Predicting Musculoskeletal Adverse Events During Moderate- to High-Intensity Walking Training in Chronic Stroke.

Area of Science:

• Neurology
• Rehabilitation Medicine
• Clinical Biomechanics

Background:

• Moderate- to high-intensity walking training (M-HIT) improves walking capacity in chronic stroke survivors.
• Musculoskeletal (MSK) adverse events are common during M-HIT, but risk prediction tools are limited.
• Baseline clinical characteristics may predict susceptibility to M-HIT-related MSK adverse events.

Purpose of the Study:

• To develop and internally validate a predictive model for MSK adverse events during a 12-week M-HIT program.
• To identify baseline clinical characteristics associated with increased risk of MSK adverse events in chronic stroke patients undergoing M-HIT.

Main Methods:

• 100 participants from HIT-Stroke Trials 1 and 2 were analyzed.
• Logistic regression models evaluated combinations of baseline characteristics (orthopedic history, pain, motor function, exercise history, demographics, stroke chronicity, psychological health).
• Leave-one-out cross-validation was used for internal validation, with performance assessed by the C-statistic.

Main Results:

• 32.0% of participants experienced MSK adverse events.
• An optimal three-variable model included prior orthopedic condition (OR 3.02), Fugl-Meyer lower extremity motor score (OR 1.14), and regular walking exercise participation (OR 0.17).
• The model showed moderate discrimination (cross-validated C-statistic = 0.74).

Conclusions:

• Pre-existing orthopedic conditions and better lower-extremity motor function at baseline increase the odds of MSK adverse events during M-HIT.
• Regular walking exercise participation at baseline is associated with lower odds of MSK adverse events.
• Baseline characteristics can help identify individuals at higher risk for MSK adverse events during M-HIT, warranting closer monitoring or risk-reduction strategies.