Background. One of the strongest modifiable determinants of rehabilitation outcome is exercise dose. Technologies enabling self-directed exercise offer a pragmatic means to increase dose, but the extent to which they achieve this in unselected cohorts, under real-world constraints, is poorly understood. Objective. Here we quantify the exercise dose achieved by inpatient stroke survivors using an adapted upper limb (UL) exercise gaming (exergaming) device and compare this with conventional (supervised) therapy. Methods. Over 4 months, patients presenting with acute stroke and associated UL impairment were screened at a single stroke centre. Participants were trained in a single session and provided with the device for unsupervised use during their inpatient admission. Results. From 75 patients referred for inpatient UL therapy, we recruited 30 (40%), of whom 26 (35%) were able to use the device meaningfully with their affected UL. Over a median enrolment time of 8 days (IQR: 5–14), self-directed UL exercise duration using the device was 26 minutes per day (median; IQR: 16–31), in addition to 25 minutes daily conventional UL therapy (IQR: 12–34; same cohort plus standard care audit; joint n = 50); thereby doubling total exercise duration (51 minutes; IQR: 32–64) relative to standard care (Z = 4.0, P <.001). The device enabled 104 UL repetitions per day (IQR: 38–393), whereas conventional therapy achieved 15 UL repetitions per day (IQR: 11–23; Z = 4.3, P <.001). Conclusion. Self-directed adapted exergaming enabled participants in our stroke inpatient cohort to increase exercise duration 2-fold, and repetitions 8-fold, compared to standard care, without requiring additional professional supervision.

背景。康复结果最强的可修改决定因素之一是运动剂量。支持自主运动的技术提供了一种增加剂量的实用方法，但在现实世界的限制下，它们在未经选择的队列中实现这一目标的程度却知之甚少。客观。在这里，我们量化了住院中风幸存者使用经过调整的上肢 (UL) 运动游戏 (exergaming) 设备实现的运动剂量，并将其与常规（监督）疗法进行比较。方法。在 4 个月内，出现急性中风和相关 UL 损伤的患者在单个中风中心进行了筛查。参与者在一次课程中接受了培训，并在住院期间提供了该设备以供在无人监督的情况下使用。结果。从 75 名转诊接受住院 UL 治疗的患者中，我们招募了 30 名（40%），其中 26 名（35%）能够有效地使用该设备来治疗他们受影响的 UL。在 8 天的中位登记时间（IQR：5-14）中，除了每天 25 分钟的常规 UL 治疗外，使用该设备的自主 UL 锻炼持续时间为每天 26 分钟（中位数；IQR：16-31）。 IQR：12-34；同一队列加上标准护理审计；联合 n = 50)；从而使总运动持续时间（51 分钟；IQR：32-64）相对于标准护理（Z = 4.0，P <.001）加倍。该设备每天可实现 104 次 UL 重复（IQR：38-393），而传统疗法每天可实现 15 次 UL 重复（IQR：11-23；Z = 4.3，P <.001）。结论. 与标准护理相比，自我指导的适应性锻炼使我们中风住院患者队列的参与者能够将运动持续时间增加 2 倍，重复次数增加 8 倍，而无需额外的专业监督。