Predictors of Daily Steps at 1-Year Poststroke: A Secondary Analysis of a Randomized Controlled Trial.

Abstract

Walking has the potential to improve endurance and community participation after stroke. Obtaining ≥6000 daily steps can decrease subsequent stroke risk. Early identification of those prone to low daily steps could facilitate interventions that lead to increased walking and improved health. The purpose of this study was to (1) determine which factors at 2 months poststroke can predict daily step counts at 1 year and (2) determine what step count at 2 months corresponds to obtaining ≥6000 daily steps at 1-year poststroke. This was a secondary analysis of data from the Locomotor Experience Applied Post Stroke trial, which enrolled participants with walking speeds <0.80 m/second at 2 months poststroke. Daily steps were assessed at 2 months and 1-year poststroke. Linear regression was used to predict daily step counts at 1 year based on factors including age, sex, race and/or ethnicity, stroke severity, walking speed, endurance, fitness, motor function, balance, and balance confidence. A receiver operating characteristic curve determined which step count corresponded to reaching ≥6000 steps at 1 year. Data from 206 participants, mean age=63 (13) years, 43% female, mean baseline daily step count=2922 (2749) steps, were analyzed. The final model to predict daily steps at 1 year poststroke contained daily steps at 2 months and balance (Berg Balance Scale score); these factors explained 38% of the variability in daily steps at 1 year (P≤0.001). Participants obtaining ≥1632 daily steps at 2 months were 1.86 (95% CI, 1.52–2.27) times more likely to reach ≥6000 daily steps at 1-year poststroke. Daily steps and balance at 2 months poststroke were the strongest predictors of future daily steps. Improving daily physical activity and targeting balance early after stroke may be necessary to increase physical activity at 1-year poststroke.