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McDonell I, Barr C, van den Berg M. Implementing circuit class training can increase therapy time and functional independence in people with stroke receiving inpatient rehabilitation: findings from a retrospective observational clinical audit. Physiother Theory Pract 2024; 40:1383-1389. [PMID: 36724415 DOI: 10.1080/09593985.2023.2172634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Increased therapy time and task-specific practice can improve functional recovery post stroke. This observational study aimed to determine whether the clinical implementation of circuit training increases therapy time and improves function in stroke rehabilitation. METHODS In a retrospective clinical audit, medical records of 110 people (mean age 78.7, standard deviation 13.0, 49.1% male, 57.3% severe stroke) admitted to a stroke inpatient rehabilitation ward were evaluated to determine the differences between pre (Individual Therapy (IT), n = 55) and post (Circuit Class Therapy (CCT), n = 55) service change implementation. The primary outcome was the amount of time spent in physiotherapy daily (minutes). Secondary outcomes included the Functional Independence Measure (FIM) score and length of stay (LOS). RESULTS The CCT Group spent significantly more time in physiotherapy daily during their rehabilitation LOS compared to the IT Group (mean difference 8.45 (95% CI 5.99 to 10.90) mins, p < 0.001). No significant between-group differences were observed for FIM scores or LOS (p ≥ 0.066). CONCLUSION This study suggests that the clinical implementation of CCT can significantly increase therapy time by close to 9 minutes per session, with functional gains that are equivalent to usual care. This was achieved with a patient-to-staff ratio of 3:1, compared to the 1:1 ratio in IT, concurring with existing evidence in support of CCT as an alternative service delivery model for inpatient stroke rehabilitation.
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Affiliation(s)
- Imogen McDonell
- Clinical Rehabilitation, College of Nursing and Health Sciences, Flinders University, Tonsley Campus, Clovelly Park, Australia
- Inpatient Rehabilitation, Mona Vale Hospital, Mona Vale, Australia
| | - Chris Barr
- Clinical Rehabilitation, College of Nursing and Health Sciences, Flinders University, Tonsley Campus, Clovelly Park, Australia
| | - Maayken van den Berg
- Clinical Rehabilitation, College of Nursing and Health Sciences, Flinders University, Tonsley Campus, Clovelly Park, Australia
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2
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Jharbade M, Ramachandran S, V S, Solomon M J. Functional Training for Lower Extremities in Stroke Survivors: A Scoping Review. Cureus 2024; 16:e58087. [PMID: 38738032 PMCID: PMC11088721 DOI: 10.7759/cureus.58087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Engaging in meaningful and repetitive goal-oriented functional tasks can effectively enhance neuroplasticity and facilitate recovery following a stroke. This particular approach has primarily been studied in relation to functional outcomes and has predominantly focused on late subacute and chronic stroke patients. However, there is a lack of information regarding the standardized protocol of lower extremity functional training, its constituent elements, and its impact on motor recovery during the early subacute phase of stroke. The aim of this study was to examine the available evidence related to the intervention protocol of lower extremity functional training in order to identify common training elements and assess their impact on motor and functional outcomes in stroke survivors. A systematic search was conducted on PubMed and Scopus, covering the period from 2000 to 2022. A total of 1786 articles were retrieved and screened based on predefined inclusion criteria. A total of 36 articles were included in this review. The primary findings were classified into categories such as intervention protocols for functional training and their constituent elements, outcome measures utilized, minimal clinically important differences (MCID) reported, and the conclusions drawn by the respective studies. Only a limited quantity of studies reported on the intervention protocol of lower extremity functional training. The majority of these studies focused on the efficacy of functional training for enhancing gait and balance, as evaluated through functional outcome assessments, particularly in the context of chronic stroke patients. In most studies, the evaluation of outcomes was typically based on statistical significance rather than clinical significance. In light of these findings, it is recommended that future studies be conducted during the early subacute phase of stroke to further investigate the impact of functional training on motor outcomes. This will contribute to a broader understanding of the benefits of functional training in facilitating motor recovery in the lower extremities and its clinical significance in stroke survivors.
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Affiliation(s)
- Meenakshi Jharbade
- Department of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research. (Deemed to be University), Chennai, IND
| | - Sivakumar Ramachandran
- Department of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research. (Deemed to be University), Chennai, IND
| | - Shankar V
- Department of Neurology, Sri Ramachandra Institute of Higher Education and Research. (Deemed to be University), Chennai, IND
| | - John Solomon M
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, IND
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3
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Hancock SL, Thayabaranathan T, Cameron J, Stolwyk R, Lawrence M, Johnson L, Hillier S, Hackett M, Cadilhac DA. Comparisons between group- and individual-based interventions to support recovery from stroke and ischaemic heart disease in the community: a scoping review. Disabil Rehabil 2024:1-10. [PMID: 38279793 DOI: 10.1080/09638288.2024.2305300] [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: 07/29/2023] [Accepted: 12/27/2023] [Indexed: 01/29/2024]
Abstract
PURPOSE To map and summarise available literature on the effectiveness or other benefits of group- and individual-based interventions provided for adults living with stroke or ischaemic heart disease (IHD) in the community. MATERIAL AND METHODS The review was conducted based on JBI methodology and reported using Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Articles were retrieved from: Medline, PsychInfo, Embase, Scopus, and CINAHL from 2002-2022. Extracted data from eligible studies included type of health outcomes (e.g., impairments), retention and adherence, social connectedness, and the costs associated with group- and individual-based interventions. RESULTS After screening, five articles (representing 4 unique studies) comparing a group- and individual-based intervention were included (total sample size n = 87). Three types of interventions were assessed: exercise (3/5), communication (1/5), and occupational therapy (1/5). Effectiveness of group- and individual-based interventions at improving health outcomes (i.e. physical ability, communication, motivation, and quality of life) is unclear. Currently there is insufficient evidence to guide clinical practice. CONCLUSIONS There is limited evidence comparing interventions delivered in a group and individual modality for adults living with stroke or IHD. Adequately powered studies are needed to determine if mode of delivery is equivalent or more cost effective.
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Affiliation(s)
- Shaun L Hancock
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - Tharshanah Thayabaranathan
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - Jan Cameron
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - Rene Stolwyk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia
| | - Maggie Lawrence
- School of Health and Life Sciences, Department of Nursing and Community Health, Glasgow Caledonian University, Scotland
| | - Liam Johnson
- School of Behavioural and Health Sciences, Australian Catholic University, Victoria, Australia
- Physiotherapy Department, Melbourne School of Health Sciences, University of Melbourne, Victoria, Australia
| | - Susan Hillier
- Allied Health and Human Performance, University of South Australia, Australia
| | - Maree Hackett
- Mental Health, The George Institute for Global Health, New South Wales, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
- Stroke theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia
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4
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Donnellan-Fernandez K, Ioakim A, Hordacre B. Revisiting dose and intensity of training: Opportunities to enhance recovery following stroke. J Stroke Cerebrovasc Dis 2022; 31:106789. [PMID: 36162377 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106789] [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: 07/28/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 10/31/2022] Open
Abstract
PURPOSE Stroke is a global leading cause of adult disability with survivors often enduring persistent impairments and loss of function. Both intensity and dosage of training appear to be important factors to help restore behavior. However, current practice fails to achieve sufficient intensity and dose of training to promote meaningful recovery. The purpose of this review is to propose therapeutic solutions that can help achieve a higher dose and/or intensity of therapy. Raising awareness of these intensive, high-dose, treatment strategies might encourage clinicians to re-evaluate current practice and optimize delivery of stroke rehabilitation for maximal recovery. METHODS Literature that tested and evaluated solutions to increase dose or intensity of training was reviewed. For each therapeutic strategy, we outline evidence of clinical benefit, supporting neurophysiological data (where available) and discuss feasibility of clinical implementation. RESULTS Possible therapeutic solutions included constraint induced movement therapy, robotics, circuit therapy, bursts of training, gaming technologies, goal-oriented instructions, and cardiovascular exercise. CONCLUSION Our view is that clinicians should evaluate current practice to determine how intensive high-dose training can be implemented to promote greater recovery after stroke.
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Affiliation(s)
| | - Andrew Ioakim
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Brenton Hordacre
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia.
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5
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Peniche PDC, Pinto APDS, Ribeiro RLMN, Martins JC, Faria CDCDM. Recruitment, retention, attendance, and adherence of a randomized controlled trial to evaluate the effects of task-specific training with individuals post stroke. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/20008529012022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Individuals who suffered stroke benefit from different therapeutic strategies whose efficacy has been proved by well-designed randomized controlled trials (RCTs). Understanding study steps may assist researchers in conducting future RCTs. Thus, the objective of this study was to describe the process of recruitment, retention, attendance, and adherence in conducting RCTs with individuals in the chronic phase of stroke in the municipality of Belo Horizonte/MG/Brazil, with the purpose of investigating the efficacy of specific task training for both lower and upper limbs in improving patients’ physical activity and mobility. Results showed that, of the 674 potential participants, it was impossible to contact 240 individuals and 384 were excluded from our sample for failing to meet eligibility criteria. In total, 50 individuals participated in clinical evaluations and 14 were excluded from the study for the same reason. Overall, 36 individuals started the interventions, a 5.3% recruitment rate. An 80.6% retention rate was observed. In total, seven individuals left the study, mainly due to lack of interest in the activities. We found an 80.9% attendance rate, and the main reason for missing medical appointments was incompatibility with treatment schedule. We also observed an 82.7% adherence rate. Of these, 180 interrupted sessions were mainly due to patients leaving early. These results indicate some difficulties found in conducting RCTs with individuals in the chronic phase of stroke, especially regarding specific task training. Despite these difficulties, the proposed intervention can be considered feasible.
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6
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Peniche PDC, Pinto APDS, Ribeiro RLMN, Martins JC, Faria CDCDM. Recrutamento, retenção, presença e adesão de um ensaio clínico aleatorizado para avaliar os efeitos do treino específico da tarefa em indivíduos pós-acidente vascular encefálico. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/20008529012022pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Indivíduos acometidos pelo acidente vascular encefálico (AVE) se beneficiam de diferentes estratégias terapêuticas que apresentam comprovação da eficácia por meio da condução de ensaios clínicos aleatorizados (ECA) bem delineados. Compreender as etapas do estudo pode auxiliar os pesquisadores na realização de futuros ensaios clínicos. Dessa forma, o objetivo deste estudo foi descrever o processo de recrutamento, retenção, presença e adesão na condução de um ECA realizado com indivíduos pós-AVE na fase crônica na cidade de Belo Horizonte (MG), Brasil, com o propósito de investigar a eficácia do treino específico da tarefa para membros superiores e inferiores na melhora do nível de atividade física e mobilidade. Nos resultados, foi observado que dos 674 potenciais participantes, não foi possível contatar 240; 384 não foram avaliados por não atenderem aos critérios de elegibilidade. Participaram da avaliação presencial 50 indivíduos e 14 não fizeram parte do estudo pelo mesmo motivo. Apenas 36 indivíduos iniciaram as intervenções (taxa de recrutamento de 5,3%). Uma taxa de retenção de 80,6% foi observada. Sete indivíduos abandonaram o estudo, principalmente por desinteresse pelas atividades. A taxa de presença foi de 80,9%, e o principal motivo para ausência nas sessões foi incompatibilidade de horário com as consultas médicas. A taxa de adesão foi de 82,7%, com 180 interrupções durante as sessões, sendo sair mais cedo o motivo mais comum. Esses resultados indicam algumas dificuldades no processo de condução do ECA com indivíduos na fase crônica do AVE envolvendo treino específico da tarefa. Apesar dessas dificuldades, a intervenção proposta pode ser considerada viável.
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7
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Short MR, Hernandez-Pavon JC, Jones A, Pons JL. EEG hyperscanning in motor rehabilitation: a position paper. J Neuroeng Rehabil 2021; 18:98. [PMID: 34112208 PMCID: PMC8194127 DOI: 10.1186/s12984-021-00892-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/31/2021] [Indexed: 11/10/2022] Open
Abstract
Studying the human brain during interpersonal interaction allows us to answer many questions related to motor control and cognition. For instance, what happens in the brain when two people walking side by side begin to change their gait and match cadences? Adapted from the neuroimaging techniques used in single-brain measurements, hyperscanning (HS) is a technique used to measure brain activity from two or more individuals simultaneously. Thus far, HS has primarily focused on healthy participants during social interactions in order to characterize inter-brain dynamics. Here, we advocate for expanding the use of this electroencephalography hyperscanning (EEG-HS) technique to rehabilitation paradigms in individuals with neurological diagnoses, namely stroke, spinal cord injury (SCI), Parkinson's disease (PD), and traumatic brain injury (TBI). We claim that EEG-HS in patient populations with impaired motor function is particularly relevant and could provide additional insight on neural dynamics, optimizing rehabilitation strategies for each individual patient. In addition, we discuss future technologies related to EEG-HS that could be developed for use in the clinic as well as technical limitations to be considered in these proposed settings.
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Affiliation(s)
- Matthew R Short
- Legs + Walking Lab, Shirley Ryan AbilityLab, Floor 24, 355 E Erie St, Chicago, IL, 60611, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, IL, USA
| | - Julio C Hernandez-Pavon
- Legs + Walking Lab, Shirley Ryan AbilityLab, Floor 24, 355 E Erie St, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alyssa Jones
- Legs + Walking Lab, Shirley Ryan AbilityLab, Floor 24, 355 E Erie St, Chicago, IL, 60611, USA
| | - Jose L Pons
- Legs + Walking Lab, Shirley Ryan AbilityLab, Floor 24, 355 E Erie St, Chicago, IL, 60611, USA. .,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, IL, USA. .,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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8
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Cheng DKY, Dagenais M, Alsbury-Nealy K, Legasto JM, Scodras S, Aravind G, Takhar P, Nekolaichuk E, Salbach NM. Distance-limited walk tests post-stroke: A systematic review of measurement properties. NeuroRehabilitation 2021; 48:413-439. [PMID: 33967070 PMCID: PMC8293643 DOI: 10.3233/nre-210026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/15/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Improving walking capacity is a key objective of post-stroke rehabilitation. Evidence describing the quality and protocols of standardized tools for assessing walking capacity can facilitate their implementation. OBJECTIVE To synthesize existing literature describing test protocols and measurement properties of distance-limited walk tests in people post-stroke. METHODS Electronic database searches were completed in 2017. Records were screened and appraised for quality. RESULTS Data were extracted from 43 eligible articles. Among the 12 walk tests identified, the 10-metre walk test (10mWT) at a comfortable pace was most commonly evaluated. Sixty-three unique protocols at comfortable and fast paces were identified. Walking pace and walkway surface, but not walkway length, influenced walking speed. Intraclass correlation coefficients for test-retest reliability ranged from 0.80-0.99 across walk tests. Measurement error values ranged from 0.04-0.40 and 0.06 to 0.20 for the 10mWT at comfortable and fast and paces, respectively. Across walk tests, performance was most frequently correlated with measures of strength, balance, and physical activity (r = 0.26-0.8, p < 0.05). CONCLUSIONS The 10mWT has the most evidence of reliability and validity. Findings indicate that studies that include people with severe walking deficits, in acute and subacute phases of recovery, with improved quality of reporting, are needed.
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Affiliation(s)
- Darren Kai-Young Cheng
- Department of Physical Therapy, University of Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Canada
| | | | - Kyla Alsbury-Nealy
- Department of Physical Therapy, University of Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Canada
| | - Jean Michelle Legasto
- Department of Physical Therapy, University of Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Canada
| | - Stephanie Scodras
- Department of Physical Therapy, University of Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Canada
| | - Gayatri Aravind
- Michener Institute of Education, University Health Network, Canada
| | - Pam Takhar
- Department of Physical Therapy, University of Toronto, Canada
| | - Erica Nekolaichuk
- Gerstein Science Information Centre, University of Toronto, Toronto, ON, Canada
| | - Nancy Margaret Salbach
- Department of Physical Therapy, University of Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Canada
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9
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Gustavson AM, Forster JE, LeDoux CV, Stevens-Lapsley JE. Multiparticipant Rehabilitation in Skilled Nursing Facilities: An Observational Comparison Study. J Am Med Dir Assoc 2020; 21:1920-1925. [DOI: 10.1016/j.jamda.2020.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/28/2020] [Accepted: 05/02/2020] [Indexed: 11/25/2022]
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10
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Gbiri CAO, Amusa BF. Progressive task-oriented circuit training for cognition, physical functioning and societal participation in individuals with dementia. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1866. [PMID: 32776698 DOI: 10.1002/pri.1866] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 05/28/2020] [Accepted: 07/05/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Dementia is commonly associated with cognitive deficit, functional decline and societal participation restriction across multiple domains of functioning. The decline impacts not only on the individual, but also on their informal caregivers, healthcare and the social system. This clinical random controlled study investigated the efficacy of 12-week Progressive Task-oriented circuit training on cognition, physical functioning and societal participation of individuals with dementia. METHODS This study involved 31 individuals living with dementia recruited from a tertiary health institution in Lagos Nigeria. They were randomized into two groups: Progressive Task-oriented circuit training (involved in 12-week circuit training, two times a week for 70 min per session consisting of six workstations) and Control group (training with conventional treatment and home programmes). They were assessed at baseline, mid-intervention and post-intervention using Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale-Cognition (ADAS-Cog), Bristol ADLs, Community integration Questionnaire, 6-min walk test. Data analysed using the independent-samples t tests, paired t tests, Friedman two-way analysis of variance and Mann-Whitney U test (p ≤ .05). RESULTS Participants were aged 69.61 ± 3.44 years. There was significant improvement from baseline to post-intervention in cognition (30.77 ± 1.02 vs. 28.77 ± 3.30), physical functioning (28.19 ± 3.90 vs. 25.84 ± 6.26) and societal participation (3.64 ± 0.73 vs. 5.59 ± 2.76). However, the progressive Task-oriented circuit training had more significant improvement than the control group within the group in cognition (p = .000), physical functioning (p = .000), and societal participation (p = .000). There was no statistical difference within the Control group with cognition (p = .097), Physical functioning (p = 1.000). Meanwhile there was statistically significant effect between both groups on cognition, physical functioning and societal participation post-intervention (p < .005). CONCLUSION Although both Task-oriented Circuit Training and conventional treatment with home exercise programmes are efficacious, Progressive Task-oriented Circuit Training is more efficacious in enhancing and developing therapeutic strategies to train cognition, improve functional performance and societal participation in the rehabilitation of individuals with dementia.
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Affiliation(s)
- Caleb Ademola Omuwa Gbiri
- Department of Physiotherapy, Stroke and Nervous System Disorders Research Group, College of Medicine, University of Lagos, Lagos, Nigeria
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11
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Yang F, Butler AJ. Efficacy of Controlled Whole-Body Vibration Training on Improving Fall Risk Factors in Stroke Survivors: A Meta-analysis. Neurorehabil Neural Repair 2020; 34:275-288. [PMID: 32106762 DOI: 10.1177/1545968320907073] [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] [Indexed: 12/16/2022]
Abstract
Background. Controlled whole-body vibration (CWBV) training has been applied to people with stroke. However, it remains inconclusive if CWBV reduces fall risk in this population. Objective. To (1) assess the immediate and retention effects of CWBV training on fall risk factors in people at postacute and chronic stages of stroke and (2) examine if CWBV dosage is correlated with the effect size (ES) for 3 fall risk factors: body balance, functional mobility, and knee strength. Methods. Twelve randomized controlled trials were included. ES was calculated as the standardized mean difference, and meta-analyses were completed using a random-effects model. Results. CWBV training may lead to improved balance and mobility immediately after training (ES = 0.27, P = .03 for balance; ES = 0.34, P = .02 for mobility) but not at the 3-month follow-up test (ES = 0.02, P = .89 for balance; ES = 0.70, P = .11 for mobility). CWBV affects knee strength capacity with mild ES (ES = 0.08 and 0.11, respectively, for immediate and retention effect; P ≥ .68 for both). Metaregression indicated that the immediate ES is strongly correlated with training dosage for balance (r = 0.649; P = .029) and mobility (r = 0.785; P = .036). Conclusions. CWBV training may benefit balance and mobility immediately, but the training effect may not persist among people with stroke. Additionally, the CWBV dosage correlates with the ES for body balance and mobility. More high-quality studies are needed to determine the retention effects of CWBV training.
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Affiliation(s)
- Feng Yang
- Georgia State University, Atlanta, GA, USA
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12
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Meseguer-Henarejos AB, Rubio-Aparicio M, López-Pina JA, Carles-Hernández R, Gómez-Conesa A. Characteristics that affect score reliability in the Berg Balance Scale: a meta-analytic reliability generalization study. Eur J Phys Rehabil Med 2019; 55:570-584. [DOI: 10.23736/s1973-9087.19.05363-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Kang M, Bladon J, Sergio LE. Group format rehabilitation is equally effective as individual therapy in patients with surgically repaired rotator cuff tears. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1795. [PMID: 31231927 DOI: 10.1002/pri.1795] [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: 01/30/2019] [Revised: 03/18/2019] [Accepted: 05/17/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Does group physiotherapy methods produce different results when compared with individual physiotherapy in persons with surgically repaired rotator cuff tears? No studies to date have examined the feasibility or effectiveness of such therapy formats. Given the prevalence of rotator cuff tears, a study examining group format therapy is warranted and can produce evidence to transform care for rotator cuff tear rehabilitation. METHODS We analyzed the electronic medical records of persons that underwent rotator cuff repair surgery followed by the prescribedpost-surgical physiotherapy at Southlake Regional Health Centre. Both groups were provided standard physiotherapy intervention protocol for post-operative rotator cuff tear. Active range of motion (AROM), quick disabilities of the arm, shoulder and hand (Q-DASH) measures, and efficiency measures were examined for differences between groups. RESULTS No significant differences between AROM (abduction p = .92, lateral rotation p = .64, and flexion p = 1.00) and Q-DASH (p = .62) measures between groups were observed at discharge. Overall, group therapy participants required a greater number of visits (p = .000); however, when separated by age groups, only the 60- to 69-year-old participants significantly differed in number of visits between groups (p = .000), whereas no difference was observed in the 50- to 59-year-old participants (p = .14). CONCLUSION Group format physiotherapy may be equally effective as individual formats in improving AROM and functional outcomes of participants with surgically repaired rotator cuff tears. Further research is needed to determine the optimal age range for group therapy interventions in this population.
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Affiliation(s)
- Mani Kang
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Jen Bladon
- The John and Margaret Bahen Rehabilitation Program, Southlake Regional Health Centre, Newmarket, ON, Canada
| | - Lauren E Sergio
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.,The John and Margaret Bahen Rehabilitation Program, Southlake Regional Health Centre, Newmarket, ON, Canada
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14
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Tiwari D, Daly C, Alsalaheen B. Home-based circuit training program for an adolescent female with severe traumatic brain injury: A case report. Physiother Theory Pract 2017; 34:137-145. [PMID: 28876156 DOI: 10.1080/09593985.2017.1370750] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Adolescents with traumatic brain injury (TBI) are often discharged from physical therapy (PT) services without transitioning into exertional conditioning programs. Active participation in physical activities with peers at school is essential to achieve a sense of accomplishment and acceptance. Factors such as reduced aerobic fitness and residual gait impairments can lead to limited participation and peer interaction. The purpose of this case report was to describe the impact of home-based circuit training (HBCT) focusing on strength and balance on gait speed (GS), energy expenditure, and functional performance in a 17-year-old female with severe TBI. The participant sustained a TBI from a motor vehicle crash. Although she was ambulatory and independent with the basic activities of daily living following two years of rehabilitation, she presented with activity limitations and participation restrictions at school. The participant performed a 4-week HBCT program developed by a school physical therapist that focused on strength and balance. At the end of 4 weeks, improvements were observed in 6 MWT (change = 79.7 m), GS (change = 0.22 m/s), and the COPM scores (performance score change = 2.8, satisfaction score change = 2.2, MCID = 2). Improvements in functional performance, gait speed, and self-perception of occupational performance were observed following 4-week HBCT. Future clinical trials on short duration, HBCT program for children and young adults with TBI are recommended in order to establish effectiveness of HBCT.
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Affiliation(s)
- Devashish Tiwari
- a Department of Physical Therapy , University of Michigan-Flint , Flint, MI, USA
| | - Carol Daly
- a Department of Physical Therapy , University of Michigan-Flint , Flint, MI, USA
| | - Bara Alsalaheen
- a Department of Physical Therapy , University of Michigan-Flint , Flint, MI, USA
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Dunn A, Marsden DL, Barker D, Van Vliet P, Spratt NJ, Callister R. Cardiorespiratory fitness and walking endurance improvements after 12 months of an individualised home and community-based exercise programme for people after stroke. Brain Inj 2017; 31:1617-1624. [PMID: 28872360 DOI: 10.1080/02699052.2017.1355983] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the immediate and longer-term effects of an individually tailored, home- and community-based exercise programme with ongoing remote support in people with stroke on cardiorespiratory fitness (CRF), ambulation and health-related quality of life (HRQoL). METHODS Twenty people 5.3 ± 3.5 months post stroke completed the 12-week HowFITSS? exercise programme aimed at increasing CRF and daily physical activity. Support was provided by phone and email, which decreased in frequency over time. Participants were assessed at baseline, then at 3, 6 and 12 months after initiation of the intervention. CRF (VO2peak) was evaluated using a portable metabolic system during the 6-minute walk test (6MWT), the Shuttle Walk Test (SWT) and the cycle graded exercise test (cGXT). Walking speed, balance, body composition, fatigue, depression and HRQoL were also measured. RESULTS CRF improved significantly from pre-intervention to 12-month follow-up on the 6MWT (Effect Size, ES = 0.87; p = 0.002) and cGXT (ES = 0.60; p < 0.001), with more modest improvements on the SWT (ES = 0.52; p = 0.251). From baseline to 12 months, significant within-participant improvements were found for self-selected walking speed, balance and HRQoL. Performances on the remaining tests were maintained over the post-intervention period. CONCLUSION There may be health benefits of providing people with stroke an exercise intervention with long-term support that encourages increased regular physical activity.
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Affiliation(s)
- Ashlee Dunn
- a Priority Research Centre for Physical Activity and Nutrition, University of Newcastle , Callaghan , New South Wales , Australia.,d Hunter Medical Research Institute , New Lambton Heights , New South Wales , Australia
| | - Dianne L Marsden
- b Priority Research Centre for Stroke and Brain Injury, University of Newcastle , Callaghan , New South Wales , Australia.,d Hunter Medical Research Institute , New Lambton Heights , New South Wales , Australia.,e Hunter Stroke Service, Hunter New England Local Health District, New Lambton Heights , New Lambton Heights , New South Wales , Australia
| | - Daniel Barker
- c School of Medicine and Population Health , University of Newcastle , Callaghan , New South Wales , Australia
| | - Paulette Van Vliet
- b Priority Research Centre for Stroke and Brain Injury, University of Newcastle , Callaghan , New South Wales , Australia.,d Hunter Medical Research Institute , New Lambton Heights , New South Wales , Australia
| | - Neil J Spratt
- b Priority Research Centre for Stroke and Brain Injury, University of Newcastle , Callaghan , New South Wales , Australia.,d Hunter Medical Research Institute , New Lambton Heights , New South Wales , Australia.,e Hunter Stroke Service, Hunter New England Local Health District, New Lambton Heights , New Lambton Heights , New South Wales , Australia
| | - Robin Callister
- a Priority Research Centre for Physical Activity and Nutrition, University of Newcastle , Callaghan , New South Wales , Australia.,d Hunter Medical Research Institute , New Lambton Heights , New South Wales , Australia
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Abstract
BACKGROUND Treadmill training, with or without body weight support using a harness, is used in rehabilitation and might help to improve walking after stroke. This is an update of the Cochrane review first published in 2003 and updated in 2005 and 2014. OBJECTIVES To determine if treadmill training and body weight support, individually or in combination, improve walking ability, quality of life, activities of daily living, dependency or death, and institutionalisation or death, compared with other physiotherapy gait-training interventions after stroke. The secondary objective was to determine the safety and acceptability of this method of gait training. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched 14 February 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Reviews of Effects (DARE) (the Cochrane Library 2017, Issue 2), MEDLINE (1966 to 14 February 2017), Embase (1980 to 14 February 2017), CINAHL (1982 to 14 February 2017), AMED (1985 to 14 February 2017) and SPORTDiscus (1949 to 14 February 2017). We also handsearched relevant conference proceedings and ongoing trials and research registers, screened reference lists, and contacted trialists to identify further trials. SELECTION CRITERIA Randomised or quasi-randomised controlled and cross-over trials of treadmill training and body weight support, individually or in combination, for the treatment of walking after stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted data, and assessed risk of bias and methodological quality. The primary outcomes investigated were walking speed, endurance, and dependency. MAIN RESULTS We included 56 trials with 3105 participants in this updated review. The average age of the participants was 60 years, and the studies were carried out in both inpatient and outpatient settings. All participants had at least some walking difficulties and many could not walk without assistance. Overall, the use of treadmill training did not increase the chances of walking independently compared with other physiotherapy interventions (risk difference (RD) -0.00, 95% confidence interval (CI) -0.02 to 0.02; 18 trials, 1210 participants; P = 0.94; I² = 0%; low-quality evidence). Overall, the use of treadmill training in walking rehabilitation for people after stroke increased the walking velocity and walking endurance significantly. The pooled mean difference (MD) (random-effects model) for walking velocity was 0.06 m/s (95% CI 0.03 to 0.09; 47 trials, 2323 participants; P < 0.0001; I² = 44%; moderate-quality evidence) and the pooled MD for walking endurance was 14.19 metres (95% CI 2.92 to 25.46; 28 trials, 1680 participants; P = 0.01; I² = 27%; moderate-quality evidence). Overall, the use of treadmill training with body weight support in walking rehabilitation for people after stroke did not increase the walking velocity and walking endurance at the end of scheduled follow-up. The pooled MD (random-effects model) for walking velocity was 0.03 m/s (95% CI -0.05 to 0.10; 12 trials, 954 participants; P = 0.50; I² = 55%; low-quality evidence) and the pooled MD for walking endurance was 21.64 metres (95% CI -4.70 to 47.98; 10 trials, 882 participants; P = 0.11; I² = 47%; low-quality evidence). In 38 studies with a total of 1571 participants who were independent in walking at study onset, the use of treadmill training increased the walking velocity significantly. The pooled MD (random-effects model) for walking velocity was 0.08 m/s (95% CI 0.05 to 0.12; P < 0.00001; I2 = 49%). There were insufficient data to comment on any effects on quality of life or activities of daily living. Adverse events and dropouts did not occur more frequently in people receiving treadmill training and these were not judged to be clinically serious events. AUTHORS' CONCLUSIONS Overall, people after stroke who receive treadmill training, with or without body weight support, are not more likely to improve their ability to walk independently compared with people after stroke not receiving treadmill training, but walking speed and walking endurance may improve slightly in the short term. Specifically, people with stroke who are able to walk (but not people who are dependent in walking at start of treatment) appear to benefit most from this type of intervention with regard to walking speed and walking endurance. This review did not find, however, that improvements in walking speed and endurance may have persisting beneficial effects. Further research should specifically investigate the effects of different frequencies, durations, or intensities (in terms of speed increments and inclination) of treadmill training, as well as the use of handrails, in ambulatory participants, but not in dependent walkers.
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Affiliation(s)
- Jan Mehrholz
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolFetscherstr. 74DresdenGermany01307
| | - Simone Thomas
- Klinik Bavaria KreischaWissenschaftliches InstitutKreischaGermany01731
| | - Bernhard Elsner
- Dresden Medical School, Technical University DresdenDepartment of Public HealthFetscherstr. 74DresdenSachsenGermany01307
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Kim K, Jung SI, Lee DK. Effects of task-oriented circuit training on balance and gait ability in subacute stroke patients: a randomized controlled trial. J Phys Ther Sci 2017. [PMID: 28626306 PMCID: PMC5468221 DOI: 10.1589/jpts.29.989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to investigate the effects of the task-oriented circuit training on balance and gait ability in subacute patients with stroke. [Subjects and Methods] Participants were randomly allocated to two groups: group 1 (subjects who performed task-oriented circuit training) and group 2 (subjects who underwent conventional physical therapy). Berg balance scale, timed up and go test, functional ambulation category, 6-minute walk test were assessed before and after four weeks of training. [Results] There were significant differences between groups for the 6-minute walk test. [Conclusion] The result of this study showed that task-oriented circuit training could improve the gait ability in patients with subacute stroke.
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Affiliation(s)
- Kyoung Kim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| | - Sang In Jung
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| | - Dong Kyu Lee
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
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Abstract
BACKGROUND Circuit class therapy (CCT) offers a supervised group forum for people after stroke to practise tasks, enabling increased practice time without increasing staffing. This is an update of the original review published in 2010. OBJECTIVES To examine the effectiveness and safety of CCT on mobility in adults with stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched January 2017), CENTRAL (the Cochrane Library, Issue 12, 2016), MEDLINE (1950 to January 2017), Embase (1980 to January 2017), CINAHL (1982 to January 2017), and 14 other electronic databases (to January 2017). We also searched proceedings from relevant conferences, reference lists, and unpublished theses; contacted authors of published trials and other experts in the field; and searched relevant clinical trials and research registers. SELECTION CRITERIA Randomised controlled trials (RCTs) including people over 18 years old, diagnosed with stroke of any severity, at any stage, or in any setting, receiving CCT. DATA COLLECTION AND ANALYSIS Review authors independently selected trials for inclusion, assessed risk of bias in all included studies, and extracted data. MAIN RESULTS We included 17 RCTs involving 1297 participants. Participants were stroke survivors living in the community or receiving inpatient rehabilitation. Most could walk 10 metres without assistance. Ten studies (835 participants) measured walking capacity (measuring how far the participant could walk in six minutes) demonstrating that CCT was superior to the comparison intervention (Six-Minute Walk Test: mean difference (MD), fixed-effect, 60.86 m, 95% confidence interval (CI) 44.55 to 77.17, GRADE: moderate). Eight studies (744 participants) measured gait speed, again finding in favour of CCT compared with other interventions (MD 0.15 m/s, 95% CI 0.10 to 0.19, GRADE: moderate). Both of these effects are considered clinically meaningful. We were able to pool other measures to demonstrate the superior effects of CCT for aspects of walking and balance (Timed Up and Go: five studies, 488 participants, MD -3.62 seconds, 95% CI -6.09 to -1.16; Activities of Balance Confidence scale: two studies, 103 participants, MD 7.76, 95% CI 0.66 to 14.87). Two other pooled balance measures failed to demonstrate superior effects (Berg Blance Scale and Step Test). Independent mobility, as measured by the Stroke Impact Scale, Functional Ambulation Classification and the Rivermead Mobility Index, also improved more in CCT interventions compared with others. Length of stay showed a non-significant effect in favour of CCT (two trials, 217 participants, MD -16.35, 95% CI -37.69 to 4.99). Eight trials (815 participants) measured adverse events (falls during therapy): there was a non-significant effect of greater risk of falls in the CCT groups (RD 0.03, 95% CI -0.02 to 0.08, GRADE: very low). Time after stroke did not make a difference to the positive outcomes, nor did the quality or size of the trials. Heterogeneity was generally low; risk of bias was variable across the studies with poor reporting of study conduct in several of the trials. AUTHORS' CONCLUSIONS There is moderate evidence that CCT is effective in improving mobility for people after stroke - they may be able to walk further, faster, with more independence and confidence in their balance. The effects may be greater later after the stroke, and are of clinical significance. Further high-quality research is required, investigating quality of life, participation and cost-benefits, that compares CCT with standard care and that also investigates the influence of factors such as stroke severity and age. The potential risk of increased falls during CCT needs to be monitored.
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Affiliation(s)
- Coralie English
- University of NewcastleSchool of Health Sciences and Priority Research Centre for Stroke and Brain InjuryUniversity DrCallaghanNSWAustralia2308
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research InstituteMelbourne and NewcastleAustralia
| | - Susan L Hillier
- University of South Australia (City East)Sansom Institute for Health ResearchNorth TerraceAdelaideSAAustralia5000
| | - Elizabeth A Lynch
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research InstituteMelbourne and NewcastleAustralia
- The University of AdelaideAdelaide Nursing SchoolAdelaideSouth AustraliaAustralia
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Martins JC, Aguiar LT, Nadeau S, Scianni AA, Teixeira-Salmela LF, Faria CDCDM. Efficacy of Task-Specific Training on Physical Activity Levels of People With Stroke: Protocol for a Randomized Controlled Trial. Phys Ther 2017; 97:640-648. [PMID: 28371936 DOI: 10.1093/physth/pzx032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 03/15/2017] [Indexed: 11/14/2022]
Abstract
BACKGROUND The majority of people after stroke demonstrate mobility limitations, which may reduce their physical activity levels. Task-specific training has been shown to be an effective intervention to improve mobility in individuals with stroke, however, little is known about the impact of this intervention on levels of physical activity. OBJECTIVES The main objective is to investigate the efficacy of task-specific training, focused on both upper and lower limbs, in improving physical activity levels and mobility in individuals with stroke. The secondary objective is to investigate the effects of the training on muscle strength, exercise capacity, and quality of life. DESIGN This is a randomized controlled trial. SETTING The setting is public health centers. PARTICIPANTS Community-dwelling people with chronic stroke. INTERVENTIONS Participants will be randomized to either an experimental or control group, who will receive group interventions 3 times per week over 12 weeks. The experimental group will undertake task-specific training, while the control group will undertake global stretching, memory exercises, and health education sessions. MEASUREMENTS Primary outcomes include measures of physical activity levels and mobility, whereas secondary outcomes are muscle strength, exercise capacity, and quality of life. The outcomes will be measured at baseline, postintervention, and at the 4- and 12-week follow-ups. CONCLUSIONS The findings of this trial have the potential to provide important insights regarding the effects of task-specific training, focused on both upper and lower limbs, in preventing secondary poststroke complications and improving the participants' general health through changes in physical activity levels.
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Affiliation(s)
- Júlia Caetano Martins
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Larissa Tavares Aguiar
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Sylvie Nadeau
- Centre de Recherche Interdisciplinaire en Réadaptation, Institut de Réadaptation Gingras-Lindsay de Montréal, Université de Montreal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Aline Alvim Scianni
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
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Marsden DL, Dunn A, Callister R, McElduff P, Levi CR, Spratt NJ. Interval circuit training for cardiorespiratory fitness is feasible for people after stroke. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2017. [DOI: 10.12968/ijtr.2017.24.5.190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aims: To determine if community-dwelling stroke survivors can achieve exercise intensities sufficient to improve cardiorespiratory fitness during a single session of circuit training using an interval training approach. Methods: Thirteen independently ambulant participants within 1 year of stroke were included in this observational study (females=54%; median age=65.6 years; interquartile range=23.9). Exercise intensities were assessed throughout an individually tailored circuit of up to seven 5-minute workstations from a selection of nine functional (e.g. walking, stairs, balance) and three ergometer (upright cycle, rower, treadmill) workstations. The interval durations ranged from 5–60 seconds. Oxygen consumption (VO2) was recorded continuously using a portable metabolic system. The average VO2 during each 30-second epoch was determined. VO2≥10.5 mL/kg/min was categorised as ≥moderate intensity. Findings: Participants exercised at VO2≥10.5 mL/kg/min for the majority of the time on the workstations [functional: 369/472 epochs (78%), ergometer: 170/204 epochs (83%)]. Most (69%) participants exercised for ≥30 minutes. No serious adverse events occurred. Conclusions: Applying interval training principles to a circuit of functional and ergometer workstations enabled ambulant participants to exercise at an intensity and for a duration that can improve cardiorespiratory fitness. The training approach appears feasible, safe and a promising way to incorporate both cardiorespiratory fitness and functional training into post-stroke management.
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Affiliation(s)
- Dianne L Marsden
- Manager, Professional Education and Development, Hunter Stroke Service, Hunter New England Local Health District; post-doctoral researcher, University of Newcastle, New South Wales, Australia
| | - Ashlee Dunn
- Research assistant/casual academic, University of Newcastle, New South Wales, Australia
| | - Robin Callister
- Professor of Human Physiology, University of Newcastle, New South Wales, Australia
| | - Patrick McElduff
- Professor of Biostatistics, University of Newcastle, New South Wales, Australia
| | - Christopher R Levi
- Director of Clinical Research and Translation, Hunter New England Local Health District, New South Wales, Australia
| | - Neil J Spratt
- Professor, University of Newcastle; senior staff specialist neurologist, Department of Neurology, John Hunter Hospital, New South Wales, Australia
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Straudi S, Martinuzzi C, Baroni A, Benedetti MG, Foti C, Sabbagh Charabati A, Pavarelli C, Basaglia N. Monitoring Step Activity During Task-Oriented Circuit Training in High-Functioning Chronic Stroke Survivors: A Proof-of-Concept Feasibility Study. Ann Rehabil Med 2017; 40:989-997. [PMID: 28119828 PMCID: PMC5256327 DOI: 10.5535/arm.2016.40.6.989] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/25/2016] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To explore the amount of practice and progression during task-oriented circuit training (TOCT) in chronic stroke survivors; to test the use of pedometers and observation-based measures in detecting step activity; to verify the possible correlation between step activity and locomotor function improvements. METHODS Six community-dwelling chronic stroke survivors underwent 10 TOCT sessions (2 hours/each) over 2 weeks in which they were trained both on a treadmill and on six task-oriented workstations (W1-W6). During the sessions, they wore a piezoelectric pedometer and step activities were recorded. Outcome measures were as follows: % of activities during which pedometers worked properly; pedometer-based measures (total step counts, treadmill steps, workstation steps-total and W2,W3,W5,W6); observation-based measures (number of repetitions in task W1 and W4); walking speed changes measured by the 10-m walking test (10MWT) and walking endurance changes (6-minute walking test) after TOCT. RESULTS During TOCT sessions (n=57), activities were recorded through pedometer-based measures in 4 out of the 6 patients. The total amount of step activity was 5,980.05±1,968.39 steps (54.29% in task-oriented workstations, 37.67% on treadmill, and 8.03% during breaks). Exercise progression was highlighted significantly by observational measures (W1, W4). A positive correlation was observed between increased gait speed and observational stair step repetitions progression (W1) (r=0.91, p=0.01) or pedometer-based tandem exercise step progression (W3) (r=0.98, p=0.01). CONCLUSION TOCT can be considered a high-intensity, progressive intervention to restore locomotor function in chronic stroke survivors. Pedometer-based measures might help in quantifying TOCT's volume of practice; however, further investigations are required.
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Affiliation(s)
- Sofia Straudi
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy.; Doctoral Program in Advanced Sciences and Technologies in Rehabilitation Medicine and Sports, University of Rome Tor Vergata, Rome, Italy
| | - Carlotta Martinuzzi
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | - Andrea Baroni
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | | | - Calogero Foti
- Doctoral Program in Advanced Sciences and Technologies in Rehabilitation Medicine and Sports, University of Rome Tor Vergata, Rome, Italy
| | | | - Claudia Pavarelli
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | - Nino Basaglia
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
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Mehdizadeh M, Hassani Mehraban A, Zahediyannasab R. The Effect of Group-Based Occupational Therapy on Performance and Satisfaction of Stroke Survivors: Pilot Trail, Neuro-Occupational View. Basic Clin Neurosci 2017; 8:69-76. [PMID: 28446952 PMCID: PMC5396176 DOI: 10.15412/j.bcn.03080109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Stroke imposes limitations on performing activities of daily living (ADL) and their level. Different therapeutic approaches are used for improving the level of performance after a stroke. This study was performed with the aim of evaluating the effect of group-based occupational therapy on improving the performance of ADL and satisfaction of its performance in patients with chronic strokes. Methods: Fourteen chronic stroke patients with the mean age of 52 years participated in the study. The participants were assigned into two groups (control and treatment). The level of performance of ADL, level of stroke disability, and participation were respectively evaluated by Barthel index (BI), modified Rankin scale (MRS), and Canadian Occupational Performance Measure (COPM). Six sessions of group therapy tasks were scheduled with an emphasis on three main activities, including mobility exercises, craft, and cooking. Results: The COPM changes in the ‘performance’ and ‘satisfaction’ scores in the treatment group and the ‘performance’ scores in the control group were significant. The MRS scale in the two groups revealed no change in the level of stroke disability. However, the changes in the ADL performance in BI were significant. Conclusion: The current study indicated that doing daily, craft, and mobility activities in the groups can affect the ‘performance’ and ‘satisfaction’ levels in stroke patients.
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Affiliation(s)
- Maryam Mehdizadeh
- Department of neuroscience, School of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Afsoon Hassani Mehraban
- Department of Occupational Therapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Roohollah Zahediyannasab
- Department of Occupational Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Salbach NM, OʼBrien KK, Brooks D, Irvin E, Martino R, Takhar P, Chan S, Howe JA. Considerations for the Selection of Time-Limited Walk Tests Poststroke: A Systematic Review of Test Protocols and Measurement Properties. J Neurol Phys Ther 2017; 41:3-17. [PMID: 27977516 DOI: 10.1097/npt.0000000000000159] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE Systematic reviews of research evidence describing the quality and methods for administering standardized outcome measures are essential to developing recommendations for their clinical application. The purpose of this systematic review was to synthesize the research literature describing test protocols and measurement properties of time-limited walk tests in people poststroke. METHODS Following an electronic search of 7 bibliographic data-bases, 2 authors independently screened titles and abstracts. One author identified eligible articles, and performed quality appraisal and data extraction. RESULTS Of 12 180 records identified, 43 articles were included. Among 5 walk tests described, the 6-minute walk test (6MWT) was most frequently evaluated (n = 36). Only 5 articles included participants in the acute phase (<1 month) poststroke. Within tests, protocols varied. Walkway length and walking aid, but not turning direction, influenced 6MWT performance. Intraclass correlation coefficients for reliability were 0.68 to 0.71 (12MWT) and 0.80 to 1.00 (2-, 3-, 5- and 6MWT). Minimal detectable change values at the 90% confidence level were 11.4 m (2MWT), 24.4 m (5MWT), and 27.7 to 52.1 m (6MWT; n = 6). Moderate-to-strong correlations (≥0.5) between 6MWT distance and balance, motor function, walking speed, mobility, and stair capacity were consistently observed (n = 33). Moderate-to-strong correlations between 5MWT performance and walking speed/independence (n = 1), and between 12MWT performance and balance, motor function, and walking speed (n = 1) were reported. DISCUSSION AND CONCLUSIONS Strong evidence of the reliability and construct validity of using the 6MWT poststroke exists; studies in the acute phase are lacking. Because protocol variations influence performance, a standardized 6MWT protocol poststroke for use across the care continuum is needed.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A150).
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Affiliation(s)
- Nancy M Salbach
- Department of Physical Therapy (N.M.S., K.K.O'B., D.B., P.T., J.-A.H.) and Department of Speech-Language Pathology (R.M.), Faculty of Medicine, University of Toronto, Canada; Institute for Work & Health, Toronto, Canada (E.I.); Allied Health Program, Toronto Western Hospital, University Health Network, Canada (S.C.); and Toronto Rehabilitation Institute, University Health Network, Canada (N.M.S., D.B., J.-A.H.)
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Hendrey G, Williams G, Clark R, Holland AE. An observational study on usual physiotherapy care in a stroke rehabilitation unit. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2016. [DOI: 10.12968/ijtr.2016.23.sup11.s549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Genevieve Hendrey
- Senior physiotherapist, Caulfield Hospital and LaTrobe University, Melbourne, Australia
| | - Gavin Williams
- Specialist neurological physiotherapist and research fellow, Epworth Hospital, Australia
| | - Ross Clark
- School of Health and Sports Science, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Anne E Holland
- Clinical chair, physiotherapy, La Trobe University and Alfred Health, Melbourne, Australia
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Effects of mirror therapy integrated with task-oriented exercise on the balance function of patients with poststroke hemiparesis: a randomized-controlled pilot trial. Int J Rehabil Res 2016; 39:70-6. [PMID: 26658524 DOI: 10.1097/mrr.0000000000000148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study aimed to explore the effects of mirror therapy integrated with task-oriented exercise on balance function in poststroke hemiparesis. Twenty patients with poststroke hemiparesis were assigned randomly to an experimental group (EG) and a control group (CG), with 10 individuals each. Participants of the EG and CG received a task-oriented exercise program with a focus on the strengthening of the lower limb and the practice of balance-related functional tasks. An additional option for the EG was front and side wall mirrors to provide visual feedback for their own movements while performing the exercise. The program was performed for 30 min, twice a day, five times per week for 4 weeks. Outcome measures included the Berg balance scale, the timed up-and-go test, and quantitative data (balance index and dynamic limits of stability). In the EG and CG, all variables showed significant differences between pretest and post-test (P<0.05), and post-test values of all variables appeared to be significantly different between two groups (P<0.05). Furthermore, in the EG, the change values between pretest and post-test values of Berg balance scale (13.00±3.20 vs. 6.60±4.55 scores), and timed up-and-go test (6.45±3.00 vs. 3.61±1.84 s), balance index (2.29±0.51 vs. 0.96±0.65 scores), dynamic limits of stability (7.70±3.83 vs. 3.70±4.60 scores) were significantly higher than those of the CG (P<0.05). The findings suggest that a mirror therapy may be used as a beneficial therapeutic option to facilitate the effects of a task-oriented exercise on balance function of patients with poststroke hemiparesis.
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Bustamante Valles K, Montes S, Madrigal MDJ, Burciaga A, Martínez ME, Johnson MJ. Technology-assisted stroke rehabilitation in Mexico: a pilot randomized trial comparing traditional therapy to circuit training in a Robot/technology-assisted therapy gym. J Neuroeng Rehabil 2016; 13:83. [PMID: 27634471 PMCID: PMC5025604 DOI: 10.1186/s12984-016-0190-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 08/26/2016] [Indexed: 11/30/2022] Open
Abstract
Background Stroke rehabilitation in low- and middle-income countries, such as Mexico, is often hampered by lack of clinical resources and funding. To provide a cost-effective solution for comprehensive post-stroke rehabilitation that can alleviate the need for one-on-one physical or occupational therapy, in lower and upper extremities, we proposed and implemented a technology-assisted rehabilitation gymnasium in Chihuahua, Mexico. The Gymnasium for Robotic Rehabilitation (Robot Gym) consisted of low- and high-tech systems for upper and lower limb rehabilitation. Our hypothesis is that the Robot Gym can provide a cost- and labor-efficient alternative for post-stroke rehabilitation, while being more or as effective as traditional physical and occupational therapy approaches. Methods A typical group of stroke patients was randomly allocated to an intervention (n = 10) or a control group (n = 10). The intervention group received rehabilitation using the devices in the Robot Gym, whereas the control group (n = 10) received time-matched standard care. All of the study subjects were subjected to 24 two-hour therapy sessions over a period of 6 to 8 weeks. Several clinical assessments tests for upper and lower extremities were used to evaluate motor function pre- and post-intervention. A cost analysis was done to compare the cost effectiveness for both therapies. Results No significant differences were observed when comparing the results of the pre-intervention Mini-mental, Brunnstrom Test, and Geriatric Depression Scale Test, showing that both groups were functionally similar prior to the intervention. Although, both training groups were functionally equivalent, they had a significant age difference. The results of all of the upper extremity tests showed an improvement in function in both groups with no statistically significant differences between the groups. The Fugl-Meyer and the 10 Meters Walk lower extremity tests showed greater improvement in the intervention group compared to the control group. On the Time Up and Go Test, no statistically significant differences were observed pre- and post-intervention when comparing the control and the intervention groups. For the 6 Minute Walk Test, both groups presented a statistically significant difference pre- and post-intervention, showing progress in their performance. The robot gym therapy was more cost-effective than the traditional one-to-one therapy used during this study in that it enabled therapist to train up to 1.5 to 6 times more patients for the approximately same cost in the long term. Conclusions The results of this study showed that the patients that received therapy using the Robot Gym had enhanced functionality in the upper extremity tests similar to patients in the control group. In the lower extremity tests, the intervention patients showed more improvement than those subjected to traditional therapy. These results support that the Robot Gym can be as effective as traditional therapy for stroke patients, presenting a more cost- and labor-efficient option for countries with scarce clinical resources and funding. Trial registration ISRCTN98578807.
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Affiliation(s)
- Karla Bustamante Valles
- Orthopaedic and Rehabilitation Engineering Center (OREC), Marquette University, Milwaukee, WI, USA.,Biomedical Engineering, ITESM, Campus Chihuahua, Chihuahua, Chihuahua, Mexico
| | - Sandra Montes
- Biomedical Engineering, ITESM, Campus Chihuahua, Chihuahua, Chihuahua, Mexico
| | | | - Adan Burciaga
- Centro de Rehabilitacion y Educacion Especial, DIF, Chihuahua, Chihuahua, Mexico
| | | | - Michelle J Johnson
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA, USA. .,Department of Biomedical Engineering, University of Pennsylvania, Philadelphia, PA, USA. .,Orthopaedic and Rehabilitation Engineering Center (OREC), Marquette University, Milwaukee, WI, USA.
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Marsden DL, Dunn A, Callister R, McElduff P, Levi CR, Spratt NJ. A Home- and Community-Based Physical Activity Program Can Improve the Cardiorespiratory Fitness and Walking Capacity of Stroke Survivors. J Stroke Cerebrovasc Dis 2016; 25:2386-98. [PMID: 27378733 DOI: 10.1016/j.jstrokecerebrovasdis.2016.06.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/23/2016] [Accepted: 06/03/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The cardiorespiratory fitness of stroke survivors is low. Center-based exercise programs that include an aerobic component have been shown to improve poststroke cardiorespiratory fitness. This pilot study aims to determine the feasibility, safety, and preliminary efficacy of an individually tailored home- and community-based exercise program to improve cardiorespiratory fitness and walking capacity in stroke survivors. METHODS Independently ambulant, community-dwelling stroke survivors were recruited. The control (n = 10) and intervention (n = 10) groups both received usual care. In addition the intervention group undertook a 12-week, individually tailored, home- and community-based exercise program, including once-weekly telephone or e-mail support. Assessments were conducted at baseline and at 12 weeks. Feasibility was determined by retention and program participation, and safety by adverse events. Efficacy measures included change in cardiorespiratory fitness (peak oxygen consumption [VO2peak]) and distance walked during the Six-Minute Walk Test (6MWT). Analysis of covariance was used for data analysis. RESULTS All participants completed the study with no adverse events. All intervention participants reported undertaking their prescribed program. VO2peak improved more in the intervention group (1.17 ± .29 L/min to 1.35 ± .33 L/min) than the control group (1.24 ± .23 L/min to 1.24 ± .33 L/min, between-group difference = .18 L/min, 95% confidence interval [CI]: .01-.36). Distance walked improved more in the intervention group (427 ± 123 m to 494 ± 67m) compared to the control group (456 ± 101m to 470 ± 106m, between-group difference = 45 m, 95% CI: .3-90). CONCLUSIONS Our individually tailored approach with once-weekly telephone or e-mail support was feasible and effective in selected stroke survivors. The 16% greater improvement in VO2peak during the 6MWT achieved in the intervention versus control group is comparable to improvements attained in supervised, center-based programs.
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Affiliation(s)
- Dianne Lesley Marsden
- School of Medicine and Public Health and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, New South Wales, Australia; Hunter Stroke Service, Hunter New England Local Health District, New Lambton Heights, New South Wales, Australia; Brain and Mental Health Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.
| | - Ashlee Dunn
- School of Biomedical Sciences and Pharmacy and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, New South Wales, Australia; Cardiovascular Research, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Robin Callister
- School of Biomedical Sciences and Pharmacy and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, New South Wales, Australia; Cardiovascular Research, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Patrick McElduff
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Christopher Royce Levi
- Brain and Mental Health Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia; Clinical Research & Translation and Neurology Department at John Hunter Hospital, Hunter New England Local Health District, New Lambton Heights, New South Wales, Australia; Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, New South Wales, Australia
| | - Neil James Spratt
- Brain and Mental Health Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia; School of Biomedical Sciences and Pharmacy and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, New South Wales, Australia; Neurology Department at John Hunter Hospital, Hunter New England Local Health District, New Lambton Heights, New South Wales, Australia
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Kim B, Park Y, Seo Y, Park S, Cho H, Moon H, Lee H, Kim M, Yu J. Effects of individualized versus group task-oriented circuit training on balance ability and gait endurance in chronic stroke inpatients. J Phys Ther Sci 2016; 28:1872-5. [PMID: 27390437 PMCID: PMC4932078 DOI: 10.1589/jpts.28.1872] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/12/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to analyze the effects of task-oriented circuit training on the balance ability and gait endurance of chronic stroke inpatients. [Subjects and Methods] The participants were 30 patients who had stroke >6 months previously, resulting in a disability such as hemiparesis. The participants were randomly divided into the group task-oriented circuit training group and the individual task-oriented circuit-training group. They performed eight types of modified task-oriented training. Balance ability and gait endurance were measured by using the Berg balance scale questionnaire and the 6-min walk test, respectively, before and after the experiment. [Results] Significant differences were observed between before and after the intervention in all variables. There was a significant difference between groups in Berg balance scale scores; however, no significant differences were seen in the timed up and go test and the 6-min walk test. [Conclusion] The results of this study indicated that group exercise can better improve the balance ability of chronic stroke inpatients after stroke than can individualized exercise intervention.
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Affiliation(s)
- Bonggil Kim
- Department of Global Sports Studies, Korea University, Republic of Korea
| | - Yunjin Park
- Department of Global Sports Studies, Korea University, Republic of Korea
| | - Yonggon Seo
- Department of Global Sports Studies, Korea University, Republic of Korea
| | - Sangseo Park
- Department of Global Sports Studies, Korea University, Republic of Korea
| | - Hyeyoung Cho
- Department of Global Sports Studies, Korea University, Republic of Korea
| | - Hyunghoon Moon
- Department of Global Sports Studies, Korea University, Republic of Korea
| | - Haelim Lee
- Department of Global Sports Studies, Korea University, Republic of Korea
| | - Myungki Kim
- Department of Global Sports Studies, Korea University, Republic of Korea
| | - Jaeho Yu
- Department of Physical Therapy, Sunmoon University, Republic of Korea
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Raymond MJ, Burge AT, Soh SE, Jeffs KJ, Winter A, Holland AE. Experiences of older adults in a group physiotherapy program at a rehabilitation hospital: A qualitative study. J Hosp Med 2016; 11:358-62. [PMID: 26821260 DOI: 10.1002/jhm.2550] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/30/2015] [Accepted: 12/18/2015] [Indexed: 11/07/2022]
Abstract
Physiotherapy delivered in a group setting has been shown to be effective in a variety of populations. However, little is known about the attitudes of older adults toward participating in group physiotherapy. The objectives of this study were to explore older inpatients' perceptions and experiences of group physiotherapy using qualitative methods. Twelve hospitalized adults aged ≥65 years who were involved in a larger randomized controlled trial undertook individual semistructured interviews regarding their experiences in group physiotherapy. Interviews were transcribed verbatim, and line by line, iterative thematic analysis was undertaken. Descriptive codes were developed, compared, and grouped together to create themes. Analysis revealed 6 major themes and 10 subthemes. All participants reported feeling happy to attend group sessions, a satisfactory alternative to individual physiotherapy. Participants described physical benefits that increased their motivation, and comparisons with their peers either motivated them or made them feel gratitude for their own health. Perceived attentiveness of group instructors contributed to participants reporting that treatment was individualized and similar to individual physiotherapy. Motivation and camaraderie with peers contributed to their enjoyment of group physiotherapy. Hospitalized older adults enjoyed exercising with their peers and valued the physical and social benefits of group physiotherapy. Journal of Hospital Medicine 2016;11:358-362. © 2016 Society of Hospital Medicine.
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Affiliation(s)
- Melissa J Raymond
- Physiotherapy Department, Caulfield Hospital, Alfred Health, Melbourne, Victoria, Australia
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Angela T Burge
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
- Physiotherapy Department, The Alfred, Alfred Health, Melbourne, Victoria, Australia
| | - Sze-Ee Soh
- Physiotherapy Department, Caulfield Hospital, Alfred Health, Melbourne, Victoria, Australia
- Physiotherapy Department and Health Services Research Unit, Monash University, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | | | - Adele Winter
- Physiotherapy Department, Caulfield Hospital, Alfred Health, Melbourne, Victoria, Australia
| | - Anne E Holland
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
- Physiotherapy Department, The Alfred, Alfred Health, Melbourne, Victoria, Australia
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Kim SM, Han EY, Kim BR, Hyun CW. Clinical application of circuit training for subacute stroke patients: a preliminary study. J Phys Ther Sci 2016; 28:169-74. [PMID: 26957751 PMCID: PMC4755997 DOI: 10.1589/jpts.28.169] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 10/14/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To investigate how task-oriented circuit training for the recovery motor control of the lower-extremity, balance and walking endurance could be clinically applied to subacute stroke inpatient group therapy. [Subjects and Methods] Twenty subacute stroke patients were randomly assigned to the intervention group (n=10) or the control group (n=10). The intervention consisted of a structured, progressive, inpatient circuit training program focused on mobility and gait training as well as physical fitness training that was performed for 90 minutes, 5 days a week for 4 weeks. The control group received individual physiotherapy of neurodevelopmental treatment for 60 minutes, 5 days a week for 4 weeks. Outcome measures were lower-extremity motor control, balance, gait endurance and activities of daily living before and after 4 weeks. [Results] There were no significant differences at baseline between the two groups. After 4 weeks, both groups showed significant improvements in all outcome measures, but there were no significant differences between the two groups during the invention period. [Conclusion] In spite of the small sample size, these findings suggest that task-oriented circuit training might be used as a cost-effective and alternative method of individual physiotherapy for the motor recovery of lower-extremity, balance and walking endurance of subacute stroke patients.
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Affiliation(s)
- Sun Mi Kim
- Department of Rehabilitation Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Republic of Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Republic of Korea
| | - Bo Ryun Kim
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Republic of Korea
| | - Chul Woong Hyun
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Republic of Korea
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Bennett L, Luker J, English C, Hillier S. Stroke survivors' perspectives on two novel models of inpatient rehabilitation: seven-day a week individual therapy or five-day a week circuit class therapy. Disabil Rehabil 2015; 38:1397-406. [PMID: 26600073 DOI: 10.3109/09638288.2015.1103788] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To explore stroke survivors' perspectives of two novel models of inpatient physiotherapy, which provide an increased amount of therapy: five days a week circuit class therapy and seven days a week individual therapy. METHOD This is a qualitative descriptive study using semi-structured interviews and thematic analysis. The participants were 10 purposively sampled stroke survivors in the post-acute phase of recovery, who had experienced seven days a week individual therapy or five days a week circuit group therapy during inpatient rehabilitation. RESULTS Three main themes emerged from the data: Too much, too little or just right; My experience - alone and together; and Meeting my needs. Findings revealed considerable variety in participants' beliefs, priorities and preferences regarding how intensely they could work; their experience of success and challenge individually and collectively; and their need to have their own unique individual needs met. Lack of choice seemed to be a linking concept between the themes. CONCLUSION In order to provide patient-centred services, novel methods of increased therapy must take into consideration the individual needs and preferences of the people accessing them. One model may not meet all these needs, hence a "menu" of options for therapy sessions (different timing, frequency, duration, content, rest and supervision) may be required to accommodate the diversity of patient needs, preferences and capacities. Implications for Rehabilitation People with stroke have diverse needs and preferences regarding the modes of delivering more therapy during rehabilitation. These diverse needs may not be met by one rigid service model. Therapists and service providers could engage their clients in a dialogue about the need for more therapy and how it can be delivered. This dialogue could include options of the various ways to increase their therapy. Therapists need to provide clear reasons and education around therapy components, including rest time and practice schedules.
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Affiliation(s)
- Leanne Bennett
- a International Centre for Allied Health Evidence, School of Health Sciences , University of South Australia , Adelaide , Australia
| | - Julie Luker
- a International Centre for Allied Health Evidence, School of Health Sciences , University of South Australia , Adelaide , Australia
| | - Coralie English
- a International Centre for Allied Health Evidence, School of Health Sciences , University of South Australia , Adelaide , Australia
| | - Susan Hillier
- a International Centre for Allied Health Evidence, School of Health Sciences , University of South Australia , Adelaide , Australia
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Effects of Functional Limb Overloading on Symmetrical Weight Bearing, Walking Speed, Perceived Mobility, and Community Participation among Patients with Chronic Stroke. Rehabil Res Pract 2015; 2015:241519. [PMID: 26600952 PMCID: PMC4639661 DOI: 10.1155/2015/241519] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 09/03/2015] [Accepted: 09/30/2015] [Indexed: 01/19/2023] Open
Abstract
Background. Stroke is a leading cause for long-term disability that often compromises the sensorimotor and gait function accompanied by spasticity. Gait abnormalities persist through the chronic stages of the condition and only a small percentage of these persons are able to walk functionally in the community. Material and Method. Patients with chronic stroke were recruited from outpatient rehabilitation unit at Department of Neurology & Neurosurgery, All India Institute of Medical Sciences, having a history of first stroke at least six months before recruitment, with unilateral motor deficits affecting gait. The patients were randomly assigned to either the functional limb overloading (FLO) or Limb Overloading Resistance Training (LORT) group and provided four weeks of training. Result. We found that there was an improvement in gait performance, weight bearing on affected limb, and perceived mobility and community participation. Conclusion. To the best of our knowledge, this is the first study that has evaluated the effects of functional limb overloading training on symmetric weight bearing, walking ability, and perceived mobility and participation in chronic hemiplegic population. The study demonstrated a beneficial effect of training on all the outcomes, suggesting that the functional limb overloading training can be a useful tool in the management of gait problems in chronic stroke patients.
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Renner CI, Outermans J, Ludwig R, Brendel C, Kwakkel G, Hummelsheim H. Group therapy task training versus individual task training during inpatient stroke rehabilitation: a randomised controlled trial. Clin Rehabil 2015; 30:637-48. [PMID: 26316552 DOI: 10.1177/0269215515600206] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 07/18/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the efficacy of intensive daily applied progressive group therapy task training with equally dosed individual progressive task training on self-reported mobility for patients with moderate to severe stroke during inpatient rehabilitation. DESIGN Randomized controlled clinical trial. SETTING In-patient rehabilitation center. SUBJECTS A total of 73 subacute patients with stroke who were not able to walk without physical assistance at randomisation. INTERVENTIONS Patients were allocated to group therapy task training (GT) or individual task training (IT). Both interventions were intended to improve walking competency and comprised 30 sessions of 90 minutes over six weeks. MAIN MEASURES Primary outcome was the mobility domain of the Stroke Impact Scale (SIS-3.0). Secondary outcomes were the other domains of SIS-3.0, standing balance, gait speed, walking distance, stair climbing, fatigue, anxiety and depression. RESULTS No adverse events were reported in either arm of the trial. There were no significant differences between groups for the SIS mobility domain at the end of the intervention (Z= -0.26, P = 0.79). No significant differences between groups were found in gait speed improvements (GT:0.38 ±0.23; IT:0.26±0.35), any other gait related parameters, or in non-physical outcomes such as depression and fatigue. CONCLUSION Inpatient group therapy task training for patients with moderate to severe stroke is safe and equally effective as a dose-matched individual task training therapy. Group therapy task training may be delivered as an alternative to individual therapy or as valuable adjunct to increase time spent in gait-related activities.
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Affiliation(s)
| | - Jacqueline Outermans
- Researchgroup Lifestyle and Health, Hogeschool Utrecht,University of Applied Sciences, Utrecht, Netherlands
| | - Ricarda Ludwig
- NRZ Neurological Rehabilitation Center, University of Leipzig, Germany
| | | | - Gert Kwakkel
- Department of Rehabilitation Medicine, MOVE Research Institute, VU University Medical Centre, Amsterdam, Netherlands Amsterdam Rehabilitation Research Center, Reade Centre for Rehabilitation and Rheumatology, Amsterdam, Netherlands
| | - Horst Hummelsheim
- NRZ Neurological Rehabilitation Center, University of Leipzig, Germany
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Fay G, Cunningham C. Awareness and management of osteoporosis among General Practitioners in Ireland. ACTA ACUST UNITED AC 2015. [DOI: 10.3233/ppr-150057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lawal IU, Hillier SL, Hamzat TK, Rhoda A. Effectiveness of a structured circuit class therapy model in stroke rehabilitation: a protocol for a randomised controlled trial. BMC Neurol 2015; 15:88. [PMID: 26055635 PMCID: PMC4460628 DOI: 10.1186/s12883-015-0348-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 05/29/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Currently, the key advocacy in neuroscientific studies for stroke rehabilitation is that therapy should be directed towards task specificity performed with multiple repetitions. Circuit Class Therapy (CCT) is well suited to accomplish multiple task-specific activities. However, while repetitive task practice is achievable with circuit class therapy, in stroke survivors repetitive activities may be affected by poor neurologic inputs to motor units, resulting in decreases in discharging rates which consequently may reduce the efficiency of muscular contraction. To accomplish multiple repetitions, stroke survivors may require augmented duration of practice. To date, no study has examined the effect of augmented duration of CCT in stroke rehabilitation, and specifically what duration of CCT is more effective in influencing functional capacity among stroke survivors. METHODS/DESIGN Using a randomised controlled trial with blinded outcome assessment, this study is aimed at determining the effectiveness of structured augmented CCT in stroke rehabilitation. Sixty-eight stroke survivors (to be recruited from a tertiary health institution in Kano, Northwest, Nigeria) will be randomised into one of four groups: three intervention groups of differing CCT durations namely: 60 min, 90 min, and 120 minuntes respectively, and a control group. Participants will take part in an 8-week structured intensive CCT intervention. Participants will be assessed at baseline, post-intervention, and six-month follow-up for the effectiveness of the varied durations of therapy, using standardised tools. Based on the WHO-ICF model, the outcomes are body structure/function, activity limitation, and participation restriction measures. DISCUSSION It is expected that the outcome of this study will clarify whether increasing CCT duration leads to better recovery of motor function in stroke survivors. TRIAL REGISTRATION Pan African Clinical Trial Registry (PACTR): PACTR201311000701191.
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Affiliation(s)
- Isa U Lawal
- Department of Physiotherapy, Faculty Community and Health Sciences, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa.
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Private Mail Bag 3011, Nigeria.
| | - Susan L Hillier
- International Centre for Allied Health Evidence, School of Health Sciences, University of South Australia (City East), Adelaide, 5000, Australia.
| | - Talhatu K Hamzat
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine University of Ibadan, Queen Elizabeth Road, Private Mail Bag 5017, GPO Dugbe, Ibadan, Nigeria.
| | - Anthea Rhoda
- Department of Physiotherapy, Faculty Community and Health Sciences, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa.
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English C, Bernhardt J, Crotty M, Esterman A, Segal L, Hillier S. Circuit class therapy or seven-day week therapy for increasing rehabilitation intensity of therapy after stroke (CIRCIT): a randomized controlled trial. Int J Stroke 2015; 10:594-602. [PMID: 25790018 DOI: 10.1111/ijs.12470] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/06/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Increased therapy has been linked to improvements in functional ability of people with stroke. AIM To determine the effectiveness of two alternative models of increased physiotherapy service delivery (seven-day week therapy or group circuit class therapy five days a week) to usual care. METHOD Three-armed randomized controlled trial with blinded assessment of outcome. People admitted with a diagnosis of stroke, previously independently ambulant and with a moderate level of disability were recruited. 'Usual care' was individual physiotherapy provided five-days a week. Seven-day week therapy was usual care physiotherapy provided seven-days a week. Participants in the circuit class therapy arm of the trial received physiotherapy in group circuit classes in two 90-min sessions, five-days a week. Primary outcome was distance walked on the six-minute walk test at four-weeks post-randomization. RESULTS Two hundred eighty-three participants were randomized; primary outcome data were available for 259 (92%). In the seven-day arm participants received an additional three hours of physiotherapy and those in the circuit class arm an additional 22 h. There were no significant between-group differences at four-weeks in walking distance (P = 0.72). Length of stay was shorter for seven-day (mean difference -2.9 days, 95% confidence interval -17.9 to 12.0) and circuit class participants (mean difference -9.2 days, 95% confidence interval -24.2 to 5.8) compared to usual care, but this was not significant. CONCLUSIONS Both seven-day therapy and group circuit class therapy increased physiotherapy time, but walking outcomes were equivalent to usual care.
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Affiliation(s)
- Coralie English
- International Centre for Allied Health Evidence, Sansom Institute of Health Research, University of South Australia, Adelaide, SA, Australia.,Stroke Division, Florey Institute of Neuroscience and Mental Health, Austin Campus, Heidelberg, Vic., Australia
| | - Julie Bernhardt
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Austin Campus, Heidelberg, Vic., Australia
| | - Maria Crotty
- Department of Rehabilitation and Aged Care, Flinders University, Bedford Park, SA, Australia
| | - Adrian Esterman
- Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Leonie Segal
- Health Economics and Social Policy Group, Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Susan Hillier
- International Centre for Allied Health Evidence, Sansom Institute of Health Research, University of South Australia, Adelaide, SA, Australia
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Bambirra C, Rodrigues MCDB, Faria CDCDM, Paula FRD. Clinical evaluation of balance in hemiparetic adults: a systematic review. FISIOTERAPIA EM MOVIMENTO 2015. [DOI: 10.1590/0103-5150.028.001.ar03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Hemiparesis is a common post-stroke impairment often associated with balance deficits. Standardized instruments for balance assessment may be useful in identifying individuals at risk of falling and evaluating intervention outcomes. Objectives To identify instruments with adequate psychometric properties and clinical application to assess balance in hemiparetic cases within the scope of physiotherapy and to verify tools most frequently used in studies that evaluated the effects of therapeutic interventions in order to improve the balance of hemiparetic patients. Methods A search was conducted in the Medline, Lilacs, PEDro, and Web of Science databases by two independent researchers, who selected and analyzed studies that evaluated the reliability and validity of balance assessment instruments and intervention results. Results and discussion The Berg Balance Scale was the most frequently used instrument in the intervention studies. Nine single-task tests (timed up and go, functional reach test, step test, four-square step test, side step test, supported standing balance, standing arm raise, static tandem standing, and weight shifting) and six multiple-task tests (Berg balance scale, Brunel balance assessment, Fugl-Meyer Assessment/balance section, mini balance evaluation systems test, and postural assessment scale for stroke patients) demonstrated adequate psychometric properties and clinical applications to assess balance in hemiparetic individuals. Conclusions The Berg Balance Scale had the most widely studied psychometric properties and was the most frequently used scale in the intervention studies. Further studies are required to validate and adapt other instruments for the Brazilian population.
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Tao J, Rao T, Lin L, Liu W, Wu Z, Zheng G, Su Y, Huang J, Lin Z, Wu J, Fang Y, Chen L. Evaluation of Tai Chi Yunshou exercises on community-based stroke patients with balance dysfunction: a study protocol of a cluster randomized controlled trial. Altern Ther Health Med 2015; 15:31. [PMID: 25888114 PMCID: PMC4359558 DOI: 10.1186/s12906-015-0555-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 02/17/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Balance dysfunction after stroke limits patients' general function and participation in daily life. Previous researches have suggested that Tai Chi exercise could offer a positive improvement in older individuals' balance function and reduce the risk of falls. But convincing evidence for the effectiveness of enhancing balance function after stroke with Tai Chi exercise is still inadequate. Considering the difficulties for stroke patients to complete the whole exercise, the current trial evaluates the benefit of Tai Chi Yunshou exercise for patients with balance dysfunction after stroke through a cluster randomization, parallel-controlled design. METHODS/DESIGN A single-blind, cluster-randomized, parallel-controlled trial will be conducted. A total of 10 community health centers (5 per arm) will be selected and randomly allocated into Tai Chi Yunshou exercise group or balance rehabilitation training group. Each community health centers will be asked to enroll 25 eligible patients into the trial. 60 minutes per each session, 1 session per day, 5 times per week and the total training round is 12 weeks. Primary and secondary outcomes will be measured at baseline and 4-weeks, 8-weeks, 12-weeks, 6-week follow-up, 12-week follow-up after randomization. Safety and economic evaluation will also be assessed. DISCUSSION This protocol aims to evaluate the effectiveness of Tai Chi Yunshou exercise for the balance function of patients after stroke. If the outcome is positive, this project will provide an appropriate and economic balance rehabilitation technology for community-based stroke patients. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR-TRC-13003641. Registration date: 22 August, 2013 http://www.chictr.org/usercenter/project/listbycreater.aspx .
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Song HS, Kim JY, Park SD. Effect of the class and individual applications of task-oriented circuit training on gait ability in patients with chronic stroke. J Phys Ther Sci 2015; 27:187-9. [PMID: 25642070 PMCID: PMC4305558 DOI: 10.1589/jpts.27.187] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 08/03/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to determine differences in gait abilities by comparing
class-based task-oriented circuit training (CTCT) and individual-based task-oriented
circuit training (ITCT). [Subjects and Methods] The subjects were 30 patients who were
diagnosed with hemiplegia due to stroke more than six months previously. They were divided
into Group I (n=10), which received conventional physiotherapy, Group II (n=10), which
received conventional physiotherapy and ITCT, and Group III (n=10), which received
conventional physiotherapy and CTCT. To determine the qualitative aspect of gait ability,
a GAITRite (CIR Systems Inc., Sparta NJ, USA) was employed, while a two-minute walking
test (2MWT) was conducted to determine the quantitative aspect. [Results] The gait ability
showed significant differences in velocity, cadence, and 2MWT between groups in the
significance test. As a result, the Bonferroni post test showed that gait velocity was
significantly different between Groups I and II and between Groups I and III, while
cadence showed a significant difference between Groups I and III. In the 2MWT, Groups I
and II and Groups I and III also showed significant differences. [Conclusion] Both the
individual and class applications task-oriented circuit training were effective for
improving gait ability. This result indicates that CTCT can improve the physical ability
of stroke patients as much as ITCT.
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Affiliation(s)
- Hyun Seung Song
- Graduate School of Physical Therapy, Daejeon University, Republic of Korea
| | - Jin Young Kim
- Department of Occupational Therapy, Howon University, Republic of Korea
| | - Seong Doo Park
- Graduate School of Physical Therapy, Daejeon University, Republic of Korea
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Tole G, Williams G, Clark R, Holland AE, Jackson J. An observational study on usual physiotherapy care in a stroke rehabilitation unit for patients with mobility deficits. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2014. [DOI: 10.12968/ijtr.2014.21.12.585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Genevieve Tole
- Senior physiotherapist, Caulfield Hospital and La Trobe University, Melbourne, Australia
| | - Gavin Williams
- Specialist neurological physiotherapist and research fellow, Epworth Hospital, Australia
| | - Ross Clark
- Lecturer, school of exercise science, australian catholic university, melbourne, australia
| | - Anne E Holland
- clinical chair, physiotherapy, La Trobe University and Alfred Health, Melbourne, Australia
| | - Joanna Jackson
- Professor, Dean of Health, University of Essex, Colchester, UK
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Miani C, Ball S, Pitchforth E, Exley J, King S, Roland M, Fuld J, Nolte E. Organisational interventions to reduce length of stay in hospital: a rapid evidence assessment. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02520] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundAvailable evidence on effective interventions to reduce length of stay in hospital is wide-ranging and complex, with underlying factors including those acting at the health system, organisational and patient levels, and the interface between these. There is a need to better understand the diverse literature on reducing the length of hospital stay.ObjectivesThis study sought to (i) describe the nature of interventions that have been used to reduce length of stay in acute care hospitals; (ii) identify the factors that are known to influence length of stay; and (iii) assess the impact of interventions on patient outcomes, service outcomes and costs.Data sourcesWe searched MEDLINE (Ovid), EMBASE, the Health Management Information Consortium and System for Information on Grey Literature in Europe for the period January 1995 to January 2013 with no limitation of publication type.MethodsWe conducted a rapid evidence synthesis of the peer-reviewed literature on organisational interventions set in or initiated from acute hospitals. We considered evidence published between 2003 and 2013. Data were analysed drawing on the principles of narrative synthesis. We also carried out interviews with eight NHS managers and clinical leads in four sites in England.ResultsA total of 53 studies met our inclusion criteria, including 19 systematic reviews and 34 primary studies. Although the overall evidence base was varied and frequently lacked a robust study design, we identified a range of interventions that showed potential to reduce length of stay. These were multidisciplinary team working, for example some forms of organised stroke care; improved discharge planning; early supported discharge programmes; and care pathways. Nursing-led inpatient units were associated with improved outcomes but, if anything, increased length of stay. Factors influencing the impact of interventions on length of stay included contextual factors and the population targeted. The evidence was mixed with regard to the extent to which interventions seeking to reduce length of stay were associated with cost savings.LimitationsWe only considered assessments of interventions which provided a quantitative estimate of the impact of the given organisational intervention on length of hospital stay. There was a general lack of robust evidence and poor reporting, weakening the conclusions that can be drawn from the review.ConclusionsThe design and implementation of an intervention seeking to reduce (directly or indirectly) the length of stay in hospital should be informed by local context and needs. This involves understanding how the intervention is seeking to change processes and behaviours that are anticipated, based on the available evidence, to achieve desired outcomes (‘theory of change’). It will also involve assessing the organisational structures and processes that will need to be put in place to ensure that staff who are expected to deliver the intervention are appropriately prepared and supported. With regard to future research, greater attention should be given to the theoretical underpinning of the design, implementation and evaluation of interventions or programmes. There is a need for further research using appropriate methodology to assess the effectiveness of different types of interventions in different settings. Different evaluation approaches may be useful, and closer relationships between researchers and NHS organisations would enable more formative evaluation. Full economic costing should be undertaken where possible, including considering the cost implications for the wider local health economy.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
| | | | | | | | | | - Martin Roland
- Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Ellen Nolte
- European Observatory on Health Systems and Policies, London School of Economics and Political Science and the London School of Hygiene & Tropical Medicine, London, UK
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Outcomes With Individual Versus Group Physical Therapy for Treating Urinary Incontinence and Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Arch Phys Med Rehabil 2014; 95:2187-98. [DOI: 10.1016/j.apmr.2014.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/03/2014] [Accepted: 07/06/2014] [Indexed: 11/21/2022]
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Sabari JS, Woodbury M, Velozo CA. Rasch analysis of a new hierarchical scoring system for evaluating hand function on the motor assessment scale for stroke. Stroke Res Treat 2014; 2014:730298. [PMID: 25177513 PMCID: PMC4142312 DOI: 10.1155/2014/730298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 05/22/2014] [Accepted: 06/10/2014] [Indexed: 11/18/2022] Open
Abstract
Objectives. (1) To develop two independent measurement scales for use as items assessing hand movements and hand activities within the Motor Assessment Scale (MAS), an existing instrument used for clinical assessment of motor performance in stroke survivors; (2) To examine the psychometric properties of these new measurement scales. Design. Scale development, followed by a multicenter observational study. Setting. Inpatient and outpatient occupational therapy programs in eight hospital and rehabilitation facilities in the United States and Canada. Participants. Patients (N = 332) receiving stroke rehabilitation following left (52%) or right (48%) cerebrovascular accident; mean age 64.2 years (sd 15); median 1 month since stroke onset. Intervention. Not applicable. Main Outcome Measures. Data were tested for unidimensionality and reliability, and behavioral criteria were ordered according to difficulty level with Rasch analysis. Results. The new scales assessing hand movements and hand activities met Rasch expectations of unidimensionality and reliability. Conclusion. Following a multistep process of test development, analysis, and refinement, we have redesigned the two scales that comprise the hand function items on the MAS. The hand movement scale contains an empirically validated 10-behavior hierarchy and the hand activities item contains an empirically validated 8-behavior hierarchy.
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Affiliation(s)
- Joyce S. Sabari
- College of Health Related Professions, Occupational Therapy Program, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Michelle Woodbury
- Ralph H Johnson VA Medical Center, Charleston, SC 29425, USA
- Department of Health Sciences and Research, Medical University of SC, Charleston, SC 29425, USA
| | - Craig A. Velozo
- Division of Occupational Therapy, Medical University of South Carolina, Charleston, SC 29425, USA
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English C, Hillier S, Kaur G, Hundertmark L. People with stroke spend more time in active task practice, but similar time in walking practice, when physiotherapy rehabilitation is provided in circuit classes compared to individual therapy sessions: an observational study. J Physiother 2014; 60:50-4. [PMID: 24856940 DOI: 10.1016/j.jphys.2013.12.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 12/13/2013] [Indexed: 11/18/2022] Open
Abstract
QUESTION Do people with stroke spend more time in active task practice during circuit class therapy sessions versus individual physiotherapy sessions? Do people with stroke practise different tasks during circuit class therapy sessions versus individual physiotherapy sessions? DESIGN Prospective, observational study. PARTICIPANTS Twenty-nine people with stroke in inpatient rehabilitation settings. INTERVENTIONS Individual therapy sessions and circuit class therapy sessions provided within a larger randomised controlled trial. OUTCOME MEASURES Seventy-nine therapy sessions were video-recorded and the footage was analysed for time spent engaged in various categories of activity. In a subsample of 28 videos, the number of steps taken by people with stroke per therapy session was counted. RESULTS Circuit class therapy sessions were of a longer duration (mean difference 38.0minutes, 95% CI 29.9 to 46.1), and participants spent more time engaged in active task practice (mean difference 23.8minutes, 95% CI 16.1 to 31.4) compared with individual sessions. A greater percentage of time in circuit class therapy sessions was spent practising tasks in sitting (mean difference 5.3%, 95% CI 2.4 to 8.2) and in sit-to-stand practice (mean difference 2.7%, 95% CI 1.4 to 4.1), and a lower percentage of time in walking practice (mean difference 19.1%, 95% CI 10.0 to 28.1) compared with individual sessions. PARTICIPANTS took an average of 371 steps (SD 418) during therapy sessions and this did not differ significantly between group and individual sessions. CONCLUSION People with stroke spent more time in active task practice, but a similar amount of time in walking practice when physiotherapy was offered in circuit class therapy sessions versus individual therapy sessions. There is a need for effective strategies to increase the amount of walking practice during physiotherapy sessions for people after stroke.
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Affiliation(s)
- Coralie English
- International Centre for Allied Health Evidence, Sansom Institute for Health Research, University of South Australia, Adelaide; Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Susan Hillier
- International Centre for Allied Health Evidence, Sansom Institute for Health Research, University of South Australia, Adelaide
| | - Gurpreet Kaur
- International Centre for Allied Health Evidence, Sansom Institute for Health Research, University of South Australia, Adelaide
| | - Laura Hundertmark
- International Centre for Allied Health Evidence, Sansom Institute for Health Research, University of South Australia, Adelaide
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Baek IH, Lee T, Song M, Goo BO. Effect of Circuit Class Training for Eight Weeks on Changes in Ratios of F-Trp/BCAAs and Depression in People with Poststroke Depression. J Phys Ther Sci 2014; 26:243-6. [PMID: 24648640 PMCID: PMC3944297 DOI: 10.1589/jpts.26.243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 09/05/2013] [Indexed: 11/25/2022] Open
Abstract
[Purpose] The purpose of the present study was to investigate the potential effects of
circuit class training (CCT) on poststroke depression through changes in branched-chain
amino acids (BCAAs) (isoleucine, leucine, and valine) and free-tryptophan (f-Trp).
[Subjects] The study subjects were 40 stroke patients with major depressive disorder. The
subjects were group-matched into an experimental and a control group according to sex,
age, height, and weight. [Methods] The experimental CCT group performed gradual
task-oriented CCT (80 min per session). The control group performed stretching exercises
and weight bearing exercises (80 min per session). Both groups performed the exercises
three times per week for eight weeks (24 sessions). Blood samples were collected
immediately before the exercise (9:10 a.m.) and after the exercise (10:30 a.m.), every two
weeks for eight weeks. [Results] The f-Trp/BCAAs ratio in the CCT group showed a
significant increase compared to the control group over time. [Conclusion] The results
show that the CCT may help to improve depression in people with poststroke depression
(PSD).
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Affiliation(s)
- Il-Hun Baek
- Department of Physical Therapy, Dong-Eui Institute of Technology, Republic of Korea
| | - Taesik Lee
- Department of Physical Therapy, Dong-Eui Institute of Technology, Republic of Korea
| | - Minyoung Song
- Department of Physical Therapy, Dong-Eui Institute of Technology, Republic of Korea
| | - Bong-Oh Goo
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan, Republic of Korea
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Thomas RE, Johnston LM, Boyd RN, Sakzewski L, Kentish MJ. GRIN: "GRoup versus INdividual physiotherapy following lower limb intra-muscular Botulinum Toxin-A injections for ambulant children with cerebral palsy: an assessor-masked randomised comparison trial": study protocol. BMC Pediatr 2014; 14:35. [PMID: 24502231 PMCID: PMC3926674 DOI: 10.1186/1471-2431-14-35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 01/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral palsy is the most common cause of physical disability in childhood. Spasticity is a significant contributor to the secondary impairments impacting functional performance and participation. The most common lower limb spasticity management is focal intramuscular injections of Botulinum Toxin-Type A accompanied by individually-delivered (one on one) physiotherapy rehabilitation. With increasing emphasis on improving goal-directed functional activity and participation within a family-centred framework, it is timely to explore whether physiotherapy provided in a group could achieve comparable outcomes, encouraging providers to offer flexible models of physiotherapy delivery. This study aims to compare individual to group-based physiotherapy following intramuscular Botulinum Toxin-A injections to the lower limbs for ambulant children with cerebral palsy aged four to fourteen years. METHODS/DESIGN An assessor-masked, block randomised comparison trial will be conducted with random allocation to either group-based or individual physiotherapy. A sample size of 30 (15 in each study arm) will be recruited. Both groups will receive six hours of direct therapy following Botulinum Toxin-A injections in either an individual or group format with additional home programme activities (three exercises to be performed three times a week). Study groups will be compared at baseline (T1), then at 10 weeks (T2, efficacy) and 26 weeks (T3, retention) post Botulinum Toxin-A injections. Primary outcomes will be caregiver/s perception of and satisfaction with their child's occupational performance goals (Canadian Occupational Performance Measure) and quality of gait (Edinburgh Visual Gait Score) with a range of secondary outcomes across domains of the International Classification of Disability, Functioning and Health. DISCUSSION This paper outlines the study protocol including theoretical basis, study hypotheses and outcome measures for this assessor-masked, randomised comparison trial comparing group versus individual models of physiotherapy following intramuscular injections of Botulinum Toxin-A to the lower limbs for ambulant children with cerebral palsy. TRIAL REGISTRATION ACTRN12611000454976.
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Affiliation(s)
- Rachel E Thomas
- Queensland Cerebral Palsy Health Service, The Royal Children's Hospital, Brisbane, Australia.
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Abstract
BACKGROUND Treadmill training, with or without body weight support using a harness, is used in rehabilitation and might help to improve walking after stroke. This is an update of a Cochrane review first published in 2005. OBJECTIVES To determine if treadmill training and body weight support, individually or in combination, improve walking ability, quality of life, activities of daily living, dependency or death, and institutionalisation or death, compared with other physiotherapy gait training interventions after stroke. The secondary objective was to determine the safety and acceptability of this method of gait training. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched June 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Reviews of Effects (DARE) (The Cochrane Library 2013, Issue 7), MEDLINE (1966 to July 2013), EMBASE (1980 to July 2013), CINAHL (1982 to June 2013), AMED (1985 to July 2013) and SPORTDiscus (1949 to June 2013). We also handsearched relevant conference proceedings and ongoing trials and research registers, screened reference lists and contacted trialists to identify further trials. SELECTION CRITERIA Randomised or quasi-randomised controlled and cross-over trials of treadmill training and body weight support, individually or in combination, for the treatment of walking after stroke. DATA COLLECTION AND ANALYSIS Two authors independently selected trials, extracted data and assessed methodological quality. The primary outcomes investigated were walking speed, endurance and dependency. MAIN RESULTS We included 44 trials with 2658 participants in this updated review. Overall, the use of treadmill training with body weight support did not increase the chances of walking independently compared with other physiotherapy interventions (risk difference (RD) -0.00, 95% confidence interval (CI) -0.02 to 0.02; P = 0.94; I² = 0%). Overall, the use of treadmill training with body weight support in walking rehabilitation for patients after stroke increased the walking velocity and walking endurance significantly. The pooled mean difference (MD) (random-effects model) for walking velocity was 0.07 m/s (95% CI 0.01 to 0.12; P = 0.02; I² = 57%) and the pooled MD for walking endurance was 26.35 metres (95% CI 2.51 to 50.19; P = 0.03; I² = 60%). Overall, the use of treadmill training with body weight support in walking rehabilitation for patients after stroke did not increase the walking velocity and walking endurance at the end of scheduled follow-up significantly. The pooled MD (random-effects model) for walking velocity was 0.04 m/s (95% CI -0.06 to 0.14; P = 0.40; I² = 40%) and the pooled MD for walking endurance was 32.36 metres (95% CI -3.10 to 67.81; P = 0.07; I² = 63%). However, for ambulatory patients improvements in walking endurance lasted until the end of scheduled follow-up (MD 58.88 metres, 95% CI 29.10 to 88.66; P = 0.0001; I² = 0%). Adverse events and drop outs did not occur more frequently in people receiving treadmill training and these were not judged to be clinically serious events. AUTHORS' CONCLUSIONS Overall, people after stroke who receive treadmill training with or without body weight support are not more likely to improve their ability to walk independently compared with people after stroke not receiving treadmill training, but walking speed and walking endurance may improve. Specifically, stroke patients who are able to walk (but not people who are not able to walk) appear to benefit most from this type of intervention. This review found that improvements in walking endurance in people able to walk may have persisting beneficial effects. Further research should specifically investigate the effects of different frequencies, durations or intensities (in terms of speed increments and inclination) of treadmill training, as well as the use of handrails, in ambulatory patients, but not in dependent walkers.
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Affiliation(s)
- Jan Mehrholz
- Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbHWissenschaftliches InstitutAn der Wolfsschlucht 1‐2KreischaGermany01731
| | - Marcus Pohl
- Klinik Bavaria KreischaAbteilung Neurologie und Fachübergreifende RehabilitationAn der Wolfsschlucht 1‐2KreischaGermany01731
| | - Bernhard Elsner
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolFetscherstr. 74DresdenGermany01307
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Hesse S, Heß A, Werner C C, Kabbert N, Buschfort R. Effect on arm function and cost of robot-assisted group therapy in subacute patients with stroke and a moderately to severely affected arm: a randomized controlled trial. Clin Rehabil 2014; 28:637-47. [PMID: 24452706 DOI: 10.1177/0269215513516967] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 11/06/2013] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate the effectiveness and efficiency of robot-assisted arm group therapy (RAGT) versus individual arm therapy (IAT) to restore motor function in the moderately to severely affected patient after stroke. DESIGN Single blind randomized controlled trial. SETTING Two in-patient neurological rehabilitation centers. PARTICIPANTS Fifty first time subacute patients with stroke and a non-functional hand. INTERVENTION The patients practiced either 30 minutes of RAGT + 30 minutes of IAT (group A) or 2x30 minutes of IAT (group B), per workday for four weeks. The RAGT consisted of six workstations enabling repetitive practice of finger, wrist, forearm and shoulder movements. Patients practiced according to their impairment level on at least two workstations per session. The IAT followed the Motor Relearning Programme, enriched by elements of the impairment-oriented training. MAIN OUTCOME MEASURE Changes of the Fugl Meyer Score (FM, 0-66) between baseline and after 4 weeks, incremental cost effectiveness. RESULTS Patients were homogeneous at study onset. All patients improved their upper limb motor function over time, but there were no between group differences. The initial (terminal) FM scores were 14.6±9.4 (25.7±16.5) in group A and 16.5±9.8 (31.1±19.1) in group B. The treatment of a single patient with RAGT cost 4.15 €, compared to 10.00 € for a patient to receive IAT. CONCLUSION RAGT in combination with IAT was equally effective as a double session of IAT regarding the restoration of upper limb motor functions in moderate to severely affected subacute patients with stroke. The treatment costs for RAGT were less.
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Affiliation(s)
- Stefan Hesse
- Medical Park Berlin, Department of Neurological Rehabilitation, Charité University, Berlin, Germany
| | - Anke Heß
- Klinik am Stein, Zentrum für NeuroGeriatrie und Rehabilitationsmedizin, Olsberg, Germany
| | - Cordula Werner C
- Medical Park Berlin, Department of Neurological Rehabilitation, Charité University, Berlin, Germany
| | - Nadine Kabbert
- Medical Park Berlin, Department of Neurological Rehabilitation, Charité University, Berlin, Germany
| | - Rüdiger Buschfort
- Klinik am Stein, Zentrum für NeuroGeriatrie und Rehabilitationsmedizin, Olsberg, Germany
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Adey-Wakeling Z, Crotty M. Upper limb rehabilitation following stroke: current evidence and future perspectives. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/ahe.13.67] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Stroke is a leading cause of disability worldwide, with its risk increasing with age. Upper limb hemiparesis is common and associated with persistent impairments and associated disabilities. Older stroke populations often suffer multiple comorbidities and restoring independence is complex. Recovery of upper limb function can be crucial for individuals to return to independent living and to participate in community life. This review describes upper limb recovery post-stroke, and some of the new therapeutic approaches available to promote recovery. Technologies (including virtual reality and telehealth) offer the opportunity for more home-based therapies, longer programs and greater access to rehabilitation for older individuals. However, the trials continue to exclude older individuals, so acceptability is poorly understood. Upper limb rehabilitation remains a research frontier, which has been energized by new technologies, but is grounded by the basic need to find ways to allow older individuals to recover independence. This paper aims to review the applicability and generalizability of current research to the older stoke survivor. Future research priorities need to be tailored to consider the older mean age of individuals in stroke rehabilitation.
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Affiliation(s)
- Zoe Adey-Wakeling
- Department of Rehabilitation & Aged Care, Flinders University, Adelaide, Australia
| | - Maria Crotty
- Department of Rehabilitation & Aged Care, Flinders University, Adelaide, Australia
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Dose and Content of Training Provided to Stroke Survivors with Severe Upper Limb Disability Undertaking Inpatient Rehabilitation: An Observational Study. BRAIN IMPAIR 2013. [DOI: 10.1017/brimp.2013.31] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: To retrain upper limb function after stroke, a high dose of activity-related therapy is recommended. However, observational studies indicate that the dose undertaken is minimal. While it is speculated that those with severe disability will perform less therapy, this remains to be explored.Objective: Quantify the dose and content of upper limb therapy performed by stroke survivors with severe upper limb disability during routine inpatient rehabilitation.Methods: Therapy provided by physiotherapists and occupational therapists to 32 stroke survivors receiving inpatient rehabilitation over 20 weekdays was recorded. Dose of individual and group therapy was analysed by discipline and severity of upper and lower limb disability. Dose and content of individual therapy was also analysed by functional domain.Results: On average, 46 minutes of individual and 11 minutes of group upper limb therapy were provided per participant, per day. Occupational therapists provided a higher dose of both individual and group therapy compared to physiotherapists (p < 0.0005). Findings suggest that greater residual upper and lower limb movement can lead to provision of a higher dose of activity-related therapy. Within individual therapy, a higher dose (29 versus 17 minutes, p < 0.002) and greater number (1218 versus 549) of impairment- than activity-related interventions were administered.Conclusions: The dose of activity-related upper limb therapy provided to stroke survivors with severe disability was limited. There is a need to identify interventions and models of service delivery that can increase the intensity and appropriateness of therapy that stroke survivors with severe disability undertake during inpatient rehabilitation.
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