title: Feasibility of Focused Stepping Practice During Inpatient Rehabilitation Poststroke and Potential Contributions to Mobility Outcomes.
abstract: BACKGROUND
  Optimal physical therapy strategies to maximize locomotor function in patients early poststroke are not well established. Emerging data indicate that substantial amounts of task-specific stepping practice may improve locomotor function, although stepping practice provided during inpatient rehabilitation is limited (<300 steps/session).
  
  
  OBJECTIVE
  The purpose of this investigation was to determine the feasibility of providing focused stepping training to patients early poststroke and its potential association with walking and other mobility outcomes.
  
  
  METHODS
  Daily stepping was recorded on 201 patients <6 months poststroke (80% < 1 month) during inpatient rehabilitation following implementation of a focused training program to maximize stepping practice during clinical physical therapy sessions. Primary outcomes included distance and physical assistance required during a 6-minute walk test (6MWT) and balance using the Berg Balance Scale (BBS). Retrospective data analysis included multiple regression techniques to evaluate the contributions of demographics, training activities, and baseline motor function to primary outcomes at discharge.
  
  
  RESULTS
  Median stepping activity recorded from patients was 1516 steps/d, which is 5 to 6 times greater than that typically observed. The number of steps per day was positively correlated with both discharge 6MWT and BBS and improvements from baseline (changes; r = 0.40-0.87), independently contributing 10% to 31% of the total variance. Stepping activity also predicted level of assistance at discharge and discharge location (home vs other facility).
  
  
  CONCLUSIONS
  Providing focused, repeated stepping training was feasible early poststroke during inpatient rehabilitation and was related to mobility outcomes. Further research is required to evaluate the effectiveness of these training strategies on short- or long-term mobility outcomes as compared with conventional interventions.
authors.affiliation: Rehabilitation Institute of Chicago, Chicago, IL, USA University of Illinois at Chicago, Chicago, IL, USA Northwestern University, Chicago, IL, USA tgh@uic.edu.
authors.forename: T George
authors.initials: TG
authors.lastname: Hornby
authors.affiliation: Rehabilitation Institute of Chicago, Chicago, IL, USA.
authors.forename: Carey L
authors.initials: CL
authors.lastname: Holleran
authors.affiliation: Rehabilitation Institute of Chicago, Chicago, IL, USA.
authors.forename: Abigail L
authors.initials: AL
authors.lastname: Leddy
authors.affiliation: Rehabilitation Institute of Chicago, Chicago, IL, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Hennessy
authors.affiliation: Rehabilitation Institute of Chicago, Chicago, IL, USA Northwestern University, Chicago, IL, USA.
authors.forename: Kristan A
authors.initials: KA
authors.lastname: Leech
authors.affiliation: Rehabilitation Institute of Chicago, Chicago, IL, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Connolly
authors.affiliation: Rehabilitation Institute of Chicago, Chicago, IL, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Moore
authors.affiliation: Rehabilitation Institute of Chicago, Chicago, IL, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Straube
authors.affiliation: Rehabilitation Institute of Chicago, Chicago, IL, USA Northwestern University, Chicago, IL, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Lovell
authors.affiliation: Rehabilitation Institute of Chicago, Chicago, IL, USA Northwestern University, Chicago, IL, USA.
authors.forename: Elliot
authors.initials: E
authors.lastname: Roth
mesh_terms: D000368:Aged; D015444:Exercise; D005081:Exercise Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology* / Q000534:rehabilitation*; D006801:Humans; D007297:Inpatients; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D012372:ROC Curve; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*
keywords: outcomes; physical exercise; rehabilitation