JMIR Publications

ABSTRACT

Background:

Circadian rhythm disruptions are a concern for post-stroke patients undergoing rehabilitation, given that it is common and might be a negative predictor of functional outcome. Our research aimed to uncover unique patterns and disruptions specific to post-stroke rehabilitation patients and identify potential differences in specific rest-activity rhythm (RAR) indicators when compared to in-patient controls with non-brain-related lesions, such as patients with spinal cord injuries.

Objective:

Our research aimed to uncover unique patterns and disruptions specific to post-stroke rehabilitation patients and identify potential differences in specific rest-activity rhythm (RAR) indicators when compared to in-patient controls with non-brain-related lesions, such as patients with spinal cord injuries.

Methods:

We obtained a 7-day recording with a wearable actigraphy from 25 post-stroke patients (36% women) with a mean age 57.4 (SD 13.3) and 25 age and gender-matched in-patient control participants (60% women) with a mean age 57.2 (SD 12.9). To assess circadian rhythm, we employed a non-parametric method to calculate key RAR indicators: relative amplitude (RA), interdaily stability (IS), and intradaily variability. RA, quantifying RAR amplitude while considering daily variations and unbalanced amplitudes, was calculated as the ratio of differences between the most active 10 continuous hours (M10) and the least active 5 continuous hours (L5) over the summation of M10 and L5. We also examined the clinical correlations between RAR indicators and delirium screening tools like the 4 A's test (4AT) and the Barthel Index (BI), which assesses delirium and activities of daily living.

Results:

Stroke patients had higher L5 values compared to the control groups: 4.29 (3.62) vs. 1.84 (3.67), P=.008, using medians (interquartile ranges) for presentation. The M10 values showed no significant differences between the groups: 38.92 (26.26) vs. 31.18 (28.83), P=.93. The stroke group presented a lower RA: 0.74 (0.28) vs. 0.88 (0.24), P=.009. Further analysis revealed no significant differences in other RAR metrics between the two groups. Among the stroke patients, a negative correlation was observed between 4AT scores and RA (ρ = -0.41, P=.045). Across all participants, positive correlations emerged between BI scores and both IS (ρ=0.34, P=.02) and M10 value (ρ =0.42, P=.002).

Conclusions:

This study highlights the relevance of circadian rhythm disruptions in post-stroke rehabilitation and provides insights into potential diagnostic and prognostic implications for RAR indicators as digital biomarkers.