Go home, sit less: the impact of home versus hospital rehabilitation environment on activity levels of stroke survivors

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: Thirty-four 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.