The aim of this study is to assess the effect of implementing best practices into current stroke rehabilitation physical therapy on walking outcomes. Participants will also be provided an activity monitor to help them track and target their walking practice to determine if this can improve walking ability.
This multi-site study will have each site start in usual care with participants consented to collecting outcome measures. The twelve inpatient stroke units include: Kelowna General Hospital, Nanaimo Regional General Hospital, Glenrose Rehabilitation Hospital, Saskatoon City Hospital, Wascana Rehabilitation Centre, Joseph Brant Hospital, Bruyère Hospital, Freeport Grand River Hospital, CIUSSS-de-l'Estrie-CHUS Centre de réadaptation de l'Estrie, Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Dr. Everett Chalmers Regional Hospital, and Queen Elizabeth Hospital. Each site will randomly switch over to Enhanced Usual Care (best practice implementation) where all physical therapists at the site will be educated on delivery of best practice for locomotor retraining. The specific therapy activities are at the discretion of the physical therapist; however, physical therapists must work towards thirty minutes of weight-bearing/stepping activity at greater than forty percent heart rate reserve. Participants will continue to be consented to collecting outcome measures. Additionally, participants will be given and trained to use activity watches to monitor their own progress.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
306
The protocol is focused on the completion of a minimum of 30 minutes of weight-bearing, walking-related activities that progressively increase in intensity informed by heart rate and step counters over 4 weeks.
Usual physical therapy
University of British Columbia
Vancouver, British Columbia, Canada
Six-minute walk Test
This test measures distance a participant can walk in 6 minutes.
Time frame: 4 weeks
Six-minute walk test
This test measures distance a participant can walk in 6 minutes.
Time frame: 12 months post-stroke
Blood pressure
Blood pressure measures physiological effects of the intervention
Time frame: 4 weeks & 12 months post-stroke
Euro-QOL 5D-5L
This test is the most widely used instrument to measure quality of life.
Time frame: 4 weeks & 12 months post-stroke
Montreal Cognitive Assessment
This test measures levels of cognitive function. Min 0, max 30, with higher scores reflecting better cognition.
Time frame: 4 weeks & 12 months post-stroke
Short Performance Physical Battery
This test measures lower extremity function. Min value 0, max value 12. Higher scores reflect better lower extremity function
Time frame: 4 weeks & 12 months post-stroke
Patient Health Questionnaire-9 (PHQ-9)
This test screens for depression. Min 0, max 27. Higher values reflect more severe symptoms.
Time frame: 4 weeks & 12 months post-stroke
Modified Rankin Scale (mRS)
This scale measures the degree of disability. Score range: minimum 0 to maximum 6. Lower score means a better outcome.
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Time frame: 4 weeks & 12 months post-stroke
Physical Activity Scale for the Elderly (PASE)
This test assesses physical activity, including leisure, household, and occupational activity. Score range: minimum 0 to maximum 400 or more. Higher score means a better outcome
Time frame: 12 months post-stroke
Step activity monitor
The number of steps per day over 3 days
Time frame: 12 months post stroke
Gait speed
self-paced gait speed in metre/second
Time frame: 4 week and 12 month post-stroke