Using pedometers to monitor walking activity in outcome assessment for pulmonary rehabilitation.
Journal - Chronic respiratory disease (England )
BACKGROUND: The purpose of this study was to determine whether a commercially available pedometer could detect changes in home-based walking activity among chronic obstructive pulmonary disease (COPD) patients completing pulmonary rehabilitation (PR). METHODS: Patients with COPD referred to outpatient PR wore a pedometer to count steps for 1 week at the beginning and 1 week at the end of PR. Patients also completed the 6-min walk test (6MWT), the Medical Research Council (MRC) dyspnea scale and the self-administered chronic respiratory disease questionnaire (CRQ) at the beginning and the end of PR. Paired t tests were used to compare pre- and post-PR changes in outcome variables. RESULTS: 45 patients with severe COPD (forced expiratory volume in 1 second [FEV(1)] 45% +/- 18% of predicted) participated in a total of 17.4 +/- 4.6 PR sessions. Significant improvements in 6MWT (49 +/- 59 m; p < .0001), MRC dyspnea score (-0.64 +/- 0.96 units; p = .003) and CRQ score (10 +/- 18 units; p = .0007) were noted following PR. Patients whose pedometer-measured steps were within 20% of observed counted steps were included in the analysis. Pedometer counts increased by 33 +/- 149 steps per hour worn after, as compared with before PR (p = .14). There was a significant inverse relationship between baseline pedometer counts and change in pedometer counts per hour post-PR (r = -.46; p = .001). Patients with low baseline activity levels had significant increases in pedometer activity (88 +/- 30 counts per hour worn) and a greater reduction in MRC dyspnea score (-0.94 vs -0.29; p = .04) following PR, whereas those with higher baseline activity levels had a decrease in pedometer activity (-19 +/- 29 counts/hour; p = .015). CONCLUSIONS: A standard pedometer worn at the waist did not detect changes in lower extremity activity following PR. This negative finding occurred despite demonstrated improvements in dyspnea, exercise tolerance and quality of life measures. Although pedometers are inexpensive and easy to use, they may not be sensitive enough to be used routinely as an outcome measure for PR.
Dependence in prestroke mobility predicts adverse outcomes among patients with acute ischemic stroke.
Journal - Stroke; a journal of cerebral circulation (United States )
BACKGROUND AND PURPOSE: Stroke survivors are commonly dependent in activities of daily living; however, the relation between prestroke mobility impairment and poststroke outcomes is poorly understood. The primary objective of this study was to evaluate the association between prestroke mobility impairment and 4 poststroke outcomes. The secondary objective was to evaluate the association between prestroke mobility impairment and a plan for physical therapy. METHODS: This was a secondary analysis of the National Stroke Project data, a retrospective cohort of Medicare beneficiaries who were hospitalized with an acute ischemic stroke (1998 to 2001). Logistic-regression modeling was used to examine the adjusted association between prestroke mobility impairment with patient outcomes and a plan for physical therapy. RESULTS: Among the 67,445 patients hospitalized with an ischemic stroke, 6% were dependent in prestroke mobility. Prestroke mobility dependence was independently associated with an increased odds of poststroke mobility impairment (odds ratio [OR]=9.9; 95% CI, 9.0 to 10.8); in-hospital mortality (OR=2.4; 95% CI, 2.2 to 2.7); discharge to a skilled nursing facility (OR=3.5; 95% CI, 3.2 to 3.8); and the combination of in-hospital death or discharge to a skilled nursing facility (OR=3.5; 95% CI, 3.3 to 3.8). Prestroke mobility dependence was independently associated with a decreased odds of having a plan for physical therapy (OR=0.79; 95% CI, 0.73 to 0.85). CONCLUSIONS: These data, obtained from a large, geographically diverse cohort from the United States, demonstrate a strong association between dependence in prestroke mobility and adverse outcomes among elderly stroke patients. Clinicians should screen patients for prestroke mobility impairment to identify patients at greatest risk for adverse events.
|ISSN : ||1524-4628|
|Mesh Heading : ||Activities of Daily Living Acute Disease Aged Aged, 80 and over Brain Ischemia Dependency (Psychology) Female Geriatric Assessment Humans Male Motor Activity Physical Therapy Modalities Predictive Value of Tests Risk Factors Stroke epidemiology epidemiology|
|Mesh Heading Relevant : ||Disability Evaluation physiopathology rehabilitation physiopathology rehabilitation|