The Relationship of Physical Impairment, Physical Activity Level, And Fall Rates In The Stroke Patients

Abstract

PURPOSE: The study aimed to investigate the relationship of physical activity level (PAL), physical impairment and fall rates in community dwelling stroke patients. The physical impairment included motor recovery, functional ability and spasticity. METHOD: This study included twenty community-dwelling stroke patients (mean age: 64.4± 9.57 yrs; time since stroke: 2.3±2.4 yrs). All subjects could ambulate 10 m with or without walk-aid. The participants recalled the history of falls in the past half year. Motor recovery was assessed by Fugl-Meyer Assessment (FMA).Spasticity of hemi-paretic limbs were measured by Modified Ashworth Scale (MAS). Five-Times-Sit-to-Stand (FTSS) was to evaluate the functional ability. RT3 tri-axial accelerometers were used to measured energy expenditure(kcal/min) for estimating PAL.Subjects wore the sensors on the non-paretic hip for three consecutive days. Pearson product-moment correlation was performed to investigate relationships between PAL (kcal/kg/day) and FMA, and FTSS. Mann-Whitney U test was used to examine the difference of PAL between non-fallers and fallers, and between mild (MAS score 1~2) and moderate (MAS score 3~4) spasticity subjects. Linear multiple regressions were for the analysis of predictive effects between the related factors and PAL. RESULTS: The mean ± SD of PAL, FMA, and FTSS were 27.12±3.55 (kcal/kg/day), 174.45±47.91, 17.94±8.74 (secs) respectively. PAL showed moderate positive correlation with FMA (r = .46; p<0.5) and moderate negative correlation with FTSST(r = -.50; p<0.5). There was no significant difference (p=.24) for PAL between mild and moderate spasticity groups (28.32±1.26 vs. 25.66±0.65 kcal/kg/day, p=.24). PAL between twelve non-fallers and eight fallers were 28.44±1.13 vs. 25.14±.5 kcal/kg/day showed significant difference (p=.03). Linear regression analysis showed FTSS contributed 25% of the explained variance (p<.05) and is the most relevant factor to affect PAL. CONCLUSION: This study demonstrated functional ability and motor function were the important factors to influence PAL of community dwelling stroke patients and a lower PAL were related to increase fall risk. Clinicians should prescribe the treatment strategy focus on improving functional ability and motor function to promote higher PAL of stroke survivors.