Clinical value of assessing motor performance in postacute stroke patients.
D Flury, F Massé, A Paraschiv-Ionescu and 3 others
PMID 34167546WHAT IT FOUND
In 15 postacute stroke patients, wearable sensors showed daily walking and arm use varied widely and did not match clinical capacity scores.
A patient with good walking capacity could still be mostly sedentary, or a slow walker could cover long distances at home.
Key findings
01Sensor-measured walking performance and physical activity varied substantially among patients regardless of their clinical walking capacity, with time spent walking ranging from 2.9% to 20.2% of recording time.
02Arm activity in daily life did not match clinical capacity: patients who all scored the maximum on the Action Research Arm Test used the impaired arm between 326 and 1570 seconds per hour of sitting.
03The authors note that clinical capacity measures explained only up to 54% of the variance in walking performance in prior larger studies, so daily-life performance cannot be inferred from clinical tests in an individual patient.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Fifteen patients in a single centre, with no comparison group, no randomisation and no intervention, so this describes what happened rather than testing whether performance data improve outcomes. The recording averaged 5.03 hours in one day, whereas the authors note prior work suggests three days are needed for valid daily-activity data; a single morning-to-evening window may not represent a patient's usual activity. The morning clinic visit may have motivated patients to be more active than usual, and the authors cannot rule this out. All patients could already walk more than 10 metres unaided and used no walking aid, so the findings say nothing about more severely affected patients. Sensors had to be fitted and removed by a clinical scientist in clinic and at home, which the authors themselves call unrealistic for routine practice. The authors state the clinical value of these measures is still to be shown, since no study has yet tested whether using them changes patient outcomes.
Declared interests
Funded by the REWIRE EU FP7 Project and the P&K Pühringer Stiftung. The wearable sensor device used (Physilog 4) is made by Gait Up Ltd., Lausanne, Switzerland, which the authors name in the methods; the supplied text does not include a separate author disclosure statement about this company.
The easy way to misread this
Do not read this as evidence that wearable sensors improve stroke rehabilitation. The study measured 15 patients for about five hours on one day, gave no treatment, and compared nothing; the authors themselves state it remains to be shown whether using daily-life performance data for therapy planning leads to better outcomes.