Sedentary Behavior and Physical Activity Assessment Following Botulinum Toxin A Treatment in Stroke Patients: A Comparative Pilot Study

Background In most patients with stroke, sedentary behaviors (SED) increase, and physical activity (PA) decreases over time. This has cumulative effects on the efficacy of physical rehabilitation interventions. This study aimed to determine the effects of botulinum toxin injections (BoNT-A) on SED and PA, and to determine the agreement between device-measured and self-report methods in stroke survivors with spasticity. Methods SED and PA were assessed in 17 chronic stroke survivors (mean age 49.7 years) with upper or lower limb spasticity following BoNT-A injections. Clinical assessments included spasticity, neurological impairment, functional ambulation, independence, and quality of life. SED and PA were also measured at baseline (T0), 6 weeks (T1), and 12 weeks (T2) using accelerometry and the International Physical Activity Questionnaire (IPAQ), categorizing activity into SED, low [light intensity physical activity (LIPA)], and moderate physical activity (MPA)-to-vigorous physical activity (VPA) levels. Multilevel mixed-effects linear regression models were used to determine the effects of BoNT-A on time spent in SED and PA. Bland–Altman plots were used to determine the agreement between the device measured and self-report methods. Results Accelerometry revealed a significant reduction in sedentary time and an increase in low-LIPA times at T2 only, whereas IPAQ-reported SED significantly decreased and LIPA increased at T1 and T2. Substantial increases in LIPA, MPA, and VPA times were also found with IPAQ at T2 only. IPAQ significantly underestimated the time spent in SED and overestimated VPA compared to accelerometry. Conclusions BoNT-A injections reduced SED time and increased light-intensity PA in stroke survivors with spasticity. Self-report measures, such as the IPAQ, may not measure the true impact of interventions, such as BoNT-A, on PA in patients with stroke.