Researcher(s)
- Sanjana Gontu, Biological Sciences, University of Delaware
Faculty Mentor(s)
- Darcy Reisman, Department of Physical Therapy, University of Delaware
Abstract
Introduction
Each year, 795,000 Americans experience a stroke. Many survivors are less active than even the most sedentary adults, increasing risk of recurrent stroke or health complications. Step activity monitoring (SAM) programs, such as the one used in the PROWALKS clinical trial, have led to increased daily walking in stroke survivors. However, access to Physical Therapy (PT) clinics may be limited due to financial, transportation, or other barriers. SAM programs delivered by trained volunteers outside of a clinic may improve accessibility for individuals facing these barriers
The purpose of this study was to evaluate the effectiveness, safety, and feasibility of a volunteer-led, PT-advised SAM program in a non-clinical setting to increase daily walking in individuals with chronic stroke. We hypothesized that the intervention would be safe and feasible, and participants would demonstrate increased steps per day (SPD) after the intervention.
Methods
Fifteen individuals completed the intervention thus far; however, only 12 individuals, > 6 months post stroke (1M/11F; average age = 68 ± 9.08 yrs) were included due to FitbitTM malfunctions. Over 12 weeks, participants monitored their steps using a Fitbit and completed motivational interviewing-based coaching with a Doctor of Physical Therapy (DPT) student. Licensed PTs conducted pre/post-intervention evaluations. The primary outcome of this study was change in SPD from pre- to post-intervention.
Results
Eight participants increased their SPD (mean change=2,273), while four participants decreased (mean change=-1,732), for an overall average increase of 938 SPD (n=12, p=0.11). The PROWALKS SAM group demonstrated a larger increase (1,542 SPD, n=68, p<0.001). Participants in this study attended 18 sessions and wore the Fitbit 6.6 days/week, versus 24 check-in sessions attended and 4.4 Fitbit-worn days/week in PROWALKS.
Discussion
There were no statistically significant changes in SPD. The smaller mean increase when compared to PROWALKS may reflect differences in intervention structure or participant-specific factors. Lower attendance in our community-based pilot study from its more inclusive but less controlled study design. However, greater Fitbit adherence in this study supports the feasibility of a non-clinical SAM intervention delivery. This pilot is still ongoing, and further analysis may clarify effectiveness and feasibility once all individuals complete the program.