Feasibility of a physiotherapist-supervised walking program with telephone coaching to increase physical activity following acquired brain injury

Caitlyn Payne; Janelle Gesch; Esther Smits; Charlotte Brakenridge; Venerina Johnston; Paul A. Gardiner; Tracy Comans; Ryan Bell; Elise Gane

doi:10.1071/IB23095

RESEARCH ARTICLE (Open Access)

Next Contents Vol 25(2)

Feasibility of a physiotherapist-supervised walking program with telephone coaching to increase physical activity following acquired brain injury

Caitlyn Payne ^A , Janelle Gesch ^A ^B , Esther Smits

^C , Charlotte Brakenridge

^C ^D , Venerina Johnston

^E ^F , Paul A. Gardiner

^G , Tracy Comans

^H , Ryan Bell ^B and Elise Gane

^A ^E ^I ^*

+ Author Affiliations

- Author Affiliations

^A Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Qld, Australia.

^B Brain Injury Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Qld, Australia.

^C RECOVER Injury Research Centre, The University of Queensland, Brisbane, Qld, Australia.

^D School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Qld, Australia.

^E School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia.

^F Centre for Health Research, University of Southern Queensland, Darling Heights, Qld, Australia.

^G School of Public Health, The University of Queensland, Brisbane, Qld, Australia.

^H Centre for Health Services Research, The University of Queensland, Brisbane, Qld, Australia.

^I Centre for Functioning and Health Research, Metro South Health, Brisbane, Qld, Australia.

^* Correspondence to: e.gane@uq.edu.au

Handling Editor: Suzanne Kuys

Brain Impairment 25, IB23095 https://doi.org/10.1071/IB23095

Submitted: 8 September 2023 Accepted: 9 May 2024 Published: 29 May 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of the Australasian Society for the Study of Brain Impairment. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

Physical activity has health benefits for adults with acquired brain injury, but it is a challenge to increase physical activity during inpatient rehabilitation. The objectives of this pilot study were to determine whether a physiotherapy-supervised inpatient walking program was feasible and able to improve physical activity and sedentary behaviour in the short and medium term.

Methods

Adults with acquired brain injury receiving inpatient rehabilitation undertook twice-weekly supervised walks plus behavioural therapy for 4 weeks. Feasibility was measured via recruitment, participation and drop out rates, adverse events and intervention delivery costs. Physical activity and sedentary behaviour were measured with an activPAL. Assessments were conducted at baseline, post-intervention and 3–6 months post-intervention.

Results

The program was safe to deliver (no adverse events), recruitment rate was 55% (16/29) and the participation rate for eligible individuals was high (14/19, 74%). However, the program had a high drop out rate (7/16, 44%) and physical activity and sedentary behaviour did not significantly change during the 4-week intervention. Costs were AU$427.71/participant. Physical activity and sedentary behaviour did improve 3–6 months after the intervention (vs baseline, on average: +3913 steps per day, 95% CI: 671, 7156).

Conclusion

This pilot study demonstrated a supervised physiotherapy walking program is safe and feasible to recruit in an inpatient setting. However, drop out during the study was high and behaviour change did not occur. More work is required to boost physical activity during sub-acute rehabilitation for acquired brain injury.

Keywords: behavioural therapy, brain injury, hospital rehabilitation, physical activity, physiotherapy, sedentary behaviour, self-management, walking.

References

Australian Institute of Health and Welfare (2018) ‘Physical activity across the life stages.’ (AIHW: Canberra, ACT, Australia)

Barrett S, Begg S, O’Halloran P, Kingsley M (2018) Integrated motivational interviewing and cognitive behaviour therapy can increase physical activity and improve health of adult ambulatory care patients in a regional hospital: the Healthy4U randomised controlled trial. BMC Public Health 18(1), 1166.
| Crossref | Google Scholar | PubMed |

Basford JR, Chou LS, Kaufman KR, Brey RH, Walker A, Malec JF, Moessner AM, Brown AW (2003) An assessment of gait and balance deficits after traumatic brain injury. Archives of Physical Medicine and Rehabilitation 84(3), 343-349.
| Crossref | Google Scholar | PubMed |

Batey P, Rome K, Finn P, Hanchard N (2003) Assessing Reliability of Measurement of Gait Velocity. Physiotherapy 89(5), 313-317.
| Crossref | Google Scholar |

Bell KR, Temkin NR, Esselman PC, Doctor JN, Bombardier CH, Fraser RT, Hoffman JM, Powell JM, Dikmen S (2005) The effect of a scheduled telephone intervention on outcome after moderate to severe traumatic brain injury: a randomized trial. Archives of Physical Medicine and Rehabilitation 86(5), 851-856.
| Crossref | Google Scholar | PubMed |

Bellon K, Kolakowsky-Hayner S, Wright J, Huie H, Toda K, Bushnik T, Englander J (2015) A home-based walking study to ameliorate perceived stress and depressive symptoms in people with a traumatic brain injury. Brain Injury 29(3), 313-319.
| Crossref | Google Scholar | PubMed |

Billinger SA, Arena R, Bernhardt J, Eng JJ, Franklin BA, Johnson CM, MacKay-Lyons M, Macko RF, Mead GE, Roth EJ, Shaughnessy M, Tang A (2014) Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 45(8), 2532-2553.
| Crossref | Google Scholar | PubMed |

Burke JF, Stulc JL, Skolarus LE, Sears ED, Zahuranec DB, Morgenstern LB (2013) Traumatic brain injury may be an independent risk factor for stroke. Neurology 81(1), 33-39.
| Crossref | Google Scholar | PubMed |

Chaudhuri A, Behan PO (2004) Fatigue in neurological disorders. The Lancet 363(9413), 978-988.
| Crossref | Google Scholar | PubMed |

Chen P, Lin KC, Liing RJ, Wu CY, Chen CL, Chang KC (2016) Validity, responsiveness, and minimal clinically important difference of EQ-5D-5L in stroke patients undergoing rehabilitation. Quality of Life Research 25(6), 1585-1596.
| Crossref | Google Scholar | PubMed |

Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan KM, Marra CA (2010) Does a home-based strength and balance programme in people aged ≥80 years provide the best value for money to prevent falls? A systematic review of economic evaluations of falls prevention interventions. British Journal of Sports Medicine 44(2), 80-89.
| Crossref | Google Scholar | PubMed |

Deloitte Access Economics (2020) ‘No Postcode Untouched: Stroke in Australia 2020.’ (Deloitte Access Economics: Australia)

Department of Health (2021) ‘Australia’s Physical Activity and Sedentary Behaviour Guidelines for Adults Aged 18-64.’ (Department of Health and Aged Care: Canberra, ACT, Australia) Available at https://www.health.gov.au/topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians/for-adults-18-to-64-years

D’Isabella NT, Shkredova DA, Richardson JA, Tang A (2017) Effects of exercise on cardiovascular risk factors following stroke or transient ischemic attack: a systematic review and meta-analysis. Clinical Rehabilitation 31(12), 1561-1572.
| Crossref | Google Scholar | PubMed |

Driver S, Woolsey A (2016) Evaluation of a Physical Activity Behavior Change Program for Individuals With a Brain Injury. Archives of Physical Medicine and Rehabilitation 97(9, Supplement), S194-S200.
| Crossref | Google Scholar | PubMed |

Driver S, Ede A, Dodd Z, Stevens L, Warren AM (2012a) What barriers to physical activity do individuals with a recent brain injury face? Disability and Health Journal 5(2), 117-125.
| Crossref | Google Scholar | PubMed |

Driver S, Irwin K, Woolsey A, Pawlowski J (2012b) Creating an effective physical activity-based health promotion programme for adults with a brain injury. Brain Injury 26(12), 1482-1492.
| Crossref | Google Scholar | PubMed |

Driver S, Irwin K, Woolsey A, Warren AM (2013) Piloting a physical activity centred education programme for adults with a brain injury. Brain Injury 27(10), 1173-1180.
| Crossref | Google Scholar | PubMed |

Driver S, McShan E, Swank C, Calhoun S, Bennett M, Callender L, Holden A, Juengst S, Bell K, Douglas M, Kramer K, Dubiel R (2023) Efficacy of the Diabetes Prevention Program Group Lifestyle Balance Program Modified for Individuals with TBI (GLB-TBI): results from a 12-month Randomized Controlled Trial. Annals of Behavioral Medicine 57(2), 131-145.
| Crossref | Google Scholar | PubMed |

Eldridge SM, Lancaster GA, Campbell MJ, Thabane L, Hopewell S, Coleman CL, Bond CM (2016) Defining Feasibility and Pilot Studies in Preparation for Randomised Controlled Trials: Development of a Conceptual Framework. PLoS One 11(3), e0150205.
| Crossref | Google Scholar | PubMed |

Fann JR, Bombardier CH, Vannoy S, Dyer J, Ludman E, Dikmen S, Marshall K, Barber J, Temkin N (2015) Telephone and in-person cognitive behavioral therapy for major depression after traumatic brain injury: a randomized controlled trial. Journal of Neurotrauma 32(1), 45-57.
| Crossref | Google Scholar | PubMed |

Farag I, Howard K, Hayes AJ, Ferreira ML, Lord SR, Close JT, Vogler C, Dean CM, Cumming RG, Sherrington C (2015) Cost-effectiveness of a Home-Exercise Program Among Older People After Hospitalization. Journal of the American Medical Directors Association 16(6), 490-496.
| Crossref | Google Scholar | PubMed |

Farag I, Sherrington C, Hayes A, Canning CG, Lord SR, Close JC, Fung VS, Howard K (2016) Economic evaluation of a falls prevention exercise program among people with Parkinson’s disease. Movement Disorders 31(1), 53-61.
| Crossref | Google Scholar | PubMed |

Fazio S, Stocking J, Kuhn B, Doroy A, Blackmon E, Young HM, Adams JY (2020) How much do hospitalized adults move? A systematic review and meta-analysis. Applied Nursing Research 51, 151189.
| Crossref | Google Scholar | PubMed |

Fini NA, Holland AE, Keating J, Simek J, Bernhardt J (2017) How physically active are people following stroke? Systematic review and quantitative synthesis. Physical Therapy 97, 707-717.
| Crossref | Google Scholar |

Guggisberg AG, Chauvigné L, Pignat JM (2020) [Fatigue after acquired brain injury and its impact on socio-professional reintegration]. Revue Medicale Suisse 16(692), 901-903.
| Google Scholar | PubMed |

Halabchi F, Alizadeh Z, Sahraian MA, Abolhasani M (2017) Exercise prescription for patients with multiple sclerosis; potential benefits and practical recommendations. BMC Neurology 17(1), 185.
| Crossref | Google Scholar | PubMed |

Hamilton M, Khan M, Clark R, Williams G, Bryant A (2016) Predictors of physical activity levels of individuals following traumatic brain injury remain unclear: a systematic review. Brain Injury 30(7), 819-828.
| Crossref | Google Scholar | PubMed |

Hart T, Brenner L, Clark AN, BOgner JA, Novack TA, Chervoneva I, Nakase-Richardson R, Arango-Lasprilla JC (2011) Major and Minor Depression After Traumatic Brain Injury. Archives of Physical Medicine and Rehabilitation 92(8), 1211-1219.
| Crossref | Google Scholar | PubMed |

Hartmann A, Rundek T, Mast H, Paik MS, Boden-Albala B, Mohr JP, Sacco RL (2001) Mortality and causes of death after first ischemic stroke. Neurology 57, 2000-2005.
| Crossref | Google Scholar | PubMed |

Herdman M, Gudex C, Lloyd A, Janssen MF, Kind P, Parkin D, Bonsel G, Badia X (2011) Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Quality of Life Research 20(10), 1727-1736.
| Crossref | Google Scholar | PubMed |

Hoffman JM, Bell KR, Powell JM, Behr J, Dunn EC, Dikmen S, Bombardier CH (2010) A randomized controlled trial of exercise to improve mood after traumatic brain injury. Physical Medicine and Rehabilitation 2, 911-919.
| Crossref | Google Scholar | PubMed |

Jones K, Hawke F, Newman J, Miller JA, Burns J, Jakovljevic DG, Gorman G, Turnbull DM, Ramdharry G (2021) Interventions for promoting physical activity in people with neuromuscular disease. Cochrane Database of Systematic Reviews 5(5), CD013544.
| Crossref | Google Scholar | PubMed |

Julious SA (2005) Sample size of 12 per group rule of thumb for a pilot study. Pharmaceutical Statistics 4(4), 287-291.
| Crossref | Google Scholar |

Kelly S, Martin S, Kuhn I, Cowan A, Brayne C, Lafortune L (2016) Barriers and Facilitators to the Uptake and Maintenance of Healthy Behaviours by People at Mid-Life: A Rapid Systematic Review. PLoS One 11(1), e0145074.
| Crossref | Google Scholar |

Kirkness CJ, Cain KC, Becker KJ, Tirschwell DL, Buzaitis AM, Weisman PL, McKenzie S, Teri L, Kohen R, Veith RC, Mitchell PH (2017) Randomized trial of telephone versus in-person delivery of a brief psychosocial intervention in post-stroke depression. BMC Research Notes 10(1), 500.
| Crossref | Google Scholar | PubMed |

Kunkel D, Fitton C, Burnett M, Ashburn A (2015) Physical inactivity post-stroke: a 3-year longitudinal study. Disability and Rehabilitation 37(4), 304-310.
| Crossref | Google Scholar | PubMed |

Kuzma E, Lourida I, Moore SF, Levine DA, Ukoumunne OC, Llewellyn DJ (2018) Stroke and dementia risk: a systematic review and meta-analysis. Alzheimer’s & Dementia 14, 1416-1426.
| Crossref | Google Scholar | PubMed |

Lamont R (2013) Community ambulation in people with Parkinson’s disease. PhD Thesis, The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia.

Lancaster GA, Dodd S, Williamson PR (2004) Design and analysis of pilot studies: recommendations for good practice. Journal of Evaluation in Clinical Practice 10(2), 307-312.
| Crossref | Google Scholar | PubMed |

Li W, Risacher SL, McAllister TW, Saykin AJ (2016) Traumatic brain injury and age at onset of cognitive impairment in older adults. Journal of Neurology 263(7), 1280-1285.
| Crossref | Google Scholar | PubMed |

PAL Technologies (2021) CREA. Available at https://kb.palt.com/articles/crea

Lund A, Michelet M, Sandvik L, Wyller T, Sveen U (2012) A lifestyle intervention as supplement to a physical activity programme in rehabilitation after stroke: a randomized controlled trial. Clinical Rehabilitation 26(6), 502-512.
| Crossref | Google Scholar | PubMed |

Lyden K, Keadle SK, Staudenmayer J, Freedson PS (2017) The activPALTM Accurately Classifies Activity Intensity Categories in Healthy Adults. Medicine and Science in Sports and Exercise 49(5), 1022-1028.
| Crossref | Google Scholar | PubMed |

Mahendran N, Kuys SS, Downie E, Ng P, Brauer SG (2016) Are Accelerometers and GPS Devices Valid, Reliable and Feasible Tools for Measurement of Community Ambulation after Stroke? Brain Impairment 17(2), 151-161.
| Crossref | Google Scholar |

Manns PJ, Baldwin E (2009) Ambulatory activity of stroke survivors: measurement options for dose, intensity, and variability of activity. Stroke 40(3), 864-867.
| Crossref | Google Scholar | PubMed |

Medley AR, Powell T (2010) Motivational Interviewing to promote self-awareness and engagement in rehabilitation following acquired brain injury: a conceptual review. Neuropsychological Rehabilitation 20(4), 481-508.
| Crossref | Google Scholar | PubMed |

Michie S, van Stralen MM, West R (2011) The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation Science 6(1), 42.
| Crossref | Google Scholar |

Michie S, Atkins L, West R (2014) ‘The behaviour change wheel: a guide to designing interventions.’ (Silverback: UK)

Moore SA, Hallsworth K, Jakovljevic DG, Blamire AM, He J, Ford GA, Rochester L, Trenell MI (2015) Effects of Community Exercise Therapy on Metabolic, Brain, Physical, and Cognitive Function Following Stroke: A Randomized Controlled Pilot Trial. Neurorehabilitation and Neural Repair 29(7), 623-635.
| Crossref | Google Scholar | PubMed |

Norman GR, Sloan JA, Wyrwich KW (2003) Interpretation of changes in health related quality of life: the remarkable universality of half a standard deviation. Medical Care 41(5), 582-592.
| Crossref | Google Scholar | PubMed |

O’Reilly GM, Curtis K, Mitra B, Kim Y, Afroz A, Hunter K, Ryder C, Hendrie DV, Rushworth N, Tee J, D’Angelo S, Solly E, Bhattacharya O, Fitzgerald MC (2023) Hospitalisations and in-hospital deaths following moderate to severe traumatic brain injury in Australia, 2015–20: a registry data analysis for the Australian Traumatic Brain Injury National Data (ATBIND) project. Medical Journal of Australia 219(7), 316-324.
| Crossref | Google Scholar | PubMed |

Prescott S, Fleming J, Doig E (2015) Goal setting approaches and principles used in rehabilitation for people with acquired brain injury: a systematic scoping review. Brain Injury 29(13–14), 1515-1529.
| Crossref | Google Scholar | PubMed |

Ramsey J, Driver S, Swank C, Bennett M, Dubiel R (2018) Physical activity intensity of patient’s with traumatic brain injury during inpatient rehabilitation. Brain Injury 32(12), 1518-1524.
| Crossref | Google Scholar | PubMed |

Ramsey KA, Loveland P, Rojer AGM, Denehy L, Goonan R, Marston C, Kay JE, Brenan J, Trappenburg MC, Lim WK, Reijnierse EM, Meskers CGM, Maier AB (2021) Geriatric Rehabilitation Inpatients Roam at Home! A Matched Cohort Study of Objectively Measured Physical Activity and Sedentary Behavior in Home-Based and Hospital-Based Settings. Journal of the American Medical Directors Association 22(12), 2432-2439.e1.
| Crossref | Google Scholar | PubMed |

Resnick B, Jenkins LS (2000) Testing the reliability and validity of the Self-Efficacy for Exercise scale. Nursing Research 49(3), 154-159.
| Crossref | Google Scholar | PubMed |

Richardson JTE (2011) Eta squared and partial eta squared as measures of effect size in educational research. Educational Research Review 6(2), 135-147.
| Crossref | Google Scholar |

Rooney S, McFadyen A, Wood L, Moffat F, Paul L (2019) Minimally important difference of the fatigue severity scale and modified fatigue impact scale in people with multiple sclerosis. Multiple Sclerosis and Related Disorders 35, 158-163.
| Crossref | Google Scholar | PubMed |

Ryan CG, Grant PM, Tigbe WW, Granat MH (2006) The validity and reliability of a novel activity monitor as a measure of walking. British Journal of Sports Medicine 40(9), 779-784.
| Crossref | Google Scholar | PubMed |

Schiehser DM, Delano-Wood L, Jak AJ, Matthews SC, Simmons AN, Jacobson MW, Filoteo JV, Bondi MW, Orff HJ, Liu L (2015) Validation of the Modified Fatigue Impact Scale in mild to moderate traumatic brain injury. Journal of Head Trauma Rehabilitation 30(2), 116-121.
| Crossref | Google Scholar | PubMed |

Shi Y, Yang D, Zeng Y, Wu W (2017) Risk Factors for Post-stroke Depression: A Meta-analysis. Frontiers in Aging Neuroscience 9, 218.
| Crossref | Google Scholar | PubMed |

Shumway-Cook A, Woollacott MH (2017) ‘Motor control: translating research into clinical practice.’ (Wolters Kluwer: Philadelphia, USA)

Sim J, Lewis M (2012) The size of a pilot study for a clinical trial should be calculated in relation to considerations of precision and efficiency. Journal of Clinical Epidemiology 65(3), 301-308.
| Crossref | Google Scholar | PubMed |

Simpson DB, Breslin M, Cumming T, de Zoete S, Gall SL, Schmidt M, English C, Callisaya ML (2018) Go Home, Sit Less: The Impact of Home Versus Hospital Rehabilitation Environment on Activity Levels of Stroke Survivors. Archives of Physical Medicine and Rehabilitation 99(11), 2216-2221.e1.
| Crossref | Google Scholar | PubMed |

Slovarp L, Azuma T, Lapointe L (2012) The effect of traumatic brain injury on sustained attention and working memory. Brain Injury 26(1), 48-57.
| Crossref | Google Scholar | PubMed |

Stroke Foundation (2023) Clinical Guidelines for Stroke Management: Chapter 5 - Rehabilitation. Available at https://informme.org.au/en/Guidelines/Clinical-Guidelines-for-Stroke-Management [accessed 1 March 2024]

Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness: a practical scale. The Lancet 304(7872), 81-84.
| Crossref | Google Scholar | PubMed |

Teasell R, Bayona N, Marshall S, Cullen N, Bayley M, Chundamala J, Villamere J, Mackie D, Rees L, Hartridge C, Lippert C, Hilditch M, Welch-West P, Weiser M, Ferri C, McCabe P, McCormick A, Aubut JA, Comper P, Salter K, Van Reekum R, Collins D, Foley N, Nowak J, Jutai J, Speechley M, Hellings C, Tu L (2007) A systematic review of the rehabilitation of moderate to severe acquired brain injuries. Brain Injury 21(2), 107-112.
| Crossref | Google Scholar | PubMed |

Thabane L, Ma J, Chu R, Cheng J, Ismaila A, Rios LP, Robson R, Thabane M, Giangregorio L, Goldsmith CH (2010) A tutorial on pilot studies: the what, why and how. BMC Medical Research Methodology 10, 1.
| Crossref | Google Scholar | PubMed |

Tremblay MS, Aubert S, Barnes JD, Saunders TJ, Carson V, Latimer-Cheung AE, Chastin SFM, Altenburg TM, Chinapaw MJM, On behalf of SBRN Terminology Consensus Project Participants (2017) Sedentary Behavior Research Network (SBRN) – Terminology Consensus Project process and outcome. International Journal of Behavioral Nutrition and Physical Activity 14(1), 75.
| Crossref | Google Scholar | PubMed |

Turner‐Stokes L, Pick A, Nair A, Disler PB, Wade DT (2015) Multi‐disciplinary rehabilitation for acquired brain injury in adults of working age. Cochrane Database of Systematic Reviews 2015(12), CD004170.
| Crossref | Google Scholar | PubMed |

Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care 30, 473-483.
| Google Scholar | PubMed |

World Health Organization (2020) ‘WHO guidelines on physical activity and sedentary behaviour.’ (WHO: Geneva, Switzerland) Available at https://iris.who.int/bitstream/handle/10665/336656/9789240015128-eng.pdf

Zgaljardic DJ, Seale GS, Schaefer LA, Temple RO, Foreman J, Elliott TR (2015) Psychiatric Disease and Post-Acute Traumatic Brain Injury. Journal of Neurotrauma 32(23), 1911-1925.
| Crossref | Google Scholar | PubMed |