{"doi":"10.2196/49530","title":"Rest-Activity Rhythm Differences in Acute Rehabilitation Between Poststroke Patients and Non–Brain Disease Controls: Comparative Study","abstract":"<jats:sec>\n                    <jats:title>Background</jats:title>\n                    <jats:p>Circadian rhythm disruptions are a common concern for poststroke patients undergoing rehabilitation and might negatively impact their functional outcomes.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective</jats:title>\n                    <jats:p>Our research aimed to uncover unique patterns and disruptions specific to poststroke rehabilitation patients and identify potential differences in specific rest-activity rhythm indicators when compared to inpatient controls with non–brain-related lesions, such as patients with spinal cord injuries.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods</jats:title>\n                    <jats:p>We obtained a 7-day recording with a wearable actigraphy device from 25 poststroke patients (n=9, 36% women; median age 56, IQR 46-71) and 25 age- and gender-matched inpatient control participants (n=15, 60% women; median age 57, IQR 46.5-68.5). To assess circadian rhythm, we used a nonparametric method to calculate key rest-activity rhythm indicators—relative amplitude, interdaily stability, and intradaily variability. Relative amplitude, quantifying rest-activity rhythm amplitude while considering daily variations and unbalanced amplitudes, was calculated as the ratio of the difference between the most active 10 continuous hours and the least active 5 continuous hours to the sum of these 10 and 5 continuous hours. We also examined the clinical correlations between rest-activity rhythm indicators and delirium screening tools, such as the 4 A’s Test and the Barthel Index, which assess delirium and activities of daily living.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Results</jats:title>\n                    <jats:p>Patients who had a stroke had higher least active 5-hour values compared to the control group (median 4.29, IQR 2.88-6.49 vs median 1.84, IQR 0.67-4.34; P=.008). The most active 10-hour values showed no significant differences between the groups (stroke group: median 38.92, IQR 14.60-40.87; control group: median 31.18, IQR 18.02-46.84; P=.93). The stroke group presented a lower relative amplitude compared to the control group (median 0.74, IQR 0.57-0.85 vs median 0.88, IQR 0.71-0.96; P=.009). Further analysis revealed no significant differences in other rest-activity rhythm metrics between the two groups. Among the patients who had a stroke, a negative correlation was observed between the 4 A’s Test scores and relative amplitude (ρ=–0.41; P=.045). Across all participants, positive correlations emerged between the Barthel Index scores and both interdaily stability (ρ=0.34; P=.02) and the most active 10-hour value (ρ=0.42; P=.002).</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions</jats:title>\n                    <jats:p>This study highlights the relevance of circadian rhythm disruptions in poststroke rehabilitation and provides insights into potential diagnostic and prognostic implications for rest-activity rhythm indicators as digital biomarkers.</jats:p>\n                  </jats:sec>","journal":"Journal of Medical Internet Research","year":2024,"id":620936,"datarank":0.29188652235829704,"base_score":1.9459101490553132,"endowment":1.9459101490553132,"self_citation_contribution":0.29188652235829704,"citation_network_contribution":0.0,"self_endowment_contribution":0.29188652235829704,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":6,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1603105,"name":"Chueh-Hung Wu","orcid":"0000-0002-3979-3541","position":1,"is_corresponding":false},{"id":765480,"name":"Chen Lin","orcid":"0000-0001-6261-8509","position":2,"is_corresponding":false},{"id":1603106,"name":"Hsiang-Chih Chang","orcid":"0009-0002-6819-7893","position":3,"is_corresponding":false},{"id":323320,"name":"Yu-Hsuan Lin","orcid":"0000-0001-7910-570X","position":4,"is_corresponding":false},{"id":620411,"name":"Shao-yu Chen","orcid":"0000-0003-4086-1721","position":5,"is_corresponding":false},{"id":1603108,"name":"Wei-Chen Hsu","orcid":"0009-0004-7969-7062","position":6,"is_corresponding":false},{"id":1603104,"name":"Huey-Wen Liang","orcid":"0000-0003-0186-3126","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Rest-Activity Rhythm Differences in Acute Rehabilitation Between Poststroke Patients and Non–Brain Disease Controls: Comparative Study","abstract":"<jats:sec>\n                    <jats:title>Background</jats:title>\n                    <jats:p>Circadian rhythm disruptions are a common concern for poststroke patients undergoing rehabilitation and might negatively impact their functional outcomes.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective</jats:title>\n                    <jats:p>Our research aimed to uncover unique patterns and disruptions specific to poststroke rehabilitation patients and identify potential differences in specific rest-activity rhythm indicators when compared to inpatient controls with non–brain-related lesions, such as patients with spinal cord injuries.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods</jats:title>\n                    <jats:p>We obtained a 7-day recording with a wearable actigraphy device from 25 poststroke patients (n=9, 36% women; median age 56, IQR 46-71) and 25 age- and gender-matched inpatient control participants (n=15, 60% women; median age 57, IQR 46.5-68.5). To assess circadian rhythm, we used a nonparametric method to calculate key rest-activity rhythm indicators—relative amplitude, interdaily stability, and intradaily variability. Relative amplitude, quantifying rest-activity rhythm amplitude while considering daily variations and unbalanced amplitudes, was calculated as the ratio of the difference between the most active 10 continuous hours and the least active 5 continuous hours to the sum of these 10 and 5 continuous hours. We also examined the clinical correlations between rest-activity rhythm indicators and delirium screening tools, such as the 4 A’s Test and the Barthel Index, which assess delirium and activities of daily living.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Results</jats:title>\n                    <jats:p>Patients who had a stroke had higher least active 5-hour values compared to the control group (median 4.29, IQR 2.88-6.49 vs median 1.84, IQR 0.67-4.34; P=.008). The most active 10-hour values showed no significant differences between the groups (stroke group: median 38.92, IQR 14.60-40.87; control group: median 31.18, IQR 18.02-46.84; P=.93). The stroke group presented a lower relative amplitude compared to the control group (median 0.74, IQR 0.57-0.85 vs median 0.88, IQR 0.71-0.96; P=.009). Further analysis revealed no significant differences in other rest-activity rhythm metrics between the two groups. Among the patients who had a stroke, a negative correlation was observed between the 4 A’s Test scores and relative amplitude (ρ=–0.41; P=.045). Across all participants, positive correlations emerged between the Barthel Index scores and both interdaily stability (ρ=0.34; P=.02) and the most active 10-hour value (ρ=0.42; P=.002).</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions</jats:title>\n                    <jats:p>This study highlights the relevance of circadian rhythm disruptions in poststroke rehabilitation and provides insights into potential diagnostic and prognostic implications for rest-activity rhythm indicators as digital biomarkers.</jats:p>\n                  </jats:sec>","is_dataset_classified":null,"base_score":1.9459101490553132,"endowment":1.9459101490553132,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"38963936","pmcid":"PMC11258522","openalex_id":"https://openalex.org/W4400313928","authors":[],"funders":[],"total_grants":0,"fwci":2.1166,"citation_percentile":0.86964127,"influential_citations":0,"citation_trend":[{"year":2024,"count":1},{"year":2025,"count":2},{"year":2026,"count":3}],"oa_status":"gold","license":"cc-by","oa_locations":[{"url":"https://doi.org/10.2196/49530","host_type":"journal"},{"url":"https://doi.org/10.2196/49530","host_type":"publisher"},{"url":"https://www.jmir.org/2024/1/e49530","host_type":"publisher"},{"url":"https://pubmed.ncbi.nlm.nih.gov/38963936","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/11258522","host_type":"repository"},{"url":"https://doaj.org/article/df238ae443af480a85712c361038b100","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC11258522","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC11258522?pdf=render","host_type":"Europe_PMC"}],"fields_of_study":["Sleep and related disorders","Cardiovascular and exercise physiology","Circadian rhythm and melatonin","Humans","Female","Male","Middle Aged","Aged","Stroke Rehabilitation","Rest","Stroke","Circadian Rhythm","Actigraphy","Case-Control Studies"],"mesh_terms":["Stroke Rehabilitation","Aged","Circadian Rhythm","Female","Humans","Male","Middle Aged","Rest","Case-Control Studies","Stroke","Actigraphy"],"keywords":["Actigraphy","Medicine","Rhythm","Circadian rhythm","Rehabilitation","Delirium","Stroke (engine)","Physical therapy","Activities of daily living","Physical medicine and rehabilitation","Internal medicine","Intensive care medicine","Circadian rhythms","Stroke Rehabilitation, Rest-activity Rhythms, Relative Amplitude, Delirium Screening, Interdaily Stability"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Good health and well-being"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-03T12:38:02.003713Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}