Protocol and pilot study of a short message service-guided training after acute stroke/transient ischemic attack to increase walking capacity and physical activity

Abstract

Physical activity in community-living individuals after a stroke is usually scarce. This protocol describes a study that will evaluate a method to increase physical activity by performing a 3-month outdoor walking and muscle strengthening program and will examine the 3-month and 1-year effects of this program on individuals with acute stroke (AS) or transient ischemic attack (TIA). In a prospective randomized controlled trial in Uppsala, Sweden, 80 individuals with AS or TIA who maintained cognitive and motor function will be randomized into groups for continuous training for three months or for regular standard care. The training will be supervised by daily cellphone-delivered messages (short message services; SMS), and the intensity, duration and workload will be gradually increased. The primary outcome is a change in walking capacity according to the 6-Minute Walk Test and chair-rising at three months. Secondary outcomes include mobility, gait speed, handgrip strength, body composition (fat mass and muscle mass), biochemical risk-markers, health-related quality of life, and cardiovascular events. Adherence to the training program will be documented with a self-reported diary and step counts over two weeks. The major study started in November 2016, and results are expected in 2019. In a pilot study of 15 subjects post-stroke (mean-age 65 years), we observed improved walking capacity (increasing from 23 to 255 m) and chair-rising (decreasing 2.42 s) from baseline to three months. SMS-guided outdoor training will be tested as a potential therapeutic strategy to increase physical activity and thereby improve walking capacity and physical function following a stroke.

Effects on walking performance and lower body strength by short message service guided training after stroke or transient ischemic attack (The STROKEWALK Study): a randomized controlled trial

“…For some individuals it was difficult to fill in the training diary, which may make such diaries less useful. Furthermore, in a pilot study 11 we intended to compare exercise instructions by text messages with recorded videos with verbal exercise instructions given by a physiotherapist and sent as links to the individuals. However, receiving text messages was clearly preferred.…”

“…Full details about the study protocol (design, recruitment, and intervention) have been described in detail elsewhere. 11 Recruitment started November 1 2016, and ended September 18 2018, when the target number of participants was reached.Thelast three-month follow-up examination was performed December 19 2018. The present study was supported by grants from the Medical faculty at Uppsala University, Swedish Stroke Association (STROKE-Riksförbundet), the Uppsala County Council and the Swedish Association of Physiotherapists, Neurology.…”

“…SMS) for three months, (2) the use of training diaries for three months and (3) pedometers for the registration of step counts during week 1 and week 12; that is, beginning and end of study.The text messages gave instructions on how to exercise to increase walking performance and improve lower body strength and were delivered through an internet service ( www.intime.nu ). 11 The communication was only in one direction; that is, the participants of the intervention group received the training instructions without being able to text back to seek help or advice.…”

“…This change was considered early after trial registration, and is described in the pilot study. 11 Secondary outcomes were the 10-metre walk test (m/s) and the Short Physical Performance Battery (0-12 points). The 10-metre walk test measures comfortable walking speed registered with a stopwatch.…”

Experimental Study on Upper-Limb Rehabilitation Training of Stroke Patients Based on Adaptive Task Level: A Preliminary Study

“…In China, approximately 13 million individuals are stroke survivors, and the prevalence is increasing, with 2 million new stroke patients yearly [2]. Overall, the mean age of stroke patients worldwide is increasing, whereas the onset of stroke tends to be younger in China [2] and Sweden [3]. Due to the lack of effective treatment for the disease, stroke is characterized by high mortality and disability.…”