Katharine Scrivener’s research while affiliated with Macquarie University and other places

The association between device-based (activPAL) and self-reported [Incidental Exercise and Planned Exercise Questionnaire (IPEQ)] measures of physical activity has not been investigated. This study aimed to determine the association between activPAL and IPEQ measures of physical activity in a sample of community-dwelling older people after stroke. Data from an exploratory analysis embedded within a randomized trial was used. Spearman correlation was used to assess the relationship between activPAL (upright time and step count) and IPEQ (self-reported total exercise time) measures at three timepoints [months 0 ( n = 46), 6 ( n = 39) and 12 ( n = 36)] Strong Spearman correlation between upright time and self-reported total exercise time ( r = 0.51–0.72) and step count and self-reported total exercise time was found at all timepoints ( r = 0.54–0.62). Though further research could confirm these results in a larger sample, there is potential for the IPEQ to be used as a simple estimate of physical activity in a clinical setting.

Background Maintaining mobility in the long term after stroke can be challenging. Furthermore, access to ongoing physiotherapy or exercise programs is limited. There is a need to investigate new models of service delivery to improve mobility in the longer term after stroke. A mobility booster program may be a solution, facilitating short-term access to physiotherapy on an as-needed basis. The aim of this project is to determine the feasibility of conducting a clinical trial of a short-term, high-dose mobility booster program (HiWalk) and measure clinical outcomes in order to estimate the power for a future efficacy trial. Method A multi-site, assessor-blinded pilot randomized trial will be undertaken to compare HiWalk in addition to usual care with usual care alone in 50 participants. Feasibility outcomes include recruitment, adherence, and safety. Clinical outcomes include walking speed, capacity and self-efficacy at 1-month and 6-months. Discussion A mobility booster program may be a successful way to deliver mobility training in the longer term after stroke. This pilot trial will progress the investigation of this model and assist in planning a future definitive trial. Most importantly, it will confirm the feasibility of delivering a novel high-dose, short-term booster program. Trial registration ANZCTR (ACTRN: ACTRN12623000316606p).

Purpose of Review Rehabilitation following stroke is a complex series of assistive and catalytic interventions enabling a survivor to recover and adapt to their stroke. To achieve adaptation, rehabilitation should supplement healthcare across the continuum, however comprehensive evidence on the provision of stroke rehabilitation in Australia is lacking. The aim of this paper was to describe stroke rehabilitation provision, collecting data using the World Health Organisation (WHO) template for rehabilitation information collection (TRIC). Data were analysed descriptively to complete the Systematic Assessment of Rehabilitation Situation (STARS) assessment. Recent Findings Challenges include inadequacies in reporting and poor data integration between state- and nationally-funded rehabilitation programs and a lack of evidence illustrating continuity of care across rehabilitation settings. Particular gaps in data on stroke rehabilitation in Indigenous populations and a lack of research to date on cultural acceptability of effective interventions were noted. Summary The economic benefit of improved access to stroke rehabilitation nationally is clear, however achieving this needs collaborative and integrated efforts from multiple stakeholders. Findings will inform the establishment of national priorities to strengthen stroke rehabilitation in Australia.

Purpose: The Falls After Stroke Trial (FAST) intervention involves habit-forming functional exercise and mobility practice which may increase physical activity. This substudy of FAST explores physical activity in community-dwelling people after stroke comparing the FAST intervention to usual care. Methods: This study used a subset of 49 participants from a randomised trial. Outcome measures were taken at baseline, 6- and 12-months. The primary outcome was physical activity (step count, upright time and sedentary time, activPAL4™ micro). Results: Thirty-nine participants (80%) had valid primary outcome data at 6 months and 36 participants (73%) at 12 months. Compared to baseline, the experimental group completed 485 (95% CI -434 to 1405) more steps/day than the control group at 6 months and 724 (95% CI -239 to 1667) more steps/day at 12 months; and spent 36 (95% CI -46 to 118) fewer min/day in sedentary behaviour than the control group at 6 months and 34 (95% CI -51 to 119) fewer min/day at 12 months, although the differences were not significant. Conclusions: FAST may improve physical activity more than usual care at 6- and 12-months but results are inconclusive. Further research could be conducted to confirm any benefit in a larger sample.

The present study aims to describe the chair, bed, and toilet heights in rehabilitation hospitals and home environments to challenge rehabilitation clinicians to better prepare stroke survivors for discharge home. This study uses analysis of secondary outcomes from a multicentre, phase II randomized controlled trial (HOME Rehab trial) and additional observation of hospital environment. Data were collected from six rehabilitation hospitals and the homes of two hundred first-time stroke survivors who were aged >45 years. Chair, bed and toilet heights were measured; we measured 936 chairs and beds in hospital (17%) and home (83%) environments. Mean chair height at home was 47 cm (SD 6), which was 2 cm (95% CI, 0-4) lower than in the hospital ward and 5 cm (95% CI, 3-7) lower than in the hospital gym. Mean toilet height at home was 42 cm (SD 3), which was 3 cm (95% CI, 2-4) lower than in the hospital. Study findings suggest a disparity in heights between hospitals and home. Although clinicians may be aware of this disparity, they need to ensure that chair and bed heights within the hospital environment are progressively made lower to better prepare stroke survivors for discharge home.

Question What is the effect of Bobath therapy on arm activity and arm strength compared with a dose-matched comparison intervention or no intervention after stroke? Design Systematic review of randomised trials with meta-analysis. Participants Adults after stroke. Intervention Bobath therapy compared with no intervention or other interventions delivered at the same dose as the Bobath therapy. Outcome measures Arm activity outcomes and arm strength outcomes. Trial quality was assessed with the PEDro scale. Results Thirteen trials were included; all compared Bobath with another intervention, which were categorised as: task-specific training (five trials), arm movements (five trials), robotics (two trials) and mental practice (one trial). The PEDro scale scores ranged from 5 to 8. Pooled data from five trials indicated that Bobath therapy was less effective than task-specific training for improving arm activities (SMD –1.07, 95% CI –1.59 to –0.55). Pooled data from five trials indicated that Bobath therapy was similar to or less effective than arm movements for improving arm activities (SMD –0.18, 95% CI –0.44 to 0.09). One trial indicated that Bobath therapy was less effective than robotics for improving arm activities and one trial indicated similar effects of Bobath therapy and mental practice on arm activities. For strength outcomes, pooled data from two trials indicated a large benefit of task-specific training over Bobath therapy (SMD –1.08); however, this estimate had substantial uncertainty (95% CI –3.17 to 1.01). The pooled data of three trials indicated that Bobath therapy was less effective than task-specific training for improving Fugl-Meyer scores (MD –7.84, 95% CI –12.99 to –2.69). The effects of Bobath therapy relative to other interventions on strength outcomes remained uncertain. Conclusions After stroke, Bobath therapy is less effective than task-specific training and robotics in improving arm activity and less effective than task-specific training on the Fugl-Meyer score. Registration PROSPERO CRD42021251630.

Objective To investigate the trial-based cost-effectiveness of the addition of a tailored digitally enabled exercise intervention to usual care shown to be clinically effective in improving mobility in the Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial compared to usual care alone. Design Economic evaluation alongside a pragmatic randomized controlled trial. Participants 300 people receiving inpatient aged and neurological rehabilitation were randomized to the intervention (n = 149) or usual care control group (n = 151). Main measures Incremental cost effectiveness ratios were calculated for the additional costs per additional person demonstrating a meaningful improvement in mobility (3-point in Short Physical Performance Battery) and quality-adjusted life years gained at 6 months (primary analysis). The joint probability distribution of costs and outcomes was examined using bootstrapping. Results The mean cost saving for the intervention group at 6 months was AU$2286 (95$11,190 to $6410) per participant; 68$50,000 per additional person with a meaningful improvement in mobility or quality-adjusted life year gained was 93% and 77%, respectively. Conclusions The AMOUNT intervention had a high probability of being cost-effective if decision makers are willing to pay AU$50,000 per meaningful improvement in mobility or per quality-adjusted life year gained, and a moderate probability of being cost-saving and effective considering both outcomes at 6 months post randomization.