Effect of individualized coaching at home on walking capacity in subacute stroke patients: A randomized controlled trial (Ticaa'dom)

Background: The gains in walking capacity achieved during rehabilitation often plateau, or are lost, when the patient returns home. Moreover, maintaining or increasing the patient's daily physical activity level after a stroke remains challenging. We aimed to evaluate the effectiveness of a six-month individualized coaching program at home on walking capacity, as evaluated by the six-minute walk test in subacute stroke patients. Methods: Stroke patients in the physical medicine and rehabilitation service participated in a monocentric observer blinded randomized controlled trial with two groups, intervention versus usual care control. The inclusion criteria were: age >= 18 years, first ischemic or hemorrhagic stroke, and stroke within < 6 months. Participants were randomly assigned (blocks of variable size) to an intervention group (EG) receiving individualized coaching on physical activity, or to a control group (CG) receiving standard care. The six-month program was composed of monitored physical activity, home visits and a weekly phone call. Participants were evaluated after hospital discharge (TO), at the end of the six-month program (T1) and six months later(follow-up; T2). The primary outcome was the walking distance performance, as evaluated with the six-minute walk test at T1. Results: Eighty-three participants (age: 61y [IQR = 22]; time post-stroke: 2.4 month [IQR = 1.7]; Barthel index: 100[IQR = 5]) were included in the study: (EG, n = 41; CG, n = 42). The difference between the two groups was not significant at T1(418 m [IQR = 165] for the EG and 389 m [IQR =188] for the CG; P= 0.168) and at T2(425 m [IQR = 121] for the EG vs. 382 m [IQR = 219] for the CG; P = 0.208). Conclusion: Our study shows no difference in the six-minute walk test between the two groups of subacute stroke patients after 6 months of the individualized coaching program, combining home visits, feedback on daily performance and weekly telephone calls. (C) 2020 Elsevier Masson SAS. All rights reserved.