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Goncalves S, Le Bourvellec M, Duclos NC, Mandigout S. Recommended moderate to vigorous physical activity levels for people in the chronic phase of stroke can be achieved in outpatient physiotherapy: a multicentre observational study. Top Stroke Rehabil 2024:1-10. [PMID: 39172127 DOI: 10.1080/10749357.2024.2392447] [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: 03/23/2024] [Accepted: 08/10/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Rehabilitation in the chronic phase of stroke should include 20 minutes of moderate to vigorous physical activity (MVPA). However, the level of compliance with MVPA guidelines in outpatient physiotherapy is unknown. OBJECTIVES To investigate (1) whether people in the chronic phase of stroke perform the recommended 20 minutes of MVPA during outpatient physiotherapy sessions in France, (2) whether the person's clinical characteristics influence MVPA time and (3) which interventions contribute to achievement of recommended MVPA time. METHODS This was a multicentre, cross-sectional observational study of routine outpatient physiotherapy sessions in France in people in the chronic phase of stroke. The main measures included MVPA time (determined using a heart rate monitor), clinical tests and types of physiotherapy interventions (recorded by external investigator during 2 sessions for each participant). RESULTS 84 people in the chronic phase of stroke and 152 outpatient physiotherapy sessions in 29 outpatient clinics were included (2021-2022). Median (interquartile range) MVPA time was 25 (7-45) minutes across all sessions. Fifty-nine percent of the sessions fulfilled MVPA guidelines. Among clinical tests, only the Mini-Mental Scale Examination was significantly associated with MVPA time. Endurance, balance, and functional lower limb training were associated with the achievement of MVPA guidelines. CONCLUSION Outpatient physiotherapy sessions have the potential to meet the MVPA guidelines. Further research is needed to understand the variability of compliance with MVPA guidelines and to develop strategies to increase the integration of MVPA into outpatient physiotherapy sessions.
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Affiliation(s)
- Stéphanie Goncalves
- Physical Activity and Sport Sciences, Limoges University, HAVAE, UR 20217, Limoges, France
| | - Morgane Le Bourvellec
- Physical Activity and Sport Sciences, Poitiers University, MOVE UR 20296, Poitiers, France
| | - Noémie C Duclos
- University Institute of Rehabilitation Science, INSERM, BPH ACTIVE U1219, Bordeaux University, Bordeaux, France
| | - Stéphane Mandigout
- Physical Activity and Sport Sciences, Limoges University, HAVAE, UR 20217, Limoges, France
- ILFOMER, Limoges University, HAVAE, UR 20217, Limoges, France
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Chen X, Yin L, Hou Y, Wang J, Li Y, Yan J, Tao J, Ma S. Effect of robot-assisted gait training on improving cardiopulmonary function in stroke patients: a meta-analysis. J Neuroeng Rehabil 2024; 21:92. [PMID: 38816728 PMCID: PMC11138000 DOI: 10.1186/s12984-024-01388-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/20/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVE Understanding the characteristics related to cardiorespiratory fitness after stroke can provide reference values for patients in clinical rehabilitation exercise. This meta- analysis aimed to investigate the effect of robot-assisted gait training in improving cardiorespiratory fitness in post-stroke patients, compared to conventional rehabilitation training. METHODS PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, CBM, CNKI and Wanfang databases were searched until March 18th, 2024. Randomized controlled trials (RCTs) comparing the effectiveness of robot-assisted gait training versus control group were included. The main outcome variable was peak oxygen uptake. 6-minute walking test, peak heart rate, peak inspiratory expiratory ratio as our secondary indicators. RevMan 5.3 software was used for statistical analysis. RESULTS A total of 17 articles were included, involving 689 subjects. The results showed a significant effect for robot-assisted gait training to improve VO2peak (MD = 1.85; 95% CI: -0.13 to 3.57; p = 0.04) and 6WMT (MD = 19.26; 95% CI: 10.43 to 28.08; p < 0.0001). However, no significant difference favouring robot-assisted gait training were found in HRpeak (MD = 3.56; 95% CI: -1.90 to 9.02; p = 0.20) and RERpeak (MD = -0.01; 95% CI: -0.04 to 0.01; p = 0.34). CONCLUSION These results showed that robot-assisted gait training may have a beneficial effect in improving VO2peak and 6WMT, with a moderate recommendation level according to the GRADE guidelines.
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Affiliation(s)
- Xiao Chen
- Department of Rehabilitation Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lu Yin
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yangbo Hou
- Department of Neurology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jie Wang
- Rehabilitation department of traditional Chinese Medicine, The Second Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Yongyi Li
- Rehabilitation department of traditional Chinese Medicine, The Second Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Juntao Yan
- Department of Tuina, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Jiming Tao
- Department of Rehabilitation Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Shujie Ma
- Rehabilitation department of traditional Chinese Medicine, The Second Rehabilitation Hospital of Shanghai, Shanghai, China.
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Wang C, Xu Y, Zhang L, Fan W, Liu Z, Yong M, Wu L. Comparative efficacy of different exercise methods to improve cardiopulmonary function in stroke patients: a network meta-analysis of randomized controlled trials. Front Neurol 2024; 15:1288032. [PMID: 38313560 PMCID: PMC10836840 DOI: 10.3389/fneur.2024.1288032] [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] [Received: 09/03/2023] [Accepted: 01/05/2024] [Indexed: 02/06/2024] Open
Abstract
Background Although some studies have shown that exercise has a good effect on improving the cardiopulmonary function of stroke patients, it still needs to be determined which exercise method does this more effectively. We, therefore, aimed to evaluate the effectiveness of different exercise methods in improving cardiovascular function in stroke patients through a network meta-analysis (NMA), providing a basis to select the best treatment plan for stroke patients. Methods We systematically searched CNKI, WanFang, VIP, CBM, PubMed, Embase, Web of Science, and The Cochrane Library databases from establishment to 30 April 2023. Randomized controlled trials (RCTS) on exercise improving cardiopulmonary function in stroke patients were included, and we screened the included articles and extracted the relevant data. RevMan (version 5.4) and Stata (version 17.0) were used for data analysis. Results We included 35 RCTs and a total of 2,008 subjects. Intervention measures included high-intensity interval training (HIIT), aerobic training (AT), resistance training (RT), combined aerobic and resistance exercise (CE), and conventional therapy (CT). In the network meta-analysis, the surface under the cumulative ranking area (SUCRA) ranking result indicated that HIIT improved peak oxygen uptake (VO2peak) and 6 mins walking distance (6MWD) optimally, with rankings of HIIT (100.0%) > CE (70.5%) > AT (50.2%) > RT (27.7%) > CT (1.6%), and HIIT (90.9%) > RT (60.6%) > AT (48.9%) > RT (48.1%) > CT (1.5%), respectively. The SUCRA ranking result showed that CE improved systolic blood pressure (SBP) and diastolic blood pressure (DBP) optimally, with rankings of CE (82.1%) > HIIT (49.8%) > AT (35.3%) > CT (32.8%), and CE (86.7%) > AT (45.0%) > HIIT (39.5%) > CT (28.8%), respectively. Conclusion We showed that exercise can effectively improve the cardiopulmonary function of stroke patients. HIIT was the most effective in improving VO2peak and 6MWD in stroke patients. CE was the most effective in improving SBP and DBP in stroke patients. However, due to the limitations of existing clinical studies and evidence, larger sample size, multi-center, and high-quality RCTs are needed to verify the above conclusions in the future. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier [CRD42023436773].
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Affiliation(s)
- Chengshuo Wang
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise & Health, Tianjin University of Sport, Tianjin, China
- Beijing Xiaotangshan Hospital, Beijing, China
| | - Yanan Xu
- Beijing Xiaotangshan Hospital, Beijing, China
| | - Linli Zhang
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise & Health, Tianjin University of Sport, Tianjin, China
| | - Weijiao Fan
- Beijing Xiaotangshan Hospital, Beijing, China
| | - Zejian Liu
- Beijing Xiaotangshan Hospital, Beijing, China
| | - Mingjin Yong
- Department of Rehabilitation, Lianyungang Hospital of Traditional Chinese Medicine, Lianyungang, China
| | - Liang Wu
- Beijing Xiaotangshan Hospital, Beijing, China
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David R, Billot M, Ojardias E, Parratte B, Roulaud M, Ounajim A, Louis F, Meklat H, Foucault P, Lombard C, Jossart A, Mainini L, Lavallière M, Goudman L, Moens M, Laroche D, Salga M, Genêt F, Daviet JC, Perrochon A, Compagnat M, Rigoard P. A 6-Month Home-Based Functional Electrical Stimulation Program for Foot Drop in a Post-Stroke Patient: Considerations on a Time Course Analysis of Walking Performance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159204. [PMID: 35954558 PMCID: PMC9367978 DOI: 10.3390/ijerph19159204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 12/04/2022]
Abstract
Foot drop is a common disability in post-stroke patients and represents a challenge for the clinician. To date, ankle foot orthosis (AFO) combined with conventional rehabilitation is the gold standard of rehabilitation management. AFO has a palliative mechanical action without actively restoring the associated neural function. Functional electrical stimulation (FES), consisting of stimulation of the peroneal nerve pathway, represents an alternative approach. By providing an FES device (Bioness L-300, BIONESS, Valencia, CA, USA) for 6 months to a post-stroke 22-year-old woman with a foot drop, our goal was to quantify its potential benefit on walking capacity. The gait parameters and the temporal evolution of the speed were collected with a specific connected sole device (Feet Me®) during the 10-m walking, the time up and go, and the 6-minute walking tests with AFO, FES, or without any device (NO). As a result, the walking speed changes on 10-m were clinically significant with an increase from the baseline to 6 months in AFO (+0.14 m.s−1), FES (+0.36 m.s−1) and NO (+0.32 m.s−1) conditions. In addition, the speed decreased at about 4-min in the 6-minute walking test in NO and AFO conditions, while the speed increased in the FES conditions at baseline and after 1, 3, and 6 months. In addition to the walking performance improvement, monitoring the gait speed in an endurance test after an ecological rehabilitation training program helps to examine the walking performance in post-stroke patients and to propose a specific rehabilitation program.
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Affiliation(s)
- Romain David
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86000 Poitiers, France; (R.D.); (B.P.); (M.R.); (A.O.); (P.R.)
- Department of Physical and Rehabilitation Medicine, Poitiers University Hospital, 86000 Poitiers, France; (A.J.); (L.M.)
| | - Maxime Billot
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86000 Poitiers, France; (R.D.); (B.P.); (M.R.); (A.O.); (P.R.)
- Correspondence: ; Tel.: +33-05-49-44-43-24
| | - Etienne Ojardias
- Physical Medicine and Rehabilitation Department, University Hospital of Saint-Etienne, 42270 Saint-Etienne, France;
| | - Bernard Parratte
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86000 Poitiers, France; (R.D.); (B.P.); (M.R.); (A.O.); (P.R.)
| | - Manuel Roulaud
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86000 Poitiers, France; (R.D.); (B.P.); (M.R.); (A.O.); (P.R.)
| | - Amine Ounajim
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86000 Poitiers, France; (R.D.); (B.P.); (M.R.); (A.O.); (P.R.)
| | - Frédéric Louis
- Department of Physical and Rehabilitation Medicine le Grand Feu, Rue de la Verrerie, 79000 Niort, France;
| | - Hachemi Meklat
- Department of Physical and Rehabilitation Medicine Richelieu, Rue Philippe-Vincent, 17028 La Rochelle, France; (H.M.); (P.F.); (C.L.)
| | - Philippe Foucault
- Department of Physical and Rehabilitation Medicine Richelieu, Rue Philippe-Vincent, 17028 La Rochelle, France; (H.M.); (P.F.); (C.L.)
| | - Christophe Lombard
- Department of Physical and Rehabilitation Medicine Richelieu, Rue Philippe-Vincent, 17028 La Rochelle, France; (H.M.); (P.F.); (C.L.)
| | - Anne Jossart
- Department of Physical and Rehabilitation Medicine, Poitiers University Hospital, 86000 Poitiers, France; (A.J.); (L.M.)
| | - Laura Mainini
- Department of Physical and Rehabilitation Medicine, Poitiers University Hospital, 86000 Poitiers, France; (A.J.); (L.M.)
| | - Martin Lavallière
- Module de Kinésiologie, Département des Sciences de la Santé, CISD, & Lab BioNR, Université du Québec à Chicoutimi, Chicoutimi, QC G7H 2B1, Canada;
| | - Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium; (L.G.); (M.M.)
- STIMULUS Consortium (reSearch and TeachIng neuroModULation Uz bruSsel), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Research Foundation—Flanders (FWO), 1090 Brussels, Belgium
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium; (L.G.); (M.M.)
- STIMULUS Consortium (reSearch and TeachIng neuroModULation Uz bruSsel), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Davy Laroche
- INSERM UMR1093 Cognition, Action and Sensorimotor Plasticity Research Unit, UFR des Sciences du Sport, Université Bourgogne Franche-Comté, 21078 Dijon, France;
- INSERM, Centre d’Investigation Clinique 1432, Module Plurithematique, Plateforme d’Investigation Technologique, CHU Dijon-Bourgogne, Centre d’Investigation Clinique, Module Plurithématique, Plateforme d’Investigation Technologique, 21079 Dijon, France
| | - Marjorie Salga
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, Assistance Publique—Hôpitaux de Paris (AP-HP), 92380 Garches, France; (M.S.); (F.G.)
- Inserm U1179, END-ICAP (Handicap neuromusculaire: Physiopathologie, Biothérapie et Pharmacologie Appliquées), UFR Simone Veil—Santé, Versailles Saint-Quentin-en-Yvelines University (UVSQ), 78180 Montigny-le-Bretonneux, France
| | - François Genêt
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, Assistance Publique—Hôpitaux de Paris (AP-HP), 92380 Garches, France; (M.S.); (F.G.)
- Inserm U1179, END-ICAP (Handicap neuromusculaire: Physiopathologie, Biothérapie et Pharmacologie Appliquées), UFR Simone Veil—Santé, Versailles Saint-Quentin-en-Yvelines University (UVSQ), 78180 Montigny-le-Bretonneux, France
| | - Jean-Christophe Daviet
- HAVAE UR20217 (Handicap, Ageing, Autonomy, Environment), University of Limoges, 87000 Limoges, France; (J.-C.D.); (A.P.); (M.C.)
- Department of Physical Medicine and Rehabilitation, University Hospital Center of Limoges, 87000 Limoges, France
| | - Anaick Perrochon
- HAVAE UR20217 (Handicap, Ageing, Autonomy, Environment), University of Limoges, 87000 Limoges, France; (J.-C.D.); (A.P.); (M.C.)
| | - Maxence Compagnat
- HAVAE UR20217 (Handicap, Ageing, Autonomy, Environment), University of Limoges, 87000 Limoges, France; (J.-C.D.); (A.P.); (M.C.)
- Department of Physical Medicine and Rehabilitation, University Hospital Center of Limoges, 87000 Limoges, France
| | - Philippe Rigoard
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86000 Poitiers, France; (R.D.); (B.P.); (M.R.); (A.O.); (P.R.)
- Department of Neuro-Spine & Neuromodulation, Poitiers University Hospital, 86000 Poitiers, France
- Prime Institute UPR 3346, CNRS, ISAE-ENSMA (Institut Supérieur de l’Aéronautique et de l’Espace—École Nationale Supérieure de Mécanique et d’Aérotechnique Poitiers Futuroscope), University of Poitiers, 86000 Poitiers, France
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Choi KB, Cho SH. Are Physical Therapeutics Important for Stroke Patients to Recover Their Cardiorespiratory Fitness? Medicina (B Aires) 2021; 57:medicina57111182. [PMID: 34833400 PMCID: PMC8619703 DOI: 10.3390/medicina57111182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Aspects of improving cardiorespiratory fitness should be factored into therapeutics for recovery of movement in stroke patients. This study aimed to recommend optimized cardiorespiratory fitness therapeutics that can be prescribed to stroke patients based on a literature review and an expert-modified Delphi technique. Materials and Methods: we searched PubMed, Embase, CINAHL, and Cochrane databases and yielded 13,498 articles published from 2010 to 2019 to support the development of drafts. After applying the exclusion criteria, 29 documents were analyzed (drafts, 17 articles; modified Delphi techniques, 12 articles). This literature was reviewed in combination with the results of a modified Delphi technique presented to experts in the physical medicine and rehabilitation field. Analysis of the literature and survey results was conducted at the participating university hospital. Results: the results of this analysis were as follows: first, 12 intervention items derived through a researcher’s literature review and a Delphi technique questionnaire were constructed using the Likert scale; second, we asked the experts to create two modified Delphi techniques by reconstructing the items after statistical analysis for each order comprising five categories, and 15 items were finally confirmed. Conclusions: the recommendations in this study may lead to the development of a standard decision-making process for physiotherapists to improve their patients’ cardiorespiratory fitness. Moreover, the study results can help prescribers document patient care to reduce prescription errors and improve safety. In the future, multidisciplinary studies could potentially provide better therapeutics alternatives for cardiorespiratory fitness.
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Affiliation(s)
- Ki-Bok Choi
- Team of Rehabilitation Treatment, Chosun University Hospital, 365, Pilmun-daero, Dong-gu, Gwangju 61453, Korea;
| | - Sung-Hyoun Cho
- Department of Physical Therapy, Nambu University, 23 Cheomdan Jungang-ro, Gwangsan-gu, Gwangju 62271, Korea
- Correspondence: ; Tel.: +82-10-3060-1330
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