IMproving Physical ACtivity after stroke via Treadmill training (IMPACT) and self-management : A randomized trial

Journal article

Brauer, Sandy, Kuys, Suzanne Shanelle, Ada, Louise and Paratz, Jennifer. (2022). IMproving Physical ACtivity after stroke via Treadmill training (IMPACT) and self-management : A randomized trial. International Journal of Stroke. 17(10), pp. 1137-1144. https://doi.org/10.1177/17474930221078121
AuthorsBrauer, Sandy, Kuys, Suzanne Shanelle, Ada, Louise and Paratz, Jennifer
Abstract

Aim:
To determine if treadmill training embedded in self-management education commencing during stroke inpatient rehabilitation results in more physical activity than usual gait training.

Method:
A prospective, parallel-group, randomized trial with concealed allocation, blinded measurement, and intention-to-treat analysis involving 119 stroke survivors undergoing rehabilitation who were able to walk independently was undertaken. The experimental group undertook treadmill training (40–60% heart rate reserve) and self-management education for 30 min, three times a week for 8 weeks, and the control group undertook the same amount of usual gait training. Outcomes were measured at baseline (Week 0), on completion of the intervention (Week 8), and beyond the intervention (Week 26). The primary outcome was physical activity measured as steps/day using an activity monitor. Secondary outcomes were walking ability, cardiorespiratory fitness, cardiovascular risk, depression, self-efficacy, perception of physical activity, participation, and quality of life.

Results:
After 8 weeks, the experimental group took 1436 more steps/day (95% confidence interval (CI) = 229 to 2643) than the control group. By 6 months, they took 871 more steps/day (95% CI −385 to 2129) than the control group. There was no difference between groups in any other outcome.

Conclusion:
In individuals undergoing rehabilitation after stroke, 8 weeks of treadmill training embedded in self-management resulted in more physical activity than usual gait training and this was largely maintained at 6 months, despite little effect on walking or cardiorespiratory fitness, suggesting the self-management was responsible.

Keywordsstroke; physical activity; randomized controlled trial; treadmill; walking
Year2022
JournalInternational Journal of Stroke
Journal citation17 (10), pp. 1137-1144
PublisherSAGE Publications
ISSN1747-4930
Digital Object Identifier (DOI)https://doi.org/10.1177/17474930221078121
PubMed ID35102808
Scopus EID2-s2.0-85126042654
Page range1137-1144
FunderNational Health and Medical Research Council (NHMRC)
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All rights reserved
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Controlled
Output statusPublished
Publication dates
Online01 Feb 2022
Publication process dates
Deposited01 Nov 2023
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Mudge, Alison, McRae, Prue, McHugh, Kirstie, Griffin, Lauren, Hitchen, Andrew, Walker, James, Cruickshank, Mark, Morris, Norman R. and Kuys, Suzanne Shanelle. (2016). Poor mobility in hospitalized adults of all ages. Journal of Hospital Medicine. 11(4), pp. 289 - 291. https://doi.org/10.1002/jhm.2536
General versus spinal anaesthesia and postoperative delirium in an orthogeriatric population
Ilango, Sivarajah, Pulle, Ranjeev Chrys, Bell, Jack J. and Kuys, Suzanne Shanelle. (2016). General versus spinal anaesthesia and postoperative delirium in an orthogeriatric population. Australasian Journal on Ageing. 35(1), pp. 42 - 47. https://doi.org/10.1111/ajag.12212
Direct inpatient burden caused by foot-related conditions: A multisite point-prevalence study
Lazzarini, Peter A., Hurn, Sheree E., Kuys, Suzanne Shanelle, Kamp, Maarten C., Ng, Vanessa, Thomas, Courtney, Jen, Scott D., Kinnear, Ewan, d'Emden, Michael C. and Reed, Lloyd. (2016). Direct inpatient burden caused by foot-related conditions: A multisite point-prevalence study. BMJ Open. 6(6), pp. 1 - 15. https://doi.org/10.1136/bmjopen-2015-010811
Balance self-efficacy in older adults following inpatient rehabilitation
Kuys, Suzanne S., Donovan, Jacquelin, Mattin, Sarah and Low Choy, Nancy L.. (2015). Balance self-efficacy in older adults following inpatient rehabilitation. International Journal of Rehabilitation Research. 38(2), pp. 167-172. https://doi.org/10.1097/MRR.0000000000000106
Demographics and discharge outcomes of dysvascular and non-vascular lower limb amputees at a subacute rehabilitation unit : A 7-year series
Batten, Heather, Kuys, Suzanne, McPhail, Steven, Varghese, Paulose and Nitz, Jennifer. (2015). Demographics and discharge outcomes of dysvascular and non-vascular lower limb amputees at a subacute rehabilitation unit : A 7-year series. Australian Health Review. 39(1), pp. 76-84. https://doi.org/10.1071/AH14042
A systematic review of axillary web syndrome (AWS)
Yeung, W. M., McPhail, Steven M. and Kuys, Suzanne Shanelle. (2015). A systematic review of axillary web syndrome (AWS). Journal of Cancer Survivorship. 9(4), pp. 576 - 598. https://doi.org/10.1007/s11764-015-0435-1
Comparison of sit-to-stand strategies used by older adults and people living with dementia
Dolecka, Urszula, Ownsworth, Tamara and Kuys, Suzanne. (2015). Comparison of sit-to-stand strategies used by older adults and people living with dementia. Archives of Gerontology and Geriatrics. 60(3), pp. 528 - 534. https://doi.org/10.1016/j.archger.2014.12.007
Prevalence of foot disease and risk factors in general inpatient populations: A systematic review and meta-analysis
Lazzarini, Peter A., Hurn, Sheree E., Fernando, Malindu E., Jen, Scott D., Kuys, Suzanne S., Kamp, Maarten C. and Reed, Lloyd F.. (2015). Prevalence of foot disease and risk factors in general inpatient populations: A systematic review and meta-analysis. BMJ Open. 5(11), pp. 1 - 15. https://doi.org/10.1136/bmjopen-2015-008544
Clinically important improvements in motor function are achievable during inpatient rehabilitation by stroke patients with severe motor disability : A prospective observational study
Hayward, Kathryn, Kuys, Suzanne, Barker, Ruth and Brauer, Sandra. (2014). Clinically important improvements in motor function are achievable during inpatient rehabilitation by stroke patients with severe motor disability : A prospective observational study. NeuroRehabilitation. 34(4), pp. 773 - 779. https://doi.org/10.3233/NRE-141076
Gait speed in ambulant older people in long term care : A systematic review and meta-analysis
Kuys, Suzanne, Peel, Nancye, Klein, Kerenaftali, Slater, Alexandra and Hubbard, Ruth. (2014). Gait speed in ambulant older people in long term care : A systematic review and meta-analysis. Journal of the American Medical Directors Association (JAMDA) (print). 15(3), pp. 194 - 200. https://doi.org/10.1016/j.jamda.2013.10.015
The Queensland High Risk Foot Form (QHRFF) - Is it a reliable and valid tool for foot disease?
Lazzarini, Peter A., Ng, Vanessa, Kinnear, Ewan M., Kamp, Maarten C., Kuys, Suzanne S., Hurst, Cameron and Reed, Lloyd F.. (2014). The Queensland High Risk Foot Form (QHRFF) - Is it a reliable and valid tool for foot disease? Journal of Foot and Ankle Research. 7(7), pp. 1 - 18. https://doi.org/10.1186/1757-1146-7-7
The Queensland high risk foot form (QHRFF) - is it a reliable and valid clinical research tool for foot disease?
Lazzarini, Peter A., Ng, Vanessa, Kinnear, Ewan, Kamp, Maarten C., Kuys, Suzanne Shanelle, Hurst, Cameron and Reed, Lloyd. (2014). The Queensland high risk foot form (QHRFF) - is it a reliable and valid clinical research tool for foot disease? Journal of Foot and Ankle Research. 7(1), pp. 1 - 18. https://doi.org/10.1186/1757-1146-7-7
Use and validation of the balance outcome measure for elder rehabilitation in acute care
Kuys, Suzanne, Crouch, Tom, Dolecka, Urszula, Steele, Michael and Low Choy, Nancy. (2014). Use and validation of the balance outcome measure for elder rehabilitation in acute care. New Zealand Journal of Physiotherapy. 42(1), pp. 16 - 21.
Factors affecting the ability of the stroke survivor to drive their own recovery outside of therapy during inpatient stroke rehabilitation
Eng, Xue Wen, Brauer, Sandra, Kuys, Suzanne, Lord, Matthew and Hayward, Kathryn. (2014). Factors affecting the ability of the stroke survivor to drive their own recovery outside of therapy during inpatient stroke rehabilitation. Stroke Research and Treatment. https://doi.org/10.1155/2014/626538
Factors affecting the ability of the stroke survivor to drive their own recovery outside of therapy during inpatient stroke rehabilitation
Eng, Xue Wen, Brauer, Sandra, Kuys, Suzanne Shanelle, Lord, Matthew and Hayward, Kathryn. (2014). Factors affecting the ability of the stroke survivor to drive their own recovery outside of therapy during inpatient stroke rehabilitation. Stroke Research and Treatment. https://doi.org/10.1155/2014/626538
Development and preliminary validation of the Acute Brain Injury Physiotherapy Assessment (ABIPA)
Gesch, Janelle, Low Choy, Nancy, Weeks, Benjamin, Passier, Leanne, Nascimento, Margarida, Haines, Terry and Kuys, Suzanne. (2014). Development and preliminary validation of the Acute Brain Injury Physiotherapy Assessment (ABIPA). Brain Impairment. 15(2), pp. 132 - 145. https://doi.org/10.1017/BrImp.2014.13
Activity limitations experienced by people with stroke who received inpatient rehabiliation: Differences between 2001, 2005, and 2011
Kuys, Suzanne Shanelle, Bew, Paul, Lynch, Mary and Brauer, Sandy. (2014). Activity limitations experienced by people with stroke who received inpatient rehabiliation: Differences between 2001, 2005, and 2011. Archives of Physical Medicine and Rehabilitation. 95(4), pp. 741 - 746. https://doi.org/10.1016/j.apmr.2013.12.008
The health outcomes and costs of people attending an interdisciplinary chronic disease service in regional Australia: protocol for a longitudinal cohort investigation
Tyack, Zephanie, Frakes, Kerrie-Anne, Cornwell, Petrea, Kuys, Suzanne, Barnett, Adrian and McPhail, Steven. (2013). The health outcomes and costs of people attending an interdisciplinary chronic disease service in regional Australia: protocol for a longitudinal cohort investigation. BMC Health Services Research. 13(410), pp. 1 - 7. https://doi.org/10.1186/1472-6963-13-410
Physiotherapy students find guided journals useful to develop reflective thinking and practice during their first clinical placement : A qualitative study
Constantinou, Maria and Kuys, Suzanne. (2013). Physiotherapy students find guided journals useful to develop reflective thinking and practice during their first clinical placement : A qualitative study. Physiotherapy (print). 99(1), pp. 49 - 55. https://doi.org/10.1016/j.physio.2011.12.002
Feasibility of an interdisciplinary early intervention for patients with low levels of responsiveness following an acquired brain injury
Seeto, Treena, Kuys, Suzanne Shanelle, Budden, Cassandra, Griffin, Erin, Kajewski, Haylee and McPhail, Steven. (2013). Feasibility of an interdisciplinary early intervention for patients with low levels of responsiveness following an acquired brain injury. Brain Impairment. 14(2), pp. 213 - 221. https://doi.org/10.1017/BrImp.2013.20
Frequency of urinary incontinence in people with chronic heart failure
Hwang, Rita, Chuan, Francine, Peters, Robyn and Kuys, Suzanne. (2013). Frequency of urinary incontinence in people with chronic heart failure. Heart & Lung: the journal of acute and critical care. 42(1), pp. 26 - 31. https://doi.org/10.1016/j.hrtlng.2012.08.003
Feasibility of an interdisciplinary early intervention for patients with low levels of responsiveness following an acquired brain injury
Seeto, Treena, Kuys, Suzanne, Budden, Cassandra, Griffin, Erin, Kajewski, Haylee and McPhail, Steven. (2013). Feasibility of an interdisciplinary early intervention for patients with low levels of responsiveness following an acquired brain injury. Brain Impairment. 14(2), pp. 213 - 221. https://doi.org/10.1017/BrImp.2013.20
Frequency of urinary incontinence in people with chronic heart failure
Hwang, Rita, Chuan, Francine, Peters, Robyn and Kuys, Suzanne Shanelle. (2013). Frequency of urinary incontinence in people with chronic heart failure. Heart & Lung: the journal of acute and critical care. 42(1), pp. 26 - 31. https://doi.org/10.1016/j.hrtlng.2012.08.003
Feasibility of gaming console exercise and its effect on endurance, gait and balance in people with an acquired brain injury
McClanachan, Nelson, Gesch, Janelle, Wuthapanich, Nampech, Fleming, Jennifer and Kuys, Suzanne Shanelle. (2013). Feasibility of gaming console exercise and its effect on endurance, gait and balance in people with an acquired brain injury. Brain Injury. 27(12), pp. 1402 - 1408. https://doi.org/10.3109/02699052.2013.823654
Feasibility of gaming console exercise and its effect on endurance, gait and balance in people with an acquired brain injury
McClanachan, Nelson, Gesch, Janelle, Wuthapanich, Nampech, Fleming, Jennifer and Kuys, Suzanne. (2013). Feasibility of gaming console exercise and its effect on endurance, gait and balance in people with an acquired brain injury. Brain Injury. 27(12), pp. 1402 - 1408. https://doi.org/10.3109/02699052.2013.823654
What are the key conditions associated with lower limb amputations in a major Australian teaching hospital?
Lazzarini, Peter, O'Rourke, Sharon, Russell, Anthony, Clark, Damien and Kuys, Suzanne Shanelle. (2012). What are the key conditions associated with lower limb amputations in a major Australian teaching hospital? Journal of Foot and Ankle Research. 5(12), pp. 1 - 9. https://doi.org/10.1186/1757-1146-5-12
What are the key conditions associated with lower limb amputations in a major Australian teaching hospital?
Lazzarini, Peter, O'Rourke, Sharon, Russell, Anthony, Clark, Damien and Kuys, Suzanne. (2012). What are the key conditions associated with lower limb amputations in a major Australian teaching hospital? Journal of Foot and Ankle Research. 5(1), pp. 1 - 9. https://doi.org/10.1186/1757-1146-5-12
Activity level of hospital medical inpatients: An observational study
Kuys, Suzanne S., Dolecka, Urszula E. and Guard, Amanda. (2012). Activity level of hospital medical inpatients: An observational study. Archives of Gerontology and Geriatrics. 55(2), pp. 417 - 421. https://doi.org/10.1016/j.archger.2012.02.008
Can Wii work it out?
Cyarto, Elizabeth V., Kuys, Suzanne, Henwood, Tim R. and Blackberry, Irene. (2011). Can Wii work it out? Telecommunications Journal of Australia. 61(3), pp. 37.1 - 37.12.
Higher-intensity treadmill walking during rehabilitation after stroke in feasible and not detrimental to walking pattern or quality: A pilot randomized trial
Kuys, Suzanne S., Brauer, Sandra G. and Ada, Louise. (2011). Higher-intensity treadmill walking during rehabilitation after stroke in feasible and not detrimental to walking pattern or quality: A pilot randomized trial. Clinical Rehabilitation. 25(4), pp. 316 - 326. https://doi.org/10.1177/0269215510382928
Higher-intensity treadmill walking during rehabilitation after stroke in feasible and not detrimental to walking pattern or quality : A pilot randomized trial
Kuys, Suzanne, Brauer, Sandra and Ada, Louise. (2011). Higher-intensity treadmill walking during rehabilitation after stroke in feasible and not detrimental to walking pattern or quality : A pilot randomized trial. Clinical Rehabilitation. 25(4), pp. 316 - 326. https://doi.org/10.1177/0269215510382928
Appropriate seating for medical patients: An audit
Kuys, Suzanne, Dolecka, Urszula and Morrison, Carol. (2011). Appropriate seating for medical patients: An audit. Australian Health Review. 35(3), pp. 316 - 319. https://doi.org/10.1071/AH10943
Changes in falls risk factors for geriatric diagnostic groups across inpatient, outpatient and domiciliary rehabilitation settings
Morrison, Gregory, Lee, Huang-Ling, Kuys, Suzanne, Clarke, Jane, Bew, Paul and Haines, Terry. (2011). Changes in falls risk factors for geriatric diagnostic groups across inpatient, outpatient and domiciliary rehabilitation settings. Disability and Rehabilitation. 33(11), pp. 900 - 907. https://doi.org/10.3109/09638288.2010.514019
Trial of an allied health workload allocation model
Simmons, Nadine and Kuys, Suzanne. (2011). Trial of an allied health workload allocation model. Australian Health Review. 35(2), pp. 168 - 175. https://doi.org/10.1071/AH09860
Test-retest reliability of the GAITRite system in people with stroke undergoing rehabilitation
Kuys, Suzanne, Brauer, Sandra and Ada, Louise. (2011). Test-retest reliability of the GAITRite system in people with stroke undergoing rehabilitation. Disability and Rehabilitation. 33(19-20), pp. 1848 - 1853. https://doi.org/10.3109/09638288.2010.549895
Appropriate seating for medical patients: An audit
Kuys, Suzanne S., Dolecka, Urszula E. and Morrison, Carol A.. (2011). Appropriate seating for medical patients: An audit. Australian Health Review. 35(3), pp. 316 - 319. https://doi.org/10.1071/AH10943
Gaming console exercise and cycle or treadmill exercise provide similar cardiovascular demand in adults with cystic fibrosis : A randomised cross-over trial
Kuys, Suzanne, Hall, Kathleen, Peasey, Maureen, Wood, Michelle, Cobb, Robyn and Bell, Scott. (2011). Gaming console exercise and cycle or treadmill exercise provide similar cardiovascular demand in adults with cystic fibrosis : A randomised cross-over trial. Journal of Physiotherapy. 57(1), pp. 35 - 40. https://doi.org/10.1016/S1836-9553(11)70005-4
Trial of an allied health workload allocation model
Simmons, Nadine and Kuys, Suzanne Shanelle. (2011). Trial of an allied health workload allocation model. Australian Health Review. 35(2), pp. 168 - 175. https://doi.org/10.1071/AH09860
Dose-response relationship between physiotherapy resource provision with function and balance improvements in patients following stroke : A multi-centre observational study
Haines, Terry, Kuys, Suzanne, Clarke, Jane, Morrison, Gregory and Bew, Paul. (2011). Dose-response relationship between physiotherapy resource provision with function and balance improvements in patients following stroke : A multi-centre observational study. Journal of Evaluation in Clinical Practice. 17(1), pp. 136 - 142. https://doi.org/10.1111/j.1365-2753.2010.01380.x
Higher-intensity treadmill walking during rehabilitation after stroke in feasible and not detrimental to walking pattern or quality: A pilot randomized trial
Kuys, Suzanne, Brauer, Sandra and Ada, Louise. (2011). Higher-intensity treadmill walking during rehabilitation after stroke in feasible and not detrimental to walking pattern or quality: A pilot randomized trial. Clinical Rehabilitation. 25(4), pp. 316 - 326. https://doi.org/10.1177/0269215510382928