How Should We Measure Physical Activity After Stroke? An International Consensus

Background:
Physical activity is important for secondary stroke prevention. Currently there is inconsistency of outcomes and tools used to measure physical activity following stroke.
Aims:
To establish internationally agreed recommendations to enable consistent measurement of post-stroke physical activity.
Methods:
Stroke survivors and carers were surveyed online once regarding what is important in physical activity measurement. Three survey rounds with expert stroke researchers and clinicians were conducted using Keeney’s Value Focussed Thinking Methodology.
Survey 1 identified physical activity tools, outcomes and measurement considerations which were ranked in Survey 2.
Consensus recommendations on tools were then formulated by the consensus group based on survey responses. In Survey 3 participants reviewed ranked results and evidence gathered to determine their support for consensus recommendations.
Results:
Twenty-five stroke survivors, 5 carers, 18 researchers and 17 clinicians from 16 countries participated. Time in moderate-vigorous physical activity and step count were identified as the most important outcomes to measure. Key measurement considerations included ability to measure across frequency, intensity, duration domains in real-world settings; user-friendliness, comfort and ability to detect changes.
Consensus recommendations included using the Actigraph, Actical and Activ8 devices for physical activity intensity; ActivPAL for duration and Step Activity Monitor for frequency; and the IPAQ and PASE questionnaires. Survey 3 indicated 100% support for device and 96% for questionnaire recommendations.
Conclusions:
These consensus recommendations can guide selection of physical activity measurement tools and outcomes. Tool selection will depend on measurement purpose, user-knowledge and resources. Comprehensive measurement requires the use of devices and questionnaires.