The impact of wheelchair propulsion based physical activity on functional recovery in stroke rehabilitation: a multicenter observational study

Abstract

Purpose

We aimed to evaluate the relationship between the daily wheelchair self-propulsion distance and functional recovery in subacute stroke survivors.

Methods

Seventy-four patients with stroke were prospectively recruited from four convalescent rehabilitation hospitals. All participants were unable to walk independently and required manual wheelchairs for locomotion on admission. The daily wheelchair self-propulsion distance was measured using a cycle computer that was connected to a touch switch to exclude the assistance-propulsion distance. The outcome measures were represented as the relative gain of the Functional Independence Measure (FIM) effectiveness during hospitalization. Moreover, a better functional recovery was defined as a FIM effectiveness > 50%. Participants were categorized into three groups according to tertiles of the average daily wheelchair self-propulsion distance: lowest tertile (T1, ≤0.59 km/day); middle tertile (T2, 0.60–1.23 km/day); and highest tertile (T3, ≥1.24 km/day).

Results

Multivariate logistic regression analysis adjusted for baseline characteristics showed that the T2 and T3 groups had a significant association with better FIM effectiveness, and their odds ratios (95% confidence interval, p) were 7.26 (1.13–45.85, p = .038), and 10.19 (1.15–91.75, p = .035), respectively.

Conclusions

The daily wheelchair self-propulsion distance was significantly associated with functional recovery in subacute stroke survivors.

IMPLICATIONS FOR REHABILITATION

• Non-ambulatory stroke survivors can obtain extra independent physical activity by using wheelchair self-propulsion, when they do not have someone to assist them with walking.

• This multicenter observational study revealed that the self-propulsion distance of a manual-wheelchair was significantly associated with functional recovery in subacute stroke survivors.

Keywords:

• Stroke
• physical activity
• wheelchairs
• rehabilitation
• functional recovery

Acknowledgements

We thank the nursing staff and rehabilitation therapists of our hospitals for their contributions to data collection. We are also grateful to our laboratory members for their helpful advice on drafts of this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by Tokyo Physical Therapy Association [grant number: 201703].