No abstract

Fatigue is common and persistent in stroke survivors, yet it is not known how mobility deficits, fitness, or other factors, such as social support, relate to fatigue severity, or whether subjective fatigue contributes to reduced ambulatory activity. The severity of fatigue in a sample of 53 community-dwelling subjects with chronic hemiparetic stroke was examined, and relationships among fatigue and mobility deficit severity, cardiovascular-metabolic fitness, ambulatory activity, social support, and self-efficacy for falls were identified. Measures included the Fatigue Severity Scale, timed 10-meter walks, the Berg Balance Scale, submaximal and peak VO2, total daily step activity derived from microprocessor-linked Step Activity Monitors, the Medical Outcomes Study Social Support Survey, and the Falls Efficacy Scale. Forty-six percent of the sample had severe fatigue. Fatigue showed no relationship to ambulatory activity. Fatigue severity was associated with the Berg Balance Scale (p < .01) and falls efficacy (p < .01), but not with cardiovascular fitness variables. Patients with elevated fatigue severity scores had lower social support (p < .05) and poorer falls efficacy scores (p < .05) than patients reporting less fatigue. Only falls efficacy was predictive of fatigue severity (r2 = 0.216, p < .01). Further studies are needed to evaluate whether rehabilitation strategies that include not only fitness and mobility interventions, but also social/behavioral and self-efficacy components, are associated with reduced fatigue and increased ambulation.

Background and Purpose-Nearly two thirds of stroke survivors have deficits impairing ambulatory recovery.Conventional mobility outcome measures such as timed walks and functional independence measure (FIM) do not quantify free-living ambulatory behavior. This study compared step activity monitoring (SAM) with established instruments to assess ambulatory recovery across the outpatient subacute stroke rehabilitation phase. Methods-We measured FIM mobility subscale, SAM-derived daily steps, Stroke Impact Scale (SIS) mobility scores, and timed walks in 11 subjects after discharge from inpatient rehabilitation and again 3 months later. Results-Significant improvement was measured in free-living step activity (mean gain 80%; Pϭ0.001) but not with timed walks (Pϭ0. A poststroke rehabilitation goal is to resume ambulation in home and community. 1 Although commonly used, survey-based measures of mobility recovery and timed walks may not capture elements of ambulatory behavior or mobility-dependent social participation that indicate recovery. Trained observer-rated measures, such as the Functional Independence Measure (FIM), although sensitive in severe stroke, demonstrate a ceiling effect in patients with mild to moderate disability still requiring assistance. 2 A method to measure functional ambulatory changes that account for differences in stroke severity, reported and actual performance, and daily patterns is needed.Portable microprocessor-linked step activity monitoring (SAM; Cyma Corporation) provides an accurate, reliable method for quantifying ambulatory activity across a broad range of gait deficits (Ն97% accuracy with hand-tallied step counts; PϽ0.001). [3][4][5][6] We investigated the utility of SAM to determine profiles of ambulatory activity across the subacute outpatient rehabilitation period and compared the sensitivity of SAM with conventional outcome instruments to measure ambulatory recovery. MethodsCommunity-dwelling men and women with mild-to-moderate poststroke hemiparetic gait deficits were recruited at discharge from inpatient rehabilitation. Participants provided informed consent according to approved institutional review board procedures. Exclusion criteria protected safety and controlled for extraneous factors impacting ambulatory activity.Quantifying ambulatory activity with SAM, self-selected floorwalking velocity (SSFWV), 7 FIM, 9 and Stroke Impact Scale (SIS) mobility 7 subscales was conducted 2 weeks after rehabilitation discharge and repeated 3 months later. The timed 30-foot walk is a simple and robust technique to evaluate ambulatory function in a variety of neurological conditions. SSFWV is recognized as a criterion standard index of hemiplegic motor recovery and is a key indicator of ability to manage household distances. 7,8 The FIM is widely used in rehabilitation to evaluate mobility; 2 items comprise a mobility subscale measuring domains of basic ambulation and stair climbing. The FIM subscales have established item internal consistency in 96.9% of tests and itemdiscriminant validi...