Nonparametric characteristics of the rest-activity patterns and its associated factors in patients with chronic stroke

Wearable technology is widely applied to rehabilitative assessment and care for patients with stroke. However, there is little information available on circadian rest-activity rhythm (RAR) parameters estimated from the data of wearable devices. To clarify the characteristics of RAR patterns in chronic stroke and specify factors associated with clinical assessments. Participants were recruited from stroke patients admitted to the convalescent ward of Nakadori Rehabilitation Hospital and elderly community-dwellers living in Akita Prefecture, Japan. The participants were instructed to wear the Actiwatch Spectrum Plus on the wrist of the non-paralyzed upper limb in the patient group or on the wrist of the non-dominant hand in the control group for 7 consecutive days. The nonparametric RAR parameters were calculated using the data from wearable devices, consisting of interdaily stability (IS), intradaily variability (IV), and relative amplitude (RA). The functional independence measure (FIM), clinical dementia rating (CDR), and oral function and nutritional assessment were used to evaluate clinical status in the patient group. Fifty-four participants were included for analysis, divided into the control group (n = 27) and the patient group (n = 27). As a result of binomial regression analysis, patients with chronic stroke were significantly associated with the IS × 100 value (odds ratio [OR] = 0.63; 95% confidence interval [95% CI], 0.42 to 0.95; p = 0.026), the IV × 100 value (OR = 1.04; 95% CI, 1.02 to 1.07; p = 0.001), and the RA × 100 value (OR = 0.88; 95% CI, 0.82 to 0.95; p < 0.001). Additionally, the IV value correlated with oral function and nutrition (r = -0.41, p < 0.05) within the patient group. Our results provide clinical characteristics of nonparametric RAR patterns in inpatients with chronic stroke. In light of the RAR characteristics in chronic stroke, oral function and nutritional status might have a potential impact on therapeutic interventions.