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Objective: To investigate the trial-based cost-effectiveness of the addition of a tailored digitally enabled exercise intervention to usual care shown to be clinically effective in improving mobility in the Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial compared to usual care alone. Design: Economic evaluation alongside a pragmatic randomized controlled trial. Participants: 300 people receiving inpatient aged and neurological rehabilitation were randomized to the intervention (n = 149) or usual care control group (n = 151). Main measures: Incremental cost effectiveness ratios were calculated for the additional costs per additional person demonstrating a meaningful improvement in mobility (3-point in Short Physical Performance Battery) and quality-adjusted life years gained at 6 months (primary analysis). The joint probability distribution of costs and outcomes was examined using bootstrapping. Results: The mean cost saving for the intervention group at 6 months was AU$2286 (95% Bootstrapped cost CI: −$11,190 to $6410) per participant; 68% and 67% of bootstraps showed the intervention to be dominant (i.e. more effective and cost saving) for mobility and quality-adjusted life years, respectively. The probability of the intervention being cost-effective considering a willingness to pay threshold of AU$50,000 per additional person with a meaningful improvement in mobility or quality-adjusted life year gained was 93% and 77%, respectively. Conclusions: The AMOUNT intervention had a high probability of being cost-effective if decision makers are willing to pay AU$50,000 per meaningful improvement in mobility or per quality-adjusted life year gained, and a moderate probability of being cost-saving and effective considering both outcomes at 6 months post randomization. [ABSTRACT FROM AUTHOR]

Abstract Background Responsiveness refers to a measurement tool’s ability to detect change in performance over time. The aim of the review was to summarise studies of responsiveness of lower limb physical performance measures during inpatient care after stroke. Methods A systematic literature review was conducted. Prospective studies that included participants with a diagnosis of stroke, were commenced in the acute or subacute phase of inpatient care and included a measure of a lower limb physical performance were included in this review. Results Twenty-one studies met these inclusion criteria. A variety of measures were investigated including the Berg Balance Scale, various timed walking tests and the Rivermead Mobility Index. Ten of the included studies had small sample sizes (50 participants or less), 2 studies used a convenience sample rather than consecutive recruitment and 5 studies excluded potential participants with poor physical abilities at baseline. Responsiveness varied between and within studies but was generally large, Effect Size (ES) or Standardised Response Mean (SRM) > 0.8. Measures displaying large responsiveness included the twelve-minute walk test (SRM 1.90) and the Modified Rivermead Mobility Index (SRM 1.31) when re-measured at four weeks after stroke, and the Berg Balance Scale (ES 1.11) and Postural Assessment Scale for Stroke Patients (ES 1.12) when re-measured at approximately six months after stroke. Conclusion Studies conducted to date have generally found physical performance measures after stroke to have large responsiveness i.e., to be able to detect changes. Further investigation of the responsiveness of measurement tools after stroke in larger prospective cohort studies is required.

AbstractPurposeMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONThe Falls After Stroke Trial (FAST) intervention involves habit-forming functional exercise and mobility practice which may increase physical activity. This substudy of FAST explores physical activity in community-dwelling people after stroke comparing the FAST intervention to usual care.This study used a subset of 49 participants from a randomised trial. Outcome measures were taken at baseline, 6- and 12-months. The primary outcome was physical activity (step count, upright time and sedentary time, activPAL4™ micro).Thirty-nine participants (80%) had valid primary outcome data at 6 months and 36 participants (73%) at 12 months. Compared to baseline, the experimental group completed 485 (95% CI −434 to 1405) more steps/day than the control group at 6 months and 724 (95% CI −239 to 1667) more steps/day at 12 months; and spent 36 (95% CI −46 to 118) fewer min/day in sedentary behaviour than the control group at 6 months and 34 (95% CI −51 to 119) fewer min/day at 12 months, although the differences were not significant.FAST may improve physical activity more than usual care at 6- and 12-months but results are inconclusive. Further research could be conducted to confirm any benefit in a larger sample.Physical activity levels of older community-dwelling people after stroke in the chronic phase are low.Although there is uncertainty, a tailored, multicomponent intervention involving habit-forming functional exercise and mobility practice (FAST) may have a positive impact on physical activity in people after stroke.Rehabilitation clinicians could consider the use of FAST, and in particular habit-forming functional exercise, to support physical activity opportunities in community-dwelling people after stroke.Physical activity levels of older community-dwelling people after stroke in the chronic phase are low.Although there is uncertainty, a tailored, multicomponent intervention involving habit-forming functional exercise and mobility practice (FAST) may have a positive impact on physical activity in people after stroke.Rehabilitation clinicians could consider the use of FAST, and in particular habit-forming functional exercise, to support physical activity opportunities in community-dwelling people after stroke. [ABSTRACT FROM AUTHOR]

Objective: To describe the dose of lower limb exercise completed during admission to a stroke unit, establish predictors of dose and explore the relationship between dose and walking outcomes., Design: Inception cohort study., Participants: Two hundred consecutively-admitted people with stroke., Methods: Repetitions of exercise completed throughout the admission were tallied. Possible predictors of exercise dose were recorded within 48 h of admission. Walking velocity was assessed at the beginning and end of the hospital stay., Results: Data were available for 191 (96%) participants on discharge. The mean daily dose of lower limb exercise was 288 repetitions (standard deviation (SD) 242), the variability in dose was best explained by age and disability level. The mean improvement in walking velocity was 0.43 m/s (SD 0.46), 26% of variability in walking improvement was explained by exercise repetitions and 29% was explained by a multivariable model including significant contributions from exercise repetitions (p < 0.01) and age (p = 0.03). After controlling for other factors, for every 100 daily repetitions of lower limb exercise there was an additional change in walking velocity of 0.08 m/s (95% CI 0.05 to 0.11, p < 0.01)., Conclusion: Exercise dose in a stroke unit is variable and can be predicted by age and disability. Increased exercise dose is associated with improved mobility outcomes.