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Zhou Y, Ren H, Hou X, Dong X, Zhang S, Lv Y, Li C, Yu L. The effect of exercise on balance function in stroke patients: a systematic review and meta-analysis of randomized controlled trials. J Neurol 2024:10.1007/s00415-024-12467-1. [PMID: 38834700 DOI: 10.1007/s00415-024-12467-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVE A growing body of studies has examined the effect of exercise on balance function in stroke patients, with conflicting findings. This study aimed to investigate the effect of exercise on balance function in stroke patients and to determine the optimal exercise prescription for stroke patients. METHODS We conducted an extensive search across various databases, including PubMed, Web of Science, EBSCO, Cochrane, and Scopus. The search was conducted until March 11th, 2024. Data were pooled using the weighted mean difference (WMD) and 95% confidence interval. RESULTS Twenty-nine studies fulfilled the inclusion criteria. Exercise significantly improved Berg balance scale (BBS, WMD, 5.24, P < 0.00001) and timed up and go test (TUG, WMD, - 2.91, P < 0.00001) in stroke patients. Subgroup analyses showed that aerobic exercise (WMD, 6.71, P = 0.003), exercise conducted ≥ 8 weeks (WMD, 6.43, P < 0.00001), > 3 times per week (WMD, 6.18, P < 0.00001), ≥ 60 min per session (WMD, 6.40, P < 0.0001), and ≥ 180 min per week (WMD, 7.49, P < 0.00001) were more effective in improving BBS. CONCLUSIONS Exercise improved balance function in stroke patients, and aerobic exercise might be the most effective intervention. To improve balance function, this meta-analysis provides clinicians with evidence to recommend that stroke patients participate in a minimum of 8 weeks of exercise at least 3 times per week for more than 60 min per session, with a goal of 180 min per week being achieved by increasing the frequency of exercise.
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Affiliation(s)
- Yilun Zhou
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Hao Ren
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Xiao Hou
- School of Sport Sciences, Beijing Sport University, Beijing, China
| | - Xiaosheng Dong
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission of China Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Shiyan Zhang
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Yuanyuan Lv
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Cui Li
- School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China.
| | - Laikang Yu
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China.
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China.
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Gao C, Li X, Li F, Li J, Zhang J. Non-pharmacological interventions on quality of life in stroke survivors: A systematic review and meta-analysis. Worldviews Evid Based Nurs 2024; 21:158-182. [PMID: 38429872 DOI: 10.1111/wvn.12714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/29/2023] [Accepted: 01/27/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Non-pharmacological interventions have been used in the rehabilitation of stroke survivors, but their effects on stroke survivors' quality of life (QoL) are unknown. AIM This review aimed to summarize the existing evidence regarding non-pharmacological interventions for QoL in stroke survivors and to evaluate the effectiveness of different types of interventions. METHODS We systematically searched databases including PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chinese BioMedical Literature Database, China Science and Technology Journal Database, and Wanfang data from the earliest available records to March 2023. Randomized controlled trials which explored the effects of non-pharmacological interventions on QoL in stroke patients were included. The meta-analysis was conducted to evaluate the effectiveness of different interventions on QoL. The Review Manager 5.3 was used to conduct the meta-analysis and the revised Cochrane risk-of-bias tool was used to assess the methodological quality of trials. RESULTS A total of 93,245 records were identified, and 34 articles were reviewed and summarized, of which 20 articles were included in the meta-analysis. The summary of the findings of the included studies revealed fitness training, constraint-induced movement therapy (CIMT), physical exercise, music therapy (MT), and art-based interventions may have positive effects on QoL. The fitness training improved total QoL, especially in physical domains including physical functioning (mean difference [MD] = 10.90; 95% CI [7.20, 14.59]), role physical (MD = 10.63; 95% CI [6.71, 14.55]), and global health (MD = 8.76; 95% CI [5.14, 12.38]). The CIMT had a slight effect on general QoL (standardized mean difference [SMD] = 0.48, 95% CI [0.16, 0.80]), whereas significantly improved strength (MD = 8.84; 95% CI [1.31, 16.38]), activities of daily living/instrumental activities of daily living (ADL/IADL; MD = 10.42; 95% CI [2.98, 17.87]), and mobility (MD = 8.02; 95% CI [1.21, 14.83]). MT had a positive effect on the mental health domain (SMD = 0.54; 95% CI [0.14, 0.94]). LINKING EVIDENCE TO ACTION Our findings suggest that fitness training and CIMT have a significant effect on improving physical QoL, while MT has a positive effect on improving psychological QoL. Future studies may use comprehensive and multicomponent interventions to simultaneously improve the patients' physical, psychological, and social QoL.
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Affiliation(s)
- Chang Gao
- School of Nursing, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaomei Li
- School of Nursing, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Fanling Li
- School of Nursing, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jin Li
- School of Nursing, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jingjun Zhang
- School of Nursing, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Morris JH, Irvine L, Tooman T, Dombrowski SU, McCormack B, Van Wijck F, Lawrence M. WeWalk: walking with a buddy after stroke-a pilot study evaluating feasibility and acceptability of a person-centred dyadic behaviour change intervention. Pilot Feasibility Stud 2023; 9:10. [PMID: 36639819 PMCID: PMC9837756 DOI: 10.1186/s40814-022-01227-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/08/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Evidence for benefits of physical activity after stroke is unequivocal. However, many people with stroke are inactive, spending > 80% of waking hours sedentary even when they have physical capacity for activity, indicating barriers to physical activity participation that are not physical. WeWalk is a 12-week person-centred dyadic behaviour change intervention in which a person with stroke (PWS) and a walking buddy form a dyad to work together to support the PWS to increase their physical activity by walking outdoors. This pilot study examined the feasibility of recruiting dyads, explored their perceptions of acceptability and their experiences using WeWalk, to identify required refinements before progression to a clinical trial. METHODS Design: A single-arm observational pilot study with qualitative evaluation. INTERVENTION WeWalk involved facilitated face-to-face and telephone sessions with a researcher who was also a behaviour change practitioner, supported by intervention handbooks and diaries, in which dyads agreed walking goals and plans, monitored progress, and developed strategies for maintaining walking. EVALUATION Descriptive data on recruitment and retention were collected. Interview data were collected through semi-structured interviews and analysed using thematic analysis, guided by a theoretical framework of acceptability. RESULTS We recruited 21 dyads comprising community dwelling PWS and their walking buddies. Ten dyads fully completed WeWalk before government-imposed COVID-19 lockdown. Despite lockdown, 18 dyads completed exit interviews. We identified three themes: acceptability evolves with experience, mutuality, and person-centredness with personally relevant tailoring. As dyads recognised how WeWalk components supported walking, perceptions of acceptability grew. Effort receded as goals and enjoyment of walking together were realised. The dyadic structure provided accountability, and participants' confidence developed as they experienced physical and psychological benefits of walking. WeWalk worked best when dyads exhibited relational connectivity and mutuality in setting and achieving goals. Tailoring intervention components to individual circumstances and values supported dyads in participation and achieving meaningful goals. CONCLUSION Recruiting dyads was feasible and most engaged with WeWalk. Participants viewed the dyadic structure and intervention components as acceptable for promoting outdoor walking and valued the personally tailored nature of WeWalk. Developing buddy support skills and community delivery pathways are required refinements. ISCTRN number: 34488928.
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Affiliation(s)
- Jacqui H. Morris
- grid.8241.f0000 0004 0397 2876School of Health Sciences, University of Dundee, Dundee, UK
| | - Linda Irvine
- grid.8241.f0000 0004 0397 2876School of Health Sciences, University of Dundee, Dundee, UK
| | - Tricia Tooman
- grid.8241.f0000 0004 0397 2876School of Health Sciences, University of Dundee, Dundee, UK
| | - Stephan U. Dombrowski
- grid.266820.80000 0004 0402 6152Kinesiology, University of New Brunswick Fredericton, Fredericton, New Brunswick Canada
| | - Brendan McCormack
- grid.1013.30000 0004 1936 834XNursing and Midwifery, University of Sydney, Sydney, New South Wales Australia ,grid.104846.fSchool of Health Sciences Queen Margaret University, Edinburgh, UK
| | - Frederike Van Wijck
- grid.5214.20000 0001 0669 8188School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Maggie Lawrence
- grid.5214.20000 0001 0669 8188School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Błaszcz M, Prucnal N, Wrześniewski K, Pasiut S, Mika P, Kucia M, Stach B, Woźniak M, Mirek E. Physical Activity, Psychological and Functional Outcomes in Non-Ambulatory Stroke Patients during Rehabilitation-A Pilot Study. J Clin Med 2022; 11:jcm11247260. [PMID: 36555878 PMCID: PMC9781234 DOI: 10.3390/jcm11247260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
Despite the extensive literature on stroke rehabilitation, there are few studies that comprehensively show non-ambulatory stroke patients. The aim of the study was to explore the dynamics of the change in physical activity (PA), psychological and functional outcomes, and the correlation between them in non-ambulatory patients during early in-patient post-stroke rehabilitation. Measurements were taken on 21 participants at the beginning of and 6 weeks post-conventional rehabilitation with the Barthel Index (BI), Berg Balance Scale (BBS), Trunk Control Test (TCT), Stroke Impact Scale (SIS), General Self-Efficacy Scale, Stroke Self-Efficacy Questionnaire (SSEQ), the original scale of belief in own impact on recovery (BiOIoR), Hospital Anxiety and Depression Scale, Acceptance of Illness Scale and when the patient could walk—Time Up & Go and 6 Minute Walk Test. Daily PA was assessed over 6 weeks using a Caltrac accelerometer. Only outcomes for BI, BBS, TCT, SIS, and SSEQ significantly improved 6 weeks post-rehabilitation. PA energy expenditure per day significantly increased over time (p < 0.001; effect size = 0.494), but PA only increased significantly up to the third week. PA change was correlated with BiOIoR post-treatment. Self-efficacy in self-management mediated improvement in SIS. The BiOIoR and confidence in self-management could be important factors in the rehabilitation process.
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Affiliation(s)
- Marcin Błaszcz
- Institute of Clinical Rehabilitation, University of Physical Education in Krakow, 31-571 Krakow, Poland
- Non-Public Healthcare Facility “Pasternik”, 32-085 Modlniczka, Poland
- Correspondence: (M.B.); (N.P.); (E.M.); Tel.: +48-604-249-436 (M.B.)
| | - Nina Prucnal
- Emotion and Perception Lab, Institute of Psychology, Faculty of Philosophy, Jagiellonian University, Ingardena 6, 30-060 Krakow, Poland
- Correspondence: (M.B.); (N.P.); (E.M.); Tel.: +48-604-249-436 (M.B.)
| | - Krzysztof Wrześniewski
- Department of Psychology, University of Physical Education in Krakow, 31-571 Krakow, Poland
| | - Szymon Pasiut
- Institute of Clinical Rehabilitation, University of Physical Education in Krakow, 31-571 Krakow, Poland
| | - Piotr Mika
- Institute of Clinical Rehabilitation, University of Physical Education in Krakow, 31-571 Krakow, Poland
| | - Małgorzata Kucia
- Musculoskeletal Rehabilitation Centre in “Krzeszowice”, 32-065 Krzeszowice, Poland
| | - Beata Stach
- Musculoskeletal Rehabilitation Centre in “Krzeszowice”, 32-065 Krzeszowice, Poland
- Department of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Collegium Medicum, 31-126 Krakow, Poland
| | - Marcin Woźniak
- Non-Public Healthcare Facility “Pasternik”, 32-085 Modlniczka, Poland
| | - Elżbieta Mirek
- Institute of Clinical Rehabilitation, University of Physical Education in Krakow, 31-571 Krakow, Poland
- Correspondence: (M.B.); (N.P.); (E.M.); Tel.: +48-604-249-436 (M.B.)
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Reicherzer L, Wirz M, Wieber F, Graf ES. Facilitators and barriers to health enhancing physical activity in individuals with severe functional limitations after stroke: A qualitative study. Front Psychol 2022; 13:982302. [PMID: 36337530 PMCID: PMC9628747 DOI: 10.3389/fpsyg.2022.982302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/29/2022] [Indexed: 11/28/2022] Open
Abstract
Background Patients with chronic conditions are less physically active than the general population despite knowledge of positive effects on physical and mental health. There is a variety of reasons preventing people with disabilities from achieving levels of physical activities resulting in health benefits. However, less is known about potential facilitators and barriers for physical activity (PA) in people with severe movement impairments. The aim of this study was to identify obstacles and facilitators of PA in individuals with severe disabilities. Materials and methods Using a qualitative approach to explore individuals’ subjective perspectives in depth, five community-dwelling adults (age 52–72, 2 female, 3 male) living with chronic mobility impairments after stroke that restrict independent PA were interviewed. A semi structured topic guide based on the theoretical domains framework was utilized. The interview data was analyzed thematically, and the theoretical domains framework constructs were mapped onto the main and sub-categories. Results The six main categories of facilitators and barriers along the capability, opportunity, motivation–behavior (COM-B) framework were: (1) physical capabilities, (2) psychological capabilities, (3) motivation reflective, (4) motivation automatic, (5) opportunity physical, and (6) opportunity social. The physical capabilities to independently perform PA were variable between participants but were not necessarily perceived as a barrier. Participants were highly motivated to maintain and/or increase their abilities to master their everyday lives as independently as possible. It became clear that a lack of physical opportunities, such as having access to adequate training facilities can present a barrier. Social opportunities in the form of social support, social norms, or comparisons with others can act as both facilitators and barriers. Conclusion While confirming known barriers and facilitators that impact the ability of individuals with functional limitations to be active, the findings highlight the need and opportunities for comprehensive service models based on interdisciplinary collaborations.
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Affiliation(s)
- Leah Reicherzer
- Institute of Physiotherapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Markus Wirz
- Institute of Physiotherapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Frank Wieber
- Institute of Public Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
- Social Psychology and Motivation Lab, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Eveline S. Graf
- Institute of Physiotherapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
- *Correspondence: Eveline S. Graf,
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Arienti C, Buraschi R, Pollet J, Lazzarini SG, Cordani C, Negrini S, Gobbo M. A systematic review opens the black box of "usual care" in stroke rehabilitation control groups and finds a black hole. Eur J Phys Rehabil Med 2022; 58:520-529. [PMID: 35634889 PMCID: PMC9980563 DOI: 10.23736/s1973-9087.22.07413-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION In experimental trials, new methods are tested against the "best" or "usual" care. To appraise control group (CG) interventions provided as "usual care," we focused on stroke as a leading cause of disability demanding rehabilitation as a complex intervention. EVIDENCE ACQUISITION For this methodological appraisal, we conducted a systematic review of RCTs without timespan limitation. The PICO included stroke survivors, rehabilitation, control group intervention, lower limb function. To assess the risk of bias, we used the Cochrane risk of bias tool (RoB). We identified the terminology describing the CG Program (CGP), performed a knowledge synthesis and conducted a frequency analysis of provided interventions. EVIDENCE SYNTHESIS We included 155 publications. 13.6% of the articles did not describe the CG, and 11.6% indicated only the professionals involved. In the remaining 116 studies, three studies provided an intervention according to specific guidelines, 106 different "usual care" CGPs were detected, with nine proposed twice and two between four and five times. The most adopted terminology to state "usual care" was "conventional physiotherapy." CONCLUSIONS This study shows that usual care in CG does not actually exist, as both specific terminology and consistency within CGP contents are missing. Reporting guidelines should give better assistance on this issue. These results should be verified in other fields.
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Affiliation(s)
| | | | - Joel Pollet
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | | | | | - Stefano Negrini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, La Statale University, Milan, Italy
| | - Massimiliano Gobbo
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Young R, Sage K, Broom D, Broomfield K, Church G, Smith C. Using nominal group technique to advance power assisted exercise equipment for people with stroke. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:68. [PMID: 34583773 PMCID: PMC8477577 DOI: 10.1186/s40900-021-00311-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Power assisted exercise is accessible and acceptable for people with stroke. The potential for technological advancement of the equipment to improve the user experience has been identified. Involvement of end users and service providers in the design of health technologies is essential in determining how said technology is perceived and adopted. This project invited people with stroke and service providers to influence design features and determine machine selection in the preliminary stages of a codesign research programme. AIMS To capture the perspectives of people with stroke and professionals working with people with stroke about proposed digitalisation of power assisted exercise equipment and select machines for prototype development. METHODS Nominal group technique was used to capture the perspectives, ideas, preferences and priorities of three stakeholder groups: people with stroke (n = 3, mean age 66 years), rehabilitation professionals (n = 3) and exercise scientists (n = 3). Two questions underpinned the structure of the events; 'What does an assistive exercise machine need to do to allow the person with stroke to engage in exercise?' and 'Which machines would you prioritise for use with People with Stroke?' Attendees were invited to cast votes to indicate their preferred machines. FINDINGS Synthesis of the data from the NGT identified four domains; software and interface, exercise programme, machine and accessories, setting and service. Three preferred machines from a range of nine were identified through vote counting. CONCLUSION Nominal group technique directed the selection of machines to be included in the development of the proposed technology. The vision shared by users during the structured discussion shaped the subsequent steps in the design and testing of the new technology. PATIENT AND SERVICE PROVIDER CONTRIBUTION The opinions and preferences of people with stroke, rehabilitation professionals and exercise scientists were central to key decisions which will shape the digitalisation of power assisted equipment, influence future research and guide implementation of the new technologies.
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Affiliation(s)
- Rachel Young
- Advanced Wellbeing Research Centre, Sheffield Hallam University, 2 Old Hall Road, Sheffield, S9 3TU, UK.
| | - Karen Sage
- Faculty of Health and Education, Manchester Metropolitan University, Manchester Brooks Building, 53 Bonsall Street, Manchester, M15 6GX, UK
| | - David Broom
- Academy of Sport and Physical Activity, Faculty of Health and Life Sciences, Coventry University, Sheffield, UK
| | - Katherine Broomfield
- 4National Institute for Health Research (NIHR)/Health Education England (HEE) Clinical Doctoral Research Fellow, Gloucestershire Health and Care Foundation Trust and Manchester Metropolitan University, Sheffield, UK
| | - Gavin Church
- NIHR Clinical Pre Doctoral Academic Fellow, Community Stroke Service, Sheffield Teaching Hospitals NHS Trust, Beech Hill, Norfolk Park Road, Sheffield, S2 3QE, UK
| | - Christine Smith
- Department of Allied Health Professions, Sheffield Hallam University, Collegiate Crescent Campus, Sheffield, S10 2BP, UK
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8
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Young R, Broom D, O'Brien R, Sage K, Smith C. Users' experience of community-based power assisted exercise: a transition from NHS to third sector services. Int J Qual Stud Health Well-being 2021; 16:1949899. [PMID: 34252010 PMCID: PMC8276664 DOI: 10.1080/17482631.2021.1949899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
PURPOSE Seated Power Assisted Exercise (PAE) equipment is an accessible exercise mode for people with limited mobility following stroke and is available at a small number of community-based venues. The purpose of this qualitative study was to understand the lived experience of using PAE amongst PwS in a community venue and identify recommendations for the development and advancement of PAE equipment. METHOD Semi-structured interviews were conducted with 8 participants (PwS) attending a community stroke venue where PAE equipment was available. Transcribed data were analysed using interpretative phenomenological analysis. RESULTS Three overarching themes emerged from the analysis; 1) Don't tell me I've plateaued; 2) PAE facilitates the transition into long-term recovery; 3) Reframing the experience of stroke. Participants associated the uptake of PAE alongside venue membership as a turning point in their adjustment to life following stroke. In addition, recommendations for future development of the equipment were identified. CONCLUSION These findings indicate that membership of a stroke venue alongside engagement with PAE facilitated transition from early stroke rehabilitation into longer term recovery. The results of this study have informed the need for future product design and highlighted PAE is an effective mode for continued rehabilitation in third-sector services.
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Affiliation(s)
- Rachel Young
- Department of Allied Health Professions, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - David Broom
- Academy of Sport and Physical Activity, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Rachel O'Brien
- Department of Allied Health Professions, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Karen Sage
- Department of Nursing, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Christine Smith
- Department of Allied Health Professions, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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9
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Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, Kamel H, Kernan WN, Kittner SJ, Leira EC, Lennon O, Meschia JF, Nguyen TN, Pollak PM, Santangeli P, Sharrief AZ, Smith SC, Turan TN, Williams LS. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke 2021; 52:e364-e467. [PMID: 34024117 DOI: 10.1161/str.0000000000000375] [Citation(s) in RCA: 1064] [Impact Index Per Article: 354.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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10
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Nindorera F, Nduwimana I, Thonnard JL, Kossi O. Effectiveness of walking training on balance, motor functions, activity, participation and quality of life in people with chronic stroke: a systematic review with meta-analysis and meta-regression of recent randomized controlled trials. Disabil Rehabil 2021; 44:3760-3771. [PMID: 33715555 DOI: 10.1080/09638288.2021.1894247] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To review and quantify the effects of walking training for the improvement of various aspects of physical function of people with chronic stroke. METHODS We conducted a systematic search and meta-analysis of randomized controlled trials (RCTs) of chronic stroke rehabilitation interventions published from 2008 to 2020 in English or French. Of the 6476-screened articles collated from four databases, 15 RCTs were included and analyzed. We performed a meta-regression with the total training time as dependent variable in order to have a better understanding of how did the training dosage affect the effect sizes. RESULTS Treadmill walking training was more effective on balance and motor functions (standardized mean difference (SMD)=0.70[0.02, 1.37], p = 0.04) and 0.56[0.15, 0.96], p = 0.007 respectively). Overground walking training improved significantly walking endurance (SMD = 0.38[0.16, 0.59], p < 0.001), walking speed (MD = 0.12[0.05, 0.18], p < 0.001), participation (SMD = 0.35[0.02, 0.68], p = 0.04) and quality of life (SMD = 0.46[0.12, 0.80], p = 0.008). Aquatic training improved balance (SMD = 2.41[1.20, 3.62], p < 0.001). The Meta-regression analysis did not show significant effect of total training time on the effect sizes. CONCLUSION Treadmill and overground walking protocols consisting of ≥30 min sessions conducted at least 3 days per week for about 8 weeks are beneficial for improving motor impairments, activity limitations, participation, and quality of life in people with chronic stroke.Implications for rehabilitationTreadmill walking training is effective for improving balance and motor functions.Overground walking training improved significantly walking endurance, walking speed, participation and quality of life.Treadmill and overground walking protocols consisting of ≥30 min sessions conducted at least 3 days per week for about 8 weeks are beneficial for improving motor impairments, activity limitations, participation, and quality of life in patient with chronic stroke.
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Affiliation(s)
- Félix Nindorera
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,National Center for Physical Therapy and Rehabilitation (CNRKR), Bujumbura, Burundi
| | - Ildephonse Nduwimana
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,National Center for Physical Therapy and Rehabilitation (CNRKR), Bujumbura, Burundi
| | - Jean Louis Thonnard
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,National Center for Physical Therapy and Rehabilitation (CNRKR), Bujumbura, Burundi
| | - Oyéné Kossi
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,Unité de NeuroRehabilitation, Service de Neurologie, Hospital Universitaire de Parakou, Parakou, Benin.,ENATSE (Ecole Nationale des Techniciens Supérieurs en Santé Publique et Surveillance Epidémiologique), Université de Parakou, Parakou, Benin
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11
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Veldema J, Jansen P. Aquatic therapy in stroke rehabilitation: systematic review and meta-analysis. Acta Neurol Scand 2021; 143:221-241. [PMID: 33141446 DOI: 10.1111/ane.13371] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 12/29/2022]
Abstract
The main object of this systematic review and meta-analysis is to collect the available evidence of aquatic therapy in stroke rehabilitation and to investigate the effect of this intervention in supporting stroke recovery. The PubMed, the Cochrane Central Register of Controlled Trials and the PEDro databases were searched from their inception through to 31/05/2020 on randomized controlled trials evaluating the effect of aquatic therapy on stroke recovery. Subjects´ characteristics, methodological aspects, intervention description, and outcomes were extracted. Effect sizes were calculated for each study and outcome. Overall, 28 appropriate studies (N = 961) have been identified. A comparison with no intervention indicates that aquatic therapy is effective in supporting walking, balance, emotional status and health-related quality of life, spasticity, and physiological indicators. In comparison with land-based interventions, aquatic therapy shows superior effectiveness on balance, walking, muscular strength, proprioception, health-related quality of life, physiological indicators, and cardiorespiratory fitness. Only on independence in activities of daily living the land- and water-based exercise induce similar effects. Established concepts of water-based therapy (such as the Halliwick, Ai Chi, Watsu, or Bad Ragaz Ring methods) are the most effective, aquatic treadmill walking is the least effective. The current evidence is insufficient to support this therapy form within evidence-based rehabilitation. However, the available data indicate that this therapy can significantly improve a wide range of stroke-induced disabilities. Future research should devote more attention to this highly potent intervention.
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Affiliation(s)
- Jitka Veldema
- Faculty of Human Sciences University of Regensburg Regensburg Germany
| | - Petra Jansen
- Faculty of Human Sciences University of Regensburg Regensburg Germany
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Tollár J, Nagy F, Csutorás B, Prontvai N, Nagy Z, Török K, Blényesi E, Vajda Z, Farkas D, Tóth BE, Repa I, Moizs M, Sipos D, Kedves A, Kovács Á, Hortobágyi T. High Frequency and Intensity Rehabilitation in 641 Subacute Ischemic Stroke Patients. Arch Phys Med Rehabil 2020; 102:9-18. [PMID: 32861668 DOI: 10.1016/j.apmr.2020.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/06/2020] [Accepted: 07/15/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To determine the effects of exergaming on quality of life (QoL), motor, and clinical symptoms in subacute stroke patients. DESIGN A pseudorandomized controlled trial, using a before-after test design. SETTING University hospital. PARTICIPANTS Subacute, ischemic stroke outpatients (N=3857), 680 of whom were randomized and 641 completed the study. INTERVENTIONS We determined the effects of 5 times a week twice daily (EX2; 50 sessions; n=286) and once daily (EX1; 25 sessions; n=272) exergaming and low-intensity standard care (control [CON]; 25 sessions; n=83) on clinical, mobility, blood pressure (BP), and QoL outcomes. MAIN OUTCOME MEASURES The primary outcome was Modified Rankin Scale. Secondary outcomes were activities of daily living, 5 aspects of health-related QoL, Beck Depression Inventory, 6-minute walk test (6MWT), Berg Balance Scale (BBS), and static balance (center of pressure). RESULTS During exercise, the peak heart rate was 134, 134, and 126 beats per minute in the EX2, EX1, and CON groups, respectively. mRS improved similarly in the EX2 (-1.8; effect size, d=-4.0) and EX1 (-1.4; d=-2.6) groups, but more than in the CON group (-0.7; d=-0.6). QoL, Barthel Index, BBS, 6MWT, and standing posturography improved more in the EX2 group and the same in the EX1 and CON groups. Systolic and diastolic resting BP decreased more in the EX2 and EX1 groups than in the CON group. The intervention effects did not differ between men (n=349) and women (n=292). CONCLUSIONS Twice daily compared with once daily high-intensity exergaming or once daily lower intensity standard care produced superior effects on clinical and motor symptoms, BP, and QoL in male and female subacute ischemic stroke participants.
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Affiliation(s)
- József Tollár
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary; University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary.
| | - Ferenc Nagy
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary; University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary
| | - Bence Csutorás
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Nándor Prontvai
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Zsófia Nagy
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Katalin Török
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Eszter Blényesi
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Zsolt Vajda
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary; University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary; Dr József Baka Diagnostical, Oncoradiological, Research and Educational Center, Kaposvár, Hungary
| | - Dóra Farkas
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Béla E Tóth
- Department of Pharmaceutical Surveillance and Economics, Faculty of Pharmacy, University of Debrecen, Debrecen, Hungary
| | - Imre Repa
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary; University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary; Dr József Baka Diagnostical, Oncoradiological, Research and Educational Center, Kaposvár, Hungary
| | - Mariann Moizs
- Somogy County Móricz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Dávid Sipos
- University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary; Dr József Baka Diagnostical, Oncoradiological, Research and Educational Center, Kaposvár, Hungary
| | - András Kedves
- Dr József Baka Diagnostical, Oncoradiological, Research and Educational Center, Kaposvár, Hungary
| | - Árpád Kovács
- University of Pécs, Faculty of Health Sciences, Doctoral School of Health Sciences, Pécs, Hungary; Dr József Baka Diagnostical, Oncoradiological, Research and Educational Center, Kaposvár, Hungary; Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tibor Hortobágyi
- University of Groningen, University Medical Center, Groningen, The Netherlands
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13
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Veldema J, Jansen P. Resistance training in stroke rehabilitation: systematic review and meta-analysis. Clin Rehabil 2020; 34:1173-1197. [DOI: 10.1177/0269215520932964] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: This systematic review and meta-analysis investigates the effects of resistance training in supporting the recovery in stroke patients. Data sources: PubMed, the Cochrane Central Register of Controlled Trials and the PEDro databases were reviewed up to 30 April 2020. Review methods: Randomized controlled trials were included, who compared: (i) resistance training with no intervention, (ii) resistance training with other interventions and (iii) different resistance training protocols in stroke rehabilitation. Results: Overall 30 trials ( n = 1051) were enrolled. The parameters evaluated were: (1) gait, (2) muscular force and motor function, (3) mobility, balance and postural control, (4) health related quality of life, independence and reintegration, (5) spasticity and hypertonia, (6) cardiorespiratory fitness, (7) cognitive abilities and emotional state and (8) other health-relevant physiological indicators. The data indicates that: (i) resistance training is beneficial for the majority of parameters observed, (ii) resistance training is superior to other therapies on muscular force and motor function of lower and upper limbs, health related quality of life, independence and reintegration and other health-relevant physiological indicators, not significantly different from other therapies on walking ability, mobility balance and postural control and spasticity and hypertonia, and inferior to ergometer training on cardiorespiratory fitness and (iii) the type of resistance training protocol significantly impacts its effect; leg press is more efficient than knee extension and high intensity training is superior than low intensity training. Conclusion: Current data indicates that resistance training may be beneficial in supporting the recovery of stroke patients. However, the current evidence is insufficient for evidence-based rehabilitation.
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Affiliation(s)
- Jitka Veldema
- Faculty of Psychology, Education and Sport Science, University of Regensburg, Regensburg, Germany
| | - Petra Jansen
- Faculty of Psychology, Education and Sport Science, University of Regensburg, Regensburg, Germany
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Wang CY, Miyoshi S, Chen CH, Lee KC, Chang LC, Chung JH, Shi HY. Walking ability and functional status after post-acute care for stroke rehabilitation in different age groups: a prospective study based on propensity score matching. Aging (Albany NY) 2020; 12:10704-10714. [PMID: 32482912 PMCID: PMC7346049 DOI: 10.18632/aging.103288] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/27/2020] [Indexed: 12/26/2022]
Abstract
Few studies have compared how rehabilitative post-acute care affects recovery of walking ability and other functions after stroke in different age groups. After propensity score matching (1:1), 316 stroke patients were separated into an aged group (age ≥65 years, n=158) and a non-aged group (age <65 years, n=158). Both groups significantly improved in Barthel index, EuroQol-5 dimension, Berg balance scale, 6-minute walking distance and 5-meter walking speed (P<0.001). The non-aged group had significantly larger improvements in Berg balance scale, instrumental activities of daily living, EuroQol-5 dimension and 6-minute walking distance (P<0.001) compared to the aged group. The two groups did not significantly differ in Barthel index, 5-meter walking speed, length of stay, and cost. The aged group had poorer walking ability and poorer instrumental activities of daily living compared to the non-aged group. After intensive rehabilitative post-acute care, however, the aged group improved in walking ability, functional performance and mental health. Intensive strength training for unaffected lower limbs in the stroke patients achieved good recovery of walking ability and other functions. Overall, intensive rehabilitative post-acute care improved self-care ability and decreased informal care costs. Rehabilitative PAC under per-diem reimbursement is efficient and economical for stroke patients in an aging society.
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Affiliation(s)
- Chung-Yuan Wang
- Department of Physical Medicine and Rehabilitation, Pingtung Christian Hospital, Pingtung, Taiwan.,Department of Beauty Science, Meiho University, Pingtung, Taiwan
| | - Seido Miyoshi
- Department of Rehabilitation, Asagi Hospital, Fukuoka, Japan
| | - Chang-Hung Chen
- Department of Neurology, Pingtung Christian Hospital, Pingtung, Taiwan
| | - Kai-Chun Lee
- Department of Physical Medicine and Rehabilitation, Pingtung Christian Hospital, Pingtung, Taiwan
| | - Long-Chung Chang
- Superintendent Office, Pingtung Christian Hospital, Pingtung, Taiwan
| | - Jo-Hsuan Chung
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
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15
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Veldema J, Jansen P. Ergometer Training in Stroke Rehabilitation: Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2020; 101:674-689. [DOI: 10.1016/j.apmr.2019.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/27/2019] [Indexed: 12/22/2022]
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16
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Lee J, Stone AJ. Combined Aerobic and Resistance Training for Cardiorespiratory Fitness, Muscle Strength, and Walking Capacity after Stroke: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2019; 29:104498. [PMID: 31732460 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104498] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/11/2019] [Accepted: 10/23/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cardiorespiratory fitness, measured as peak oxygen consumption, is a potent predictor of stroke risk. Muscle weakness is the most prominent impairment after stroke and is directly associated with reduced walking capacity. There is a lack of recommendations for optimal combined aerobic training and resistance training for those patients. The purpose of this study was to systematically review and quantify the effects of exercise training on cardiorespiratory fitness, muscle strength, and walking capacity after stroke. METHODS Five electronic databases were searched (until May 2019) for studies that met the following criteria: (1) adult humans with a history of stroke who ambulate independently; (2) structured exercise intervention based on combined aerobic training and resistance training; and (3) measured cardiorespiratory fitness, muscle strength, and/or walking capacity. RESULTS Eighteen studies (602 participants, average age 62 years) met the inclusion criteria. Exercise training significantly improved all 3 outcomes. In subgroup analyses for cardiorespiratory fitness, longer training duration was significantly associated with larger effect size. Likewise, for muscle strength, moderate weekly frequency and lower training volume were significantly associated with larger effect size. Furthermore, in walking capacity, moderate weekly frequency and longer training duration were significantly associated with larger effect size. CONCLUSIONS These results suggest that an exercise program consisting of moderate-intensity, 3 days per week, for 20 weeks should be considered for greater effect on cardiorespiratory fitness, muscle strength, and walking capacity in stroke patients.
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Affiliation(s)
- Junghoon Lee
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas
| | - Audrey J Stone
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas.
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Lefeber N, De Keersmaecker E, Henderix S, Michielsen M, Tamburella F, Tagliamonte NL, Molinari M, de Geus B, Kerckhofs E, Swinnen E. Physiological responses and perceived exertion during robot-assisted treadmill walking in non-ambulatory stroke survivors. Disabil Rehabil 2019; 43:1576-1584. [PMID: 31588811 DOI: 10.1080/09638288.2019.1671502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To examine physiological responses and perceived exertion during robot-assisted treadmill walking in non-ambulatory stroke survivors; compare these outcomes with aerobic exercise recommendations; and investigate the effect of robotic assistance. MATERIALS AND METHODS Twelve non-ambulatory stroke survivors (67 ± 11 years-old, 84 ± 38 d post-stroke) participated. Subjects walked three times 20 min (1 session/day) in the Lokomat: once with conventional exercise parameters, once with 60% robotic assistance and once with 100% robotic assistance. Gas exchange and heart rate were monitored continuously. Perceived exertion was assessed every 3 min during walking. RESULTS During conventional robot-assisted treadmill walking, net perceived exertion (0-14 scale) significantly increased between minute 6 (median = 2, interquartile range = 4) and 18 (median = 5, interquartile range = 4). Net physiological responses did not significantly change over time. Throughout exercise, percentage of predicted heart rate reserve was significantly below the 40% threshold (medians: 11-14%) and percentage of predicted maximum heart rate reached the 55% threshold (medians: 59-60%). Perceived exertion reached the 11-point threshold halfway. Net physiological responses and perceived exertion did not significantly differ between 60% and 100% robotic assistance. CONCLUSIONS The assistance level that non-ambulatory stroke survivors require at their highest tolerable walking speed seems too high to sufficiently stress the cardiorespiratory system during robot-assisted treadmill walking.Implications for rehabilitationThe exercise intensity of 20-minute conventional robot-assisted treadmill walking can be low, and might be too low to challenge the cardiorespiratory system of non-ambulatory stroke survivors.Lowering the level of robotic assistance from 100% to 60% does not seem to increase the exercise intensity of 20-minute robot-assisted treadmill walking.
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Affiliation(s)
- Nina Lefeber
- Rehabilitation Research - Neurological Rehabilitation Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium.,Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - Emma De Keersmaecker
- Rehabilitation Research - Neurological Rehabilitation Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium.,Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | | | | | - Federica Tamburella
- Laboratory of Robotic Neurorehabilitation and Laboratory of Spinal Rehabilitation, Fondazione Santa Lucia, IRCCS, Rome, Italy
| | - Nevio Luigi Tagliamonte
- Laboratory of Robotic Neurorehabilitation and Laboratory of Spinal Rehabilitation, Fondazione Santa Lucia, IRCCS, Rome, Italy.,Biomedical Robotics and Biomicrosystems Research Unit, Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Marco Molinari
- Laboratory of Robotic Neurorehabilitation and Laboratory of Spinal Rehabilitation, Fondazione Santa Lucia, IRCCS, Rome, Italy
| | - Bas de Geus
- Human Physiology Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eric Kerckhofs
- Rehabilitation Research - Neurological Rehabilitation Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium.,Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - Eva Swinnen
- Rehabilitation Research - Neurological Rehabilitation Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium.,Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
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Lloyd M, Skelton DA, Mead GE, Williams B, van Wijck F. Physical fitness interventions for nonambulatory stroke survivors: A mixed-methods systematic review and meta-analysis. Brain Behav 2018; 8:e01000. [PMID: 29920979 PMCID: PMC6043697 DOI: 10.1002/brb3.1000] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/10/2018] [Accepted: 04/15/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Physical fitness training after stroke is recommended in guidelines across the world, but evidence pertains mainly to ambulatory stroke survivors. Nonambulatory stroke survivors (FAC score ≤2) are at increased risk of recurrent stroke due to limited physical activity. This systematic review aimed to synthesize evidence regarding case fatality, effects, experiences, and feasibility of fitness training for nonambulatory stroke survivors. METHODS Eight major databases were searched for any type of study design. Two independent reviewers selected studies, extracted data, and assessed study quality, using published tools. Random-effects meta-analysis was used. Following their separate analysis, qualitative and quantitative data were synthesized using a published framework. RESULTS Of 13,614 records, 33 studies involving 910 nonambulatory participants met inclusion criteria. Most studies were of moderate quality. Interventions comprised assisted walking (25 studies), cycle ergometer training (5 studies), and other training (3 studies), mainly in acute settings. Case fatality did not differ between intervention (1.75%) and control (0.88%) groups (95% CI 0.13-3.78, p = 0.67). Compared with control interventions, assisted walking significantly improved: fat mass, peak heart rate, peak oxygen uptake and walking endurance, maximum walking speed, and mobility at intervention end, and walking endurance, balance, mobility, and independent walking at follow-up. Cycle ergometry significantly improved peak heart rate, work load, peak ventilation, peak carbon dioxide production, HDL cholesterol, fasting insulin and fasting glucose, and independence at intervention end. Effectiveness of other training could not be established. There were insufficient qualitative data to draw conclusions about participants' experiences, but those reported were positive. There were few intervention-related adverse events, and dropout rate ranged from 12 to 20%. CONCLUSIONS Findings suggest safety, effectiveness, and feasibility of adapted fitness training for screened nonambulatory stroke survivors. Further research needs to investigate the clinical and cost-effectiveness as well as experiences of fitness training-especially for chronic stroke survivors in community settings.
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Affiliation(s)
- Megan Lloyd
- School of Health and Life SciencesGlasgow Caledonian UniversityGlasgowUK
| | - Dawn A. Skelton
- School of Health and Life SciencesGlasgow Caledonian UniversityGlasgowUK
| | - Gillian E. Mead
- Geriatric MedicineDivision of Health SciencesCentre for Clinical Brain SciencesThe University of Edinburgh, and the Royal InfirmaryEdinburghUK
| | - Brian Williams
- School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
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