Using Compositional Data Analysis to Explore Movement Behaviors in People who have Experienced a Stroke

George Fulk, Pamela Duncan, Sandra Billinger, Bria Bartsch, Gina Bell, Keenan Batts, Ben Braxley, Emily Peterson, Karen Klingman
Purpose:

The purpose of this study was to use CoDA to analyze movement behaviors in people with stroke and to explore the association between the composition of movement behaviors and disability.

Methods:

This was a cross-sectional study at 60 days post stroke. Participants wore an activity monitor (AM) for approximately 7 days that measured time in active, sedentary, and sleep behaviors. The modified Rankin Scale (mRS) was used to measure disability. Depression (PHQ-9), gait speed (GS), age, and area deprivation index (ADI) were also measured as potential confounding covariates. CoDA was used to explore the composition of the movement behaviors and the association between movement behaviors and disability (mRS). Multiple linear regression analyses were performed for new compositions of movement behaviors by reallocating 30 minutes of time from sedentary behavior to active behavior to examine the potential impact of changing movement behavior on disability.

Results:

58 participants wore the AM for a mean of 5.4 (1.4) days. The compositional mean of the movement behaviors (10% of time in active behavior, 55% in sedentary behavior, and 35% in sleep) was significantly associated with the mRS (adjusted R2=0.5688, p0.05). Regression analysis found that reallocating time from sedentary behavior to active behavior significantly reduced disability (p0.05). For example, when 30 minutes of time was reallocated from sedentary to active behavior the predicted change in disability was an improvement of -0.12 points on the mRS (a lower score on the mRS indicates less disability) from 2.45 to 2.33.

Conclusion(s):

People post stroke spend most of their time in sedentary and sleep movement behaviors. The composition of movement behaviors was significantly associated with disability. Increasing time in active movement behaviors and reducing time in sedentary movement behaviors may reduce disability after stroke.

Implications:

This is the first report that we are aware of that uses CoDA to analyze movement behaviors after stroke. Given the importance of the full spectrum of movement behaviors on disability after stroke, researchers should consider using CoDA to understand the complex interaction among different movement behaviors after stroke and their impact on recovery.

Funding acknowledgements:
This research was supported by the National Institutes of Health NINR, Award Number R01NR018979.
Keywords:
Stroke
Movement Behaviors
Compositional Data Analysis
Primary topic:
Neurology: stroke
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Western IRB
Provide the ethics approval number:
1290669
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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