Not All Stroke Units Are the Same: A Comparison of Physical Activity Patterns in Melbourne, Australia, and Trondheim, Norway

National Stroke Research Institute, Level 1, Neurosciences Building, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg, 3081 Victoria, Australia.
Stroke (Impact Factor: 5.72). 07/2008; 39(7):2059-65. DOI: 10.1161/STROKEAHA.107.507160
Source: PubMed


Very early mobilization may be one of the most important factors contributing to the favorable outcome observed from a stroke unit in Trondheim, Norway. The aims of this study were to (1) describe and compare the pattern of physical activity of patients with stroke managed in a stroke unit with specified mobilization protocols (Trondheim) and those without in Melbourne, Australia; and (2) identify differences in activity according to stroke severity between the 2 sites.
Melbourne patients were recruited from 5 metropolitan stroke units. Trondheim patients were recruited from the stroke unit at University Hospital, Trondheim. All patients <14 days poststroke were eligible for the study. Patients receiving palliative care were excluded. Consenting participants were observed at 10-minute intervals from 8:00 am to 5:00 pm over a single day. At each observation, patient location, activity, and the people present were recorded. Negative binomial regression analyses were undertaken to assess differences in physical activity patterns between stroke units in the 2 cities.
Patients in Melbourne and Trondheim had similar baseline characteristics. Melbourne patients spent 21% more time in bed and only 12.2% undertook moderate/high activity (versus 23.2% in Trondheim, P<0.001). This difference was even more pronounced among patients with greater stroke severity. The incidence rate ratio for time spent doing standing and walking activities in Melbourne was 0.44 (95% CI: 0.32 to 0.62) when compared with Trondheim.
Higher activity levels were observed in Trondheim patients, particularly among those with more severe strokes. A greater emphasis on mobilization may make an important contribution to improved outcome. Further investigation of this is warranted.

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    • "We found that patients in stroke rehabilitation spent as much as 74% of the “active” day sedentary. Overall patients were more active than stroke survivors in studies from acute stroke units in both Norway (77%) [14, 15] and Australia (88%) [14], but the amount of sedentary time was still high compared to a healthy population (57–57.8%) [11, 30] and for a rehabilitation setting where physical training is supposed to be a central part of the program. "
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    ABSTRACT: Background. Sedentary behaviour is associated with health risks, independent of physical activity. This study aimed to investigate patterns of sedentary behaviour and physical activity among stroke survivors in rehabilitation hospitals. Methods. Stroke survivors admitted to four Swedish hospital-based rehabilitation units were recruited ≥7 days since stroke onset and their activity was measured using behavioural mapping. Sedentary behaviour was defined as lying down or sitting supported. Results. 104 patients were observed (53% men). Participants spent an average of 74% (standard deviation, SD 21%) of the observed day in sedentary activities. Continuous sedentary bouts of ≥1 hour represented 44% (SD 32%) of the observed day. A higher proportion (30%, SD 7%) of participants were physically active between 9:00 AM and 12:30 PM, compared to the rest of the observed day (23%, SD 6%, P < 0.0005). Patients had higher odds of being physically active in the hall (odds ratio, OR 1.7, P = 0.001) than in the therapy area. Conclusions. The time stroke survivors spend in stroke rehabilitation units may not be used in the most efficient way to promote maximal recovery. Interventions to promote reduced sedentary time could help improve outcome and these should be tested in clinical trials.
    Stroke Research and Treatment 03/2014; 2014:591897. DOI:10.1155/2014/591897
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    • "Physical activity, location, and people present were recorded across the day for each patient using established standardised behavioural mapping procedures , which have been previously demonstrated to have high interrater reliability [12]. High consistency of patient behaviour across days has been reported in a previous study [13]; therefore, each individual patient was observed for a single working day. Observation days were undertaken approximately every six to eight weeks and up to 10 patients could be recruited for each day of observation. "
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    ABSTRACT: Background. Common models of acute stroke care include the acute stroke unit, focusing on acute management, and the comprehensive stroke unit, incorporating acute care and rehabilitation. We hypothesise that the rehabilitation focus in the comprehensive stroke unit promotes early physical activity and discharge directly home. Methods. We conducted a two-centre prospective observational study of patients admitted to a comprehensive or acute stroke unit within 14 days poststroke. We recruited 73 patients from each site, matched on age, stroke severity, premorbid function, and walking ability. Patient activity was measured using behavioural mapping. Therapy activity was recorded by therapist report. Time to first mobilisation, discharge destination, and length of stay were extracted from the medical record. Results. The comprehensive stroke unit group included more males, fewer partial anterior circulation infarcts, more lacunar infarcts, and more patients ambulant without aids prior to their stroke. Patients in the comprehensive stroke unit spent 14.4% more (95% CI: 8.9%-19.8%; P < 0.001) of the day in moderate or high activity, 18.5% less time physically inactive (95% CI: 5.0%-32.0%; P = 0.008), and were more likely to be discharged directly home (OR 3.7; 95% CI 1.4-9.5; P = 0.007). Conclusions. Comprehensive stroke unit care may foster early physical activity, with likely discharge directly home.
    12/2013; 2013(4):498014. DOI:10.1155/2013/498014
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    • "Observation. We used a method of behavioural mapping that was developed and tested in an acute stroke population and has been shown to be reliable and acceptable to stroke survivors [14] [21] [29]. Using this method, participants are observed at 10-minute intervals, except for four randomly scheduled 10-minute breaks, over a 9 hour day. "
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    ABSTRACT: Background: If a simple system of instrumented monitoring was possible early after stroke, therapists may be able to more readily gather information about activity and monitor progress over time. Our aim was to establish whether a device containing a dual-axis accelerometer provides similar information to behavioural mapping on physical activity patterns early after stroke. Methods: Twenty participants with recent stroke ≤ 2 weeks and aged >18 were recruited and monitored at an acute stroke ward. The monitoring device (attached to the unaffected leg) and behavioural mapping (observation) were simultaneously applied from 8 a.m. to 5 p.m. Both methods recorded the time participants spent lying, sitting, and upright. Results: The median percentage and interquartile range (IQR) of time spent lying, sitting, and upright recorded by the device were 36% (15-68), 51% (28-72), and 2% (1-5), respectively. Agreement between the methods was substantial: Intraclass Correlation Coefficient (95% CI): lying 0.74 (0.46-0.89), sitting 0.68 (0.36-0.86), and upright 0.72 (0.43-0.88). Conclusion: Patients are inactive in an acute stroke setting. In acute stroke, estimates of time spent lying, sitting, and upright measured by a device are valid.
    10/2013; 2013(3):460482. DOI:10.1155/2013/460482
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