Go Home, Sit Less: The Impact of Home Versus Hospital Rehabilitation Environment on Activity Levels of Stroke Survivors.

Dawn B Simpson, Monique Breslin, Toby Cumming, Sam de Zoete, Seana L Gall, Matthew Schmidt, Coralie English, Michele L Callisaya

Journal: Archives of physical medicine and rehabilitation 2019;99(11):2216-2221.e1

PMID: 29750901

Full Text on Elsevier Science View on PubMed

Abstract

OBJECTIVE

To examine whether change in rehabilitation environment (hospital or home) and other factors influence time spent sitting upright and walking after stroke.

DESIGN

Observational study.

SETTING

Two inpatient rehabilitation units and community residences following discharge.

PARTICIPANTS

Participants (N=34) with stroke were recruited.

MAIN OUTCOME MEASURE

An activity monitor was worn continuously for 7 days during the final week in the hospital and the first week at home. Other covariates included mood, fatigue, physical function, pain, and cognition. Linear mixed models were performed to examine the associations between the environment (exposure) and physical activity levels (outcome) in the hospital and at home. Interaction terms between the exposure and other covariates were added to the model to determine whether they modified activity with change in environment.

RESULTS

The mean age of participants was 68±13 years and 53% were male. At home, participants spent 45 fewer minutes sitting (95% CI -84.8, -6.1; P=.02), 45 more minutes upright (95% CI 6.1, 84.8; P=.02), and 12 more minutes walking (95% CI 5, 19; P=.001), and completed 724 additional steps (95% CI 199, 1250; P=.01) each day compared to in the hospital. Depression at discharge predicted greater sitting time and less upright time (P=.03 respectively) at home.

CONCLUSIONS

Environmental change from hospital to home was associated with reduced sitting time and increased the time spent physically active, though depression modified this change. The rehabilitation environment may be a target to reduce sitting and promote physical activity.

Address: Menzies Institute of Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Physiotherapy Department, Royal Hobart Hospital, Tasmanian Health Service-South, Hobart, Tasmania, Australia.; Menzies Institute of Medical Research, University of Tasmania, Hobart, Tasmania, Australia.; Stroke Division, Florey Institute of Neurosciences and Mental Health, Heidleberg, Victoria, Australia.; Physiotherapy Department, Royal Hobart Hospital, Tasmanian Health Service-South, Hobart, Tasmania, Australia.; School of Health Sciences, University of Tasmania, Hobart, Tasmania, Australia.; School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, Newcastle, Australia; Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, University of Newcastle and Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; School of Health Sciences and Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia.; Menzies Institute of Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Physiotherapy Department, Royal Hobart Hospital, Tasmanian Health Service-South, Hobart, Tasmania, Australia; Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia. Electronic address: [email protected].

DOI: 10.1016/j.apmr.2018.04.012

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MeSH Terms: Accelerometry, Aged, Depression, Environment, Exercise, Female, Hospitals, Rehabilitation, Humans, Male, Middle Aged, Patient Discharge, Sitting Position, Stroke, Stroke Rehabilitation, Time Factors, Treatment Outcome