title: SIRRACT: An International Randomized Clinical Trial of Activity Feedback During Inpatient Stroke Rehabilitation Enabled by Wireless Sensing.
abstract: BACKGROUND
  Walking-related disability is the most frequent reason for inpatient stroke rehabilitation. Task-related practice is a critical component for improving patient outcomes.
  
  
  OBJECTIVE
  To test the feasibility of providing quantitative feedback about daily walking performance and motivating greater skills practice via remote sensing.
  
  
  METHODS
  In this phase III randomized, single blind clinical trial, patients participated in conventional therapies while wearing wireless sensors (triaxial accelerometers) at both ankles. Activity-recognition algorithms calculated the speed, distance, and duration of walking bouts. Three times a week, therapists provided either feedback about performance on a 10-meter walk (speed only) or walking speed feedback plus a review of walking activity recorded by the sensors (augmented). Primary outcomes at discharge included total daily walking time, derived from the sensors, and a timed 15-meter walk.
  
  
  RESULTS
  Sixteen rehabilitation centers in 11 countries enrolled 135 participants over 15 months. Sensors recorded more than 1800 days of therapy, 37 000 individual walking bouts, and 2.5 million steps. No significant differences were found between the 2 feedback groups in daily walking time (15.1 ± 13.1 vs 16.6 ± 14.3 minutes, P = .54) or 15-meter walking speed (0.93 ± 0.47 vs 0.91 ± 0.53 m/s, P = .96). Remarkably, 30% of participants decreased their total daily walking time over their rehabilitation stay.
  
  
  CONCLUSIONS
  In this first trial of remote monitoring of inpatient stroke rehabilitation, augmented feedback beyond speed alone did not increase the time spent practicing or improve walking outcomes. Remarkably modest time was spent walking. Wireless sensing, however, allowed clinicians to audit skills practice and provided ground truth regarding changes in clinically important, mobility-related activities.
authors.affiliation: University of California, Los Angeles, CA, USA.
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Dorsch
authors.affiliation: University of California, Los Angeles, CA, USA.
authors.forename: Seth
authors.initials: S
authors.lastname: Thomas
authors.affiliation: University of California, Los Angeles, CA, USA.
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Xu
authors.affiliation: University of California, Los Angeles, CA, USA.
authors.forename: William
authors.initials: W
authors.lastname: Kaiser
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Dobkin
mesh_terms: D000368:Aged; D001676:Biofeedback, Psychology / Q000379:methods*; D005260:Female; D006801:Humans; D007297:Inpatients; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D012047:Rehabilitation Centers; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D016138:Walking; D059015:Wireless Technology
keywords: accelerometer; rehabilitation; stroke; telemedicine; walking; wireless technology