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The aim of this study is to assess the effect of implementing best practices into current stroke rehabilitation physical therapy on walking outcomes. Participants will also be provided an activity monitor to help them track and target their walking practice to determine if this can improve walking ability.
This multi-site study will have each site start in usual care with participants consented to collecting outcome measures. The twelve inpatient stroke units include: Kelowna General Hospital, Nanaimo Regional General Hospital, Glenrose Rehabilitation Hospital, Saskatoon City Hospital, Wascana Rehabilitation Centre, Joseph Brant Hospital, Bruyère Hospital, Freeport Grand River Hospital, CIUSSS-de-l'Estrie-CHUS Centre de réadaptation de l'Estrie, Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Dr. Everett Chalmers Regional Hospital, and Queen Elizabeth Hospital. Each site will randomly switch over to Enhanced Usual Care (best practice implementation) where all physical therapists at the site will be educated on delivery of best practice for locomotor retraining. The specific therapy activities are at the discretion of the physical therapist; however, physical therapists must work towards thirty minutes of weight-bearing/stepping activity at greater than forty percent heart rate reserve. Participants will continue to be consented to collecting outcome measures. Additionally, participants will be given and trained to use activity watches to monitor their own progress.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Usual Physical Therapy Care | Active Comparator | Physical Therapists continue usual care |
|
| Enhanced Physical Therapy Usual Care | Experimental | Best practice implemented |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Enhancing Physical Therapy Usual Care | Behavioral | The protocol is focused on the completion of a minimum of 30 minutes of weight-bearing, walking-related activities that progressively increase in intensity informed by heart rate and step counters over 4 weeks. |
| Measure | Description | Time Frame |
|---|---|---|
| Six-minute walk Test | This test measures distance a participant can walk in 6 minutes. | 4 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Six-minute walk test | This test measures distance a participant can walk in 6 minutes. | 12 months post-stroke |
| Blood pressure | Blood pressure measures physiological effects of the intervention |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Janice J Eng, PhD | University of British Columbia | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of British Columbia | Vancouver | British Columbia | V5Z2G9 | Canada |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 42180207 | Derived | Tang WK, Lu H, Leung TWH, Fong KNK, Chan SKY, Liew VWJ. A double-blind randomized control trial of transcranial direct current stimulation in post-stroke fatigue. Front Neurol. 2026 May 7;17:1658764. doi: 10.3389/fneur.2026.1658764. eCollection 2026. | |
| 41508158 | Derived | Ackerley S, Hung SH, Sheehy L, Donkers SJ, Timofeeva P, Best KL, Peters S, Park SS, Ouellet B, Ezeugwu VE, Milot MH, Sakakibara BM, Eng JJ, Connell LA. Exploring factors influencing implementation across the explanatory-to-pragmatic trial continuum: a sequential qualitative integration of delivering higher-intensity walking exercise within inpatient stroke rehabilitation. Implement Sci Commun. 2026 Jan 8;7(1):44. doi: 10.1186/s43058-025-00812-y. |
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If required by journal for publication, the following individual participant data will be entered into a repository: age in years, sex, and outcomes as described above.
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| ID | Term |
|---|---|
| D020521 | Stroke |
| D002544 | Cerebral Infarction |
| D002545 | Brain Ischemia |
| D020520 | Brain Infarction |
| D009043 | Motor Activity |
| ID | Term |
|---|---|
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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This clinical trial uses a stepped-wedge design. Unlike typical studies where participants are randomized to two different interventions, this design has all sites start in the Usual Care period, and then switch-over to Enhanced Care at predetermined times, which will then be the new Usual Care (termed "Enhanced Usual Care").
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Assessors at each site will be blinded to intervention. Site study coordinators will be unblinded.
| Physical Therapy Usual Care | Behavioral | Usual physical therapy |
|
| 4 weeks & 12 months post-stroke |
| Euro-QOL 5D-5L | This test is the most widely used instrument to measure quality of life. | 4 weeks & 12 months post-stroke |
| Montreal Cognitive Assessment | This test measures levels of cognitive function. Min 0, max 30, with higher scores reflecting better cognition. | 4 weeks & 12 months post-stroke |
| Short Performance Physical Battery | This test measures lower extremity function. Min value 0, max value 12. Higher scores reflect better lower extremity function | 4 weeks & 12 months post-stroke |
| Patient Health Questionnaire-9 (PHQ-9) | This test screens for depression. Min 0, max 27. Higher values reflect more severe symptoms. | 4 weeks & 12 months post-stroke |
| Modified Rankin Scale (mRS) | This scale measures the degree of disability. Score range: minimum 0 to maximum 6. Lower score means a better outcome. | 4 weeks & 12 months post-stroke |
| Physical Activity Scale for the Elderly (PASE) | This test assesses physical activity, including leisure, household, and occupational activity. Score range: minimum 0 to maximum 400 or more. Higher score means a better outcome | 12 months post-stroke |
| Step activity monitor | The number of steps per day over 3 days | 12 months post stroke |
| Gait speed | self-paced gait speed in metre/second | 4 week and 12 month post-stroke |
| 41139309 | Derived | Hung SH, Ackerley S, Connell LA, Bayley MT, Best KL, Donkers SJ, Dukelow SP, Ezeugwu VE, Milot MH, Peters S, Sakakibara BM, Sheehy L, Yao J, Eng JJ. Real-World Experiences of Therapy Staff Implementing an Intensive Rehabilitation Protocol in Canadian Stroke Inpatient Rehabilitation Settings: A Multi-Site Survey Study. Phys Ther. 2025 Oct 1;105(10):pzaf111. doi: 10.1093/ptj/pzaf111. |
| 40720450 | Derived | Yan Y, Eng JJ, Hung SH, Bayley MT, Best KL, Connell LA, Donkers SJ, Dukelow SP, Ezeugwu VE, Milot MH, Sakakibara BM, Sheehy L, Wong H, Yao J, Peters S. Aerobic minutes and step number remain low in inpatient stroke rehabilitation. PLoS One. 2025 Jul 28;20(7):e0328930. doi: 10.1371/journal.pone.0328930. eCollection 2025. |
| 40683274 | Derived | Peters S, Hung SH, Bayley MT, Best KL, Connell LA, Donkers SJ, Dukelow SP, Ezeugwu VE, Milot MH, Sakakibara BM, Sheehy L, Wong H, Yang Y, Yao J, Eng JJ. Safety and effectiveness of the Walk 'n Watch structured, progressive exercise protocol delivered by physical therapists for inpatient stroke rehabilitation in Canada: a phase 3, multisite, pragmatic, stepped-wedge, cluster-randomised controlled trial. Lancet Neurol. 2025 Aug;24(8):643-655. doi: 10.1016/S1474-4422(25)00201-7. |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D007238 | Infarction |
| D007511 | Ischemia |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D009336 | Necrosis |
| D001519 | Behavior |