were illness/sickness (60%) or delay (40%). No serious adverse events occurred. CONCLUSION: Recruitment rate was low, retention rate was moderate, attendance and adherence rates were high. No serious adverse events occurred. It was feasible and safe to execute a randomized clinical trial that performed cardiopulmonary exercise testing and 12 weeks of aerobic treadmill training.

Relação entre fatores ambientais e qualidade de vida em indivíduos com acidente vascular cerebral usuários da atenção primária do Sistema Único de Saúde / Relationship between environmental factors and quality of life in post stroke users of primary health care of the Unified Health System

O fator ambiental constitui o ambiente físico, social e atitudinal em que indivíduo vive e conduz sua vida, incluindo barreiras e/ou facilitadores. A qualidade de vida é um construto amplo que envolve vários fatores, dentre eles o ambiental. A relação entre qualidade de vida relacionada à saúde (QVRS) após Acidente Vascular Cerebral (AVC) e fatores ambientais ainda é pouco explorada. Conhecer essa relação pode facilitar o processo de avaliação e planejamento de intervenções para melhora da QVRS desses indivíduos. Objetivo: Investigar a associação entre fatores ambientais e QVRS de indivíduos com AVC, na fase crônica, usuários da atenção primária à saúde de Belo Horizonte (BH)/Brasil. Métodos: Fatores ambientais foram avaliados pelo Measure of the Quality of Environment (MQE) e a QVRS pela Escala de Qualidade de Vida Específica para Acidente Vascular Encefálico (EQVE-AVE). Correlação de Spearman foi utilizada para investigar a associação entre fatores ambientais e QVRS (escore total e dos domínios do EQVE-AVE) (α=5%). Resultados: Foram encontradas associações significantes, negativas e de fraca magnitude entre fatores ambientais considerados como obstáculos com o escore total do EQVE-AVE (p =0,001; rho = -0,33) e com os domínios de mobilidade (p =0,01 rho = -0,33) e trabalho/produtividade do EQVE-AVE (p =0,03; rho = -0,28). Conclusão: Fatores ambientais e QVRS possuem associação significante, ainda que seja de fraca magnitude. Portanto, fatores ambientais considerados como obstáculos, devem ser considerados na abordagem da QVRS de indivíduos na fase crônica após AVC, usuários da atenção primária à saúde do Brasil.

Quality of life is a broad and comprehensive construct that involves several factors, including the environmental factor. However, the relationship between health-related quality of life (HRQoL) of individuals after stroke and environmental factors is still poorly understood. Knowing this relationship can facilitate the process of evaluating and planning interventions to improve HRQoL of these individuals. Objective: To investigate the association between environmental factors and HRQoL of individuals after stroke who use the primary health care in Belo Horizonte/Brazil. Methods: Environmental factors were assessed by the Measure of the Quality of Environment (MQE) and the HRQoL by the Stroke Specific Quality of Life Scale (SS-QOL). Spearman's correlation was used to investigate the association between environmental factors and HRQoL (total score and SS-QOL domains) (α = 5%). Results: Significant, negative and low associations were found between environmental factors considered as obstacles with the total SS-QOL score (p = 0.001; rho = -0.33), with the mobility (p = 0.01 rho = -0.33) and work/productivity domains of the HRQoL(p = 0.03; rho = -0.28). Conclusion: Therefore, environmental factors and HRQoL have a significant association, even if it is of low magnitude. Thus, environmental factors considered as obstacles, should be considered, along with other factors related to health and functioning when addressing the HRQoL of individuals in the chronic phase after stroke who use the Brazilian primary health care system.