Steps, duration and intensity of usual walking practice during subacute rehabilitation after stroke: an observational study

Background Duration of therapy time is an inadequate indicator of stroke rehabilitation. Steps, duration, and intensity of active therapy time may provide a better indicator of practice. Objective This study quantified usual walking practice in terms of steps, duration and intensity of active therapy time, and distance walked during physical therapy sessions in people with sub-acute stroke undertaking inpatient rehabilitation and to examine whether usual walking practice differed depending on walking ability. Methods A prospective observational study was conducted across two metropolitan rehabilitation units in Australia. Twenty-four stroke survivors were observed over three physical therapy sessions. Walking ability was categorized as unassisted or assisted based on Item 5 of the Motor Assessment Scale. Walking practice was categorized as basic or advanced. Steps, duration, intensity and distance walked were measured during physical therapy sessions. Results Overall, participants took 560 steps (SD 309) over 13 min (SD 6) at an intensity of steps 44 steps/min (SD 17) and walked 222 m (SD 143) in physical therapy. Unassisted walkers (n = 6, 25%) undertook more (or trended towards more) practice of advanced walking than assisted walkers in terms of steps (MD 254 steps, 95% CI 48–462), duration (MD 5 min, 95% CI 0–10), intensity (MD 18 steps/min, 95% CI −8 to 44) and distance (MD 112 m, 95% CI −12 to 236). Conclusion Stroke survivors undergoing inpatient rehabilitation spent approximately 20% of physical therapy actively engaged in walking practice. Those able to walk without assistance took more steps for longer, at a higher intensity.