Background: Individualizing interventions is imperative to optimize physical activity in people with chronic stroke. This secondary analysis grouped individuals with chronic stroke into clinical profiles based on baseline characteristics and examined if these clinical profiles preferentially benefitted from a specific rehabilitation intervention to improve daily step activity. Methods: Participants had non cerebellar strokes >6 months prior to enrollment, were 21-85 years old, had walking speeds of 0.3-1.0 m/s, and took <8,000 steps per day. Participants were randomized to 1 of 3 interventions: high intensity treadmill training (FAST), a step activity behavioral intervention (SAM), or a combined intervention (FAST+SAM). The primary outcome was the interaction of latent class (clinical profile) and intervention group (FAST, SAM, FAST+SAM) on a change in steps per day. Key clinical characteristics to identify the latent classes included walking speed, walking endurance, balance self efficacy, cognition, and area deprivation. Results: Of the 190 participants with complete pre and post intervention data (mean [SD] age, 64 [12] years; 93 females [48.9%]), 3 distinct profiles of people with chronic stroke were identified. Within our sample, class 1 had the lowest walking capacity (speed and endurance), lowest balance self efficacy, and highest area deprivation, and had the greatest change in step activity when enrolled in the SAM (mean[95%CI], 1624 [426-2821]) or FAST+SAM (1150 [723-1577]) intervention. Class 2 had walking capacity, baseline steps per day, and self efficacy values between Class 1 and 3, and had the greatest change in step activity when enrolled in the SAM (2002 [1193-2811]) intervention. Class 3 had the highest walking capacity, highest self efficacy, and lowest area deprivation and the greatest change in step activity when enrolled in the FAST+SAM (1532 [915-2150]) intervention. Conclusions: People with chronic stroke require different interventions to optimize a change in step activity. Clinicians can use clinically relevant measures to personalize intervention selection to augment step activity in people with chronic stroke.

The authors have declared no competing interest.

https://www.ahajournals.org/doi/10.1161/STROKEAHA.123.044596

https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-018-1044-1

This work was primarily funded by NIH/NICHD: Promoting Recovery Optimization with WALKing Exercise after Stroke (PROWALKS), 1R01HD086362; NIH/NICHD Predoctoral Training in Physical Therapy and Rehabilitation Research, T32HD007490; This research has been supported in full or part from the Foundation for Physical Therapy Research; NIH NICHD/NCMRR R25HD105583: Reproducible Rehabilitation Research Educational Program. The funding sources played no role in study design, execution, administration, or dissemination.

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The Institutional Review Board of the University of Delaware gave ethical approval for this work.[878153]

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All data produced in the present study are available upon reasonable request to the authors. Data from the primary analysis of the parent randomized control trial are available on the NICHD DASH repository.

https://dash.nichd.nih.gov/study/425019