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Yaron Katz T1,2, Hallevi H3, Giladi N4, Wachler Yannai O5, Molad J6, Dr. Nisnboym M7, Barnea R7, Findler M7, Piura Y7, Vigiser I7, Friedberg A7, Kafri M8
1University of Haifa, Haifa, Israel, 2'Ichilov' Hospital, Tel-Aviv Sourasky Medical Center, Tel - Aviv, Israel, 3'Ichilov' Hospital,Tel-Aviv Sourasky Medical Center, Director, The Cerebrovascular Disease (Stroke) Department, Neurology Division, Tel - Aviv, Israel, 4'Ichilov' Hospital, Tel-Aviv Sourasky Medical Center, Director, Neurology Division, Tel - Aviv, Israel, 5'Ichilov' Hospital, Tel-Aviv Sourasky Medical Center, Director, Physiotherapy Institute, Tel - Aviv, Israel, 6'Ichilov' Hospital, Tel-Aviv Sourasky Medical Center, The Cerebrovascular Disease (Stroke) Department, Neurology Division, Tel - Aviv, Israel, 7'Ichilov' Hospital, Tel-Aviv Sourasky Medical Center, Neurology Division, Tel - Aviv, Israel, 8University of Haifa, Department of Physical Therapy, The Faculty of Social Welfare and Health Sciences, Haifa, Israel
Background: Early mobilization post-stroke is defined as upright activities out of bed, including sitting, standing and walking, beginning within 48 hours post-stroke. Clinical guidelines recommend early mobilization to avoid secondary complications and improve functional recovery. Nonetheless, very few studies objectively characterized the activity level of individuals at the acute phase post-stroke. It is recommended to identify barriers that might limit physical activity to promote implementation of early mobilization as a therapeutic element.
Purpose: To
(1) Measure the level and pattern of physical activity among post-stroke patients in a neurological ward, according to shifts,
(2) Evaluate correlations between activity levels and patient demographic and clinical characteristics, and
(3) Identify barriers to early mobilization.
Methods: Twenty-one patients (mean age69.4 sd±33.4 years,13 men, 8 women, median NIHSS 6, range: 5-18) post-ischemic stroke, hospitalized in a neurological ward participated. Each patient wore an activity monitor (MoveMonitor+) for 2 weeks or until discharge. Stroke severity and motor function were evaluated clinically within 48 hours post-admission. Data on durations of lying, sitting, standing, and number of steps during the morning (7:00-15:00) and evening (15:00-23:00) shifts were extracted. Data were compared to detect time and shift effects, and interactions. Reasons for not getting out of bed and for returning to bed were marked daily on a follow-up sheet. Barriers were categorized as administrative or patient-related, and frequency of each barrier was recorded.
Results: Patients sat for an average of 3 hours during morning shifts and 1.5 hours during evening shifts. They took a mean of 58.3 steps (standard error mean 32.73) during morning shifts and 30.4 (standard error mean 17.16) during evening shifts. Activities were more frequent during morning than evening shifts (psitting=0.0024, pupright=0.0025, psteps=0.0009), and duration increased throughout hospitalization (psitting=0.023, pupright=0.014, psteps=0.0022). Activity levels, including sitting time and number of steps during morning shifts were not correlated with stroke severity based on the National Institutes of Health Stroke Scale (NIHSS) or with walking ability, based on the functional ambulation category scale, at admission. There was a correlation between number of steps during evening shifts and grip strength (p=0.09). Overall, 9 administrative and 10 patient-related barriers were identified. Fatigue, reported by 90.5% of patients, was the most common reported barrier to activity. This was followed by administrative barriers including waiting for medical examinations and decisions of nursing assistants.
Conclusion(s): Activities at the acute phase post-stroke mainly consisted of those requiring very minor physical effort (i.e. supported sitting) and was greater during morning as compared to evening shifts. Patient fatigue was the main barrier to activity; however, many administrative barriers were identified.
Implications: Early mobilization needs to be promoted, possibly by developing specific strategies to address the main barriers. High intensity activities should be emphasized.
Keywords: Activity monitors, early mobilization, stroke
Funding acknowledgements: This study was partially funded by an internal grant from the Graduate Studies Authority, University of Haifa.
Purpose: To
(1) Measure the level and pattern of physical activity among post-stroke patients in a neurological ward, according to shifts,
(2) Evaluate correlations between activity levels and patient demographic and clinical characteristics, and
(3) Identify barriers to early mobilization.
Methods: Twenty-one patients (mean age69.4 sd±33.4 years,13 men, 8 women, median NIHSS 6, range: 5-18) post-ischemic stroke, hospitalized in a neurological ward participated. Each patient wore an activity monitor (MoveMonitor+) for 2 weeks or until discharge. Stroke severity and motor function were evaluated clinically within 48 hours post-admission. Data on durations of lying, sitting, standing, and number of steps during the morning (7:00-15:00) and evening (15:00-23:00) shifts were extracted. Data were compared to detect time and shift effects, and interactions. Reasons for not getting out of bed and for returning to bed were marked daily on a follow-up sheet. Barriers were categorized as administrative or patient-related, and frequency of each barrier was recorded.
Results: Patients sat for an average of 3 hours during morning shifts and 1.5 hours during evening shifts. They took a mean of 58.3 steps (standard error mean 32.73) during morning shifts and 30.4 (standard error mean 17.16) during evening shifts. Activities were more frequent during morning than evening shifts (psitting=0.0024, pupright=0.0025, psteps=0.0009), and duration increased throughout hospitalization (psitting=0.023, pupright=0.014, psteps=0.0022). Activity levels, including sitting time and number of steps during morning shifts were not correlated with stroke severity based on the National Institutes of Health Stroke Scale (NIHSS) or with walking ability, based on the functional ambulation category scale, at admission. There was a correlation between number of steps during evening shifts and grip strength (p=0.09). Overall, 9 administrative and 10 patient-related barriers were identified. Fatigue, reported by 90.5% of patients, was the most common reported barrier to activity. This was followed by administrative barriers including waiting for medical examinations and decisions of nursing assistants.
Conclusion(s): Activities at the acute phase post-stroke mainly consisted of those requiring very minor physical effort (i.e. supported sitting) and was greater during morning as compared to evening shifts. Patient fatigue was the main barrier to activity; however, many administrative barriers were identified.
Implications: Early mobilization needs to be promoted, possibly by developing specific strategies to address the main barriers. High intensity activities should be emphasized.
Keywords: Activity monitors, early mobilization, stroke
Funding acknowledgements: This study was partially funded by an internal grant from the Graduate Studies Authority, University of Haifa.
Topic: Neurology: stroke
Ethics approval required: Yes
Institution: 'Ichilov' Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
Ethics committee: The Institutional Review Board (IRB) / Ethics (Helsinki) Committee,
Ethics number: 0787-16-TLV
All authors, affiliations and abstracts have been published as submitted.
