Clustering of Sedentary Behavior and Longitudinal Changes in Patients With Stroke Undergoing Rehabilitation.

The study observed patterns and changes during usual inpatient rehabilitation; it did not test a sedentary behavior intervention, so it cannot show that any treatment caused the changes. Clusters were created after the fact from sedentary indicators, and the paper did not show that these groups predict outcomes after discharge. Follow-up was only 1 month, and both measurements occurred during hospitalization, so the findings may not apply after discharge or over longer periods. Participants were studied in Japanese convalescent rehabilitation hospitals where intensive inpatient rehabilitation is typical, so results may not generalize to other health systems. The accelerometer measured total wear-time behavior but did not separate formal therapy sessions from time outside therapy, nor capture detailed therapy content. There was no formal blinding for clinical assessments, and device wear may have influenced behavior, although sedentary outcomes were objectively measured and clusters were generated post hoc. Depressive symptoms and detailed cognitive status were not assessed, so they may have influenced sedentary patterns or cluster membership. Of 517 participants with admission measurements, 420 were analyzed; some were lost to follow-up or had insufficient accelerometer wear time.

Do not read the 1-month decrease in sedentary time as evidence that a specific rehabilitation component caused it. Participants received usual multidisciplinary inpatient rehabilitation, including physical, occupational, and speech-language-hearing therapies as needed, and the study did not test a sedentary behavior intervention.