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Effect of Executive Dysfunction on Posture Control and Gait after Stroke. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:3051750. [PMID: 34675982 PMCID: PMC8526208 DOI: 10.1155/2021/3051750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/20/2021] [Indexed: 12/01/2022]
Abstract
Objective The purpose of the study was to observe the effects of executive dysfunction (ED) on gait and postural control during walking after stroke. Methods In this study, 34 subjects with stroke and ED (8 women and 26 men; age, 55.41 ± 7.89 years; time since stroke onset, 1.3 ± 0.12 months) were recruited. Stroop color-word test (SCWT), 10-meter walk test (10MWT), timed-up-and-go test (TUGT), and gait analysis were evaluated. The correlation among the correct number of Stroop tasks (SCWT-C), the number of time-consuming tasks (SCWT-T), the amount of interference (SIE-M and SIE-T) and posture control, and gait-related parameters was analyzed. Results The results indicated that SCWT-C was negatively correlated with 10MWT, TUGT, and bilateral symmetry (P < 0.05). However, there was no significant correlation between SCWT-C and stride (P > 0.05). A significant negative correlation was seen between SCWT-C and bilateral symmetry (P < 0.05). There was no significant correlation between SCWT-T and stride (P > 0.05). SCWT-T was positively correlated with TUGT, 10MWT, and bilateral symmetry (P < 0.05). SIE-T was positively correlated with TUGT and bilateral symmetry (P < 0.05). There was no significant correlation between SIE-T and 10MWT or stride (P > 0.05). SIE-M was positively correlated with TUGT and bilateral symmetry (P < 0.05). There was no significant correlation between SIE-T and 10MWT or stride (P > 0.05). Conclusions ED is closely related to the decline in postural control and the occurrence of falls. In the early phases of stroke rehabilitation, physiotherapists should focus on the patients' executive function to accelerate the recovery of postural control.
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Koiler R, Bakhshipour E, Glutting J, Lalime A, Kofa D, Getchell N. Repurposing an EMG Biofeedback Device for Gait Rehabilitation: Development, Validity and Reliability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6460. [PMID: 34203676 PMCID: PMC8296262 DOI: 10.3390/ijerph18126460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 11/17/2022]
Abstract
Gait impairment often limits physical activity and negatively impacts quality of life. EMG-Biofeedback (EMG-BFB), one of the more effective interventions for improving gait impairment, has been limited to laboratory use due to system costs and technical requirements, and has therefore not been tested on a larger scale. In our research, we aimed to develop and validate a cost-effective, commercially available EMG-BFB device for home- and community-based use. We began by repurposing mTrigger® (mTrigger LLC, Newark, DE, USA), a cost-effective, portable EMG-BFB device, for gait application. This included developing features in the cellphone app such as step feedback, success rate, muscle activity calibration, and cloud integration. Next, we tested the validity and reliability of the mTrigger device in healthy adults by comparing it to a laboratory-grade EMG system. While wearing both devices, 32 adults walked overground and on a treadmill at four speeds (0.3, 0.6, 0.9, and 1.2 m/s). Statistical analysis revealed good to excellent test-retest reliability (r > 0.89) and good to excellent agreement in the detection of steps (ICC > 0.85) at all speeds between two systems for treadmill walking. Our results indicated that mTrigger compared favorably to a laboratory-grade EMG system in the ability to assess muscular activity and to provide biofeedback during walking in healthy adults.
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Affiliation(s)
- Reza Koiler
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE 19716, USA; (E.B.); (N.G.)
| | - Elham Bakhshipour
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE 19716, USA; (E.B.); (N.G.)
| | - Joseph Glutting
- School of Education, University of Delaware, Newark, DE 19716, USA;
| | - Amy Lalime
- Product & Marketing Manager, mTrigger, LLC, Newark, DE 19713, USA;
| | - Dexter Kofa
- Dexter Kofa, Mobile App Developer, Philadelphia, PA 19120, USA;
| | - Nancy Getchell
- Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE 19716, USA; (E.B.); (N.G.)
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 19716, USA
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de Athayde Costa e Silva A, Viana da Cruz Júnior AT, Cardoso do Nascimento NI, Andrade Candeira SR, do Socorro Soares Cardoso Almeida A, Santana de Castro KJ, Costa de Lima R, Generoso Campos Pinho Barroso T, da Silva Souza G, Callegari B. Positive Balance Recovery in Ischemic Post-Stroke Patients with Delayed Access to Physical Therapy. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9153174. [PMID: 32047819 PMCID: PMC7003254 DOI: 10.1155/2020/9153174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/06/2019] [Accepted: 08/23/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Since patient's prognosis after stroke depends on its severity, brain location, and type early intervention is strongly recommended. OBJECTIVE We aimed to determine whether it is still possible to improve balance in chronic patients, who suffered Intracerebral Hemorrhagic Strokes (ICHS) or Ischemic Strokes (IS), after later intervention. METHODS 34 patients who had unilateral ICHS or IS and involved the motor cortex or sub-cortical areas took part in the study. The patients underwent clinical balance evaluation (using the Berg Balance Scale) and posturographic assessment (with a capacitive pressure platform) at the time of admission to the physiotherapy and at the end of the study. The physiotherapy intervention consisted of 20 sessions of 60 minutes carried out 3 times per week, following standard protocols: stretching; passive range of motion (ROM); active assistive ROM; active ROM; resistance training; coordination and balance activities while sitting and standing, and Large-muscle activities such as walking, treadmill, stationary cycle, combined arm-leg ergometry, arm ergometry, seated stepper and circuit training. RESULTS In the posturographic assessment, the IS group had significant lower amplitude of center of pressure (COP) anteroposterior displacement, after physical therapy intervention. Also, the 95% confidence ellipse area of the COP and the total COP displacement showed significant interaction between the subtype of stroke and the assessment period, meaning the IS group improved their balance after treatment on the contrary of ICHS. The structural analysis of the COP reinforced these results. On the other hand, no difference was observed in the clinical scale, between the assessment periods, for any subtype of stroke. CONCLUSION Only IS patients have shown balance improvements after conventional intervention. COP measurements are more sensible to assess balance in chronic patients than Berg Balance Scale.
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Affiliation(s)
| | - Alex Tadeu Viana da Cruz Júnior
- Laboratory of Human Motricity Studies, Institute of Health Sciences, Federal University of Pará, Av, Generalíssimo Deodoro 01, Belém 66073-000, Pará, Brazil
| | - Nathalya Ingrid Cardoso do Nascimento
- Laboratory of Human Motricity Studies, Institute of Health Sciences, Federal University of Pará, Av, Generalíssimo Deodoro 01, Belém 66073-000, Pará, Brazil
| | - Skarleth Raissa Andrade Candeira
- Laboratory of Human Motricity Studies, Institute of Health Sciences, Federal University of Pará, Av, Generalíssimo Deodoro 01, Belém 66073-000, Pará, Brazil
| | - Aline do Socorro Soares Cardoso Almeida
- Laboratory of Human Motricity Studies, Institute of Health Sciences, Federal University of Pará, Av, Generalíssimo Deodoro 01, Belém 66073-000, Pará, Brazil
| | | | - Ramon Costa de Lima
- Institute of Biological Sciences, Federal University of Pará, Rua Augusto Correa 01, Belém 66075-110, Pará, Brazil
| | | | - Givago da Silva Souza
- Institute of Biological Sciences, Federal University of Pará, Rua Augusto Correa 01, Belém 66075-110, Pará, Brazil
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, Pará, Brazil
| | - Bianca Callegari
- Laboratory of Human Motricity Studies, Institute of Health Sciences, Federal University of Pará, Av, Generalíssimo Deodoro 01, Belém 66073-000, Pará, Brazil
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, Pará, Brazil
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Kannan L, Vora J, Bhatt T, Hughes SL. Cognitive-motor exergaming for reducing fall risk in people with chronic stroke: A randomized controlled trial. NeuroRehabilitation 2019; 44:493-510. [PMID: 31256084 DOI: 10.3233/nre-182683] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Dual-task (simultaneous motor and cognitive task) (DT) training via virtual-reality exergaming is known to benefit balance control post-stroke. However, the efficacy of such training on DT balance control (volitional and reactive) and cognitive (executive function and attention) domains associated with fall risk remains unclear. OBJECTIVE We evaluated the efficacy of cognitive-motor exergame training (CMT) (Wii-fit games in conjunction with cognitive tasks) for improving balance control (volitional and reactive) and cognition (executive function and attention) among people with chronic stroke (PwCS). METHODS Hemiparetic, ambulatory PwCS were randomly assigned to either CMT (n = 12) or conventional training (CT) (n = 12) and underwent six weeks of high-intensity, tapered balance training. The CMT group performed Wii-fit games in conjunction with cognitive tasks, while CT group underwent customized, progressive balance training. Performance under DT conditions on Limits of Stability (volitional) and Slip-Perturbation (reactive) tests, and letter-number sequencing (cognition) determined the efficacy of CMT. RESULTS Post-intervention, under DT reactive conditions, CMT group improved both motor and cognition, while the CT group improved motor alone. Under DT volitional conditions, motor performance improved only in CMT group. CONCLUSION Cognitive-motor exergaming appears to be effective for improving balance control and cognition and could be implemented in clinical stroke rehabilitation settings.
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Affiliation(s)
- Lakshmi Kannan
- Department of Physical Therapy, Cognitive-Motor Behavior and Balance Rehabilitation Laboratory, University of Illinois at Chicago, Chicago, IL, USA
| | - Jinal Vora
- Department of Physical Therapy, Cognitive-Motor Behavior and Balance Rehabilitation Laboratory, University of Illinois at Chicago, Chicago, IL, USA
| | - Tanvi Bhatt
- Department of Physical Therapy, Cognitive-Motor Behavior and Balance Rehabilitation Laboratory, University of Illinois at Chicago, Chicago, IL, USA
| | - Susan L Hughes
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
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Choi D, Choi W, Lee S. Influence of Nintendo Wii Fit Balance Game on Visual Perception, Postural Balance, and Walking in Stroke Survivors: A Pilot Randomized Clinical Trial. Games Health J 2018. [DOI: 10.1089/g4h.2017.0126] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Donmo Choi
- Department of Physical Therapy, The Graduate School of Sahmyook University, Seoul, Korea
| | - Wonjae Choi
- Department of Physical Therapy, The Graduate School of Sahmyook University, Seoul, Korea
- Institute of Rehabilitation Science, Sahmyook University, Seoul, Korea
| | - Seungwon Lee
- Institute of Rehabilitation Science, Sahmyook University, Seoul, Korea
- Department of Physical Therapy, Sahmyook University, Seoul, Korea
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Powell L, Parker J, Martyn St-James M, Mawson S. The Effectiveness of Lower-Limb Wearable Technology for Improving Activity and Participation in Adult Stroke Survivors: A Systematic Review. J Med Internet Res 2016; 18:e259. [PMID: 27717920 PMCID: PMC5075044 DOI: 10.2196/jmir.5891] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 08/02/2016] [Accepted: 08/21/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND With advances in technology, the adoption of wearable devices has become a viable adjunct in poststroke rehabilitation. Regaining ambulation is a top priority for an increasing number of stroke survivors. However, despite an increase in research exploring these devices for lower limb rehabilitation, little is known of the effectiveness. OBJECTIVE This review aims to assess the effectiveness of lower limb wearable technology for improving activity and participation in adult stroke survivors. METHODS Randomized controlled trials (RCTs) of lower limb wearable technology for poststroke rehabilitation were included. Primary outcome measures were validated measures of activity and participation as defined by the International Classification of Functioning, Disability and Health. Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library. The Cochrane Risk of Bias Tool was used to assess the methodological quality of the RCTs. RESULTS In the review, we included 11 RCTs with collectively 550 participants at baseline and 474 participants at final follow-up including control groups and participants post stroke. Participants' stroke type and severity varied. Only one study found significant between-group differences for systems functioning and activity. Across the included RCTs, the lowest number of participants was 12 and the highest was 151 with a mean of 49 participants. The lowest number of participants to drop out of an RCT was zero in two of the studies and 19 in one study. Significant between-group differences were found across three of the 11 included trials. Out of the activity and participation measures alone, P values ranged from P=.87 to P ≤.001. CONCLUSIONS This review has highlighted a number of reasons for insignificant findings in this area including low sample sizes, appropriateness of the RCT methodology for complex interventions, a lack of appropriate analysis of outcome data, and participant stroke severity.
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Affiliation(s)
- Lauren Powell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom.
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Goliwas M, Kocur P, Furmaniuk L, Majchrzycki M, Wiernicka M, Lewandowski J. Effects of sensorimotor foot training on the symmetry of weight distribution on the lower extremities of patients in the chronic phase after stroke. J Phys Ther Sci 2015; 27:2925-30. [PMID: 26504326 PMCID: PMC4616127 DOI: 10.1589/jpts.27.2925] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 06/17/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To assess the effects of sensorimotor foot stimulation on the symmetry of weight distribution on the feet of patients in the chronic post-stroke phase. [Subjects and Methods] This study was a prospective, single blind, randomized controlled trial. In the study we examined patients with chronic stroke (post-stroke duration > 1 year). They were randomly allocated to the study group (n=8) or to the control group (n=12). Both groups completed a standard six-week rehabilitation programme. In the study group, the standard rehabilitation programme was supplemented with sensorimotor foot stimulation training. Each patient underwent two assessments of symmetry of weight distribution on the lower extremities with and without visual control, on a treadmill, with stabilometry measurements, and under static conditions. [Results] Only the study group demonstrated a significant increase in the weight placed on the leg directly affected by stroke, and a reduction in asymmetry of weight-bearing on the lower extremities. [Conclusion] Sensorimotor stimulation of the feet enhanced of weight bearing on the foot on the side of the body directly affected by stroke, and a decreased asymmetry of weight distribution on the lower extremities of patients in the chronic post-stroke phase.
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Affiliation(s)
- Magdalena Goliwas
- Department of Rehabilitation of The Locomotor System,
University School of Physical Education in Poznan,
Poland
| | - Piotr Kocur
- Department of Rehabilitation of The Locomotor System,
University School of Physical Education in Poznan,
Poland
| | - Lech Furmaniuk
- Department of Rehabilitation of The Locomotor System,
University School of Physical Education in Poznan,
Poland
| | - Marian Majchrzycki
- Department of Kinesiotherapy, University School of Physical
Education in Poznan, Poland
| | - Marzena Wiernicka
- Department of Rehabilitation of The Locomotor System,
University School of Physical Education in Poznan,
Poland
| | - Jacek Lewandowski
- Department of Rheumatology and Rehabilitation, Poznan
University of Medical Sciences, Poland
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Veerbeek JM, van Wegen E, van Peppen R, van der Wees PJ, Hendriks E, Rietberg M, Kwakkel G. What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS One 2014; 9:e87987. [PMID: 24505342 PMCID: PMC3913786 DOI: 10.1371/journal.pone.0087987] [Citation(s) in RCA: 684] [Impact Index Per Article: 68.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/30/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Physical therapy (PT) is one of the key disciplines in interdisciplinary stroke rehabilitation. The aim of this systematic review was to provide an update of the evidence for stroke rehabilitation interventions in the domain of PT. METHODS AND FINDINGS Randomized controlled trials (RCTs) regarding PT in stroke rehabilitation were retrieved through a systematic search. Outcomes were classified according to the ICF. RCTs with a low risk of bias were quantitatively analyzed. Differences between phases poststroke were explored in subgroup analyses. A best evidence synthesis was performed for neurological treatment approaches. The search yielded 467 RCTs (N = 25373; median PEDro score 6 [IQR 5-7]), identifying 53 interventions. No adverse events were reported. Strong evidence was found for significant positive effects of 13 interventions related to gait, 11 interventions related to arm-hand activities, 1 intervention for ADL, and 3 interventions for physical fitness. Summary Effect Sizes (SESs) ranged from 0.17 (95%CI 0.03-0.70; I(2) = 0%) for therapeutic positioning of the paretic arm to 2.47 (95%CI 0.84-4.11; I(2) = 77%) for training of sitting balance. There is strong evidence that a higher dose of practice is better, with SESs ranging from 0.21 (95%CI 0.02-0.39; I(2) = 6%) for motor function of the paretic arm to 0.61 (95%CI 0.41-0.82; I(2) = 41%) for muscle strength of the paretic leg. Subgroup analyses yielded significant differences with respect to timing poststroke for 10 interventions. Neurological treatment approaches to training of body functions and activities showed equal or unfavorable effects when compared to other training interventions. Main limitations of the present review are not using individual patient data for meta-analyses and absence of correction for multiple testing. CONCLUSIONS There is strong evidence for PT interventions favoring intensive high repetitive task-oriented and task-specific training in all phases poststroke. Effects are mostly restricted to the actually trained functions and activities. Suggestions for prioritizing PT stroke research are given.
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Affiliation(s)
- Janne Marieke Veerbeek
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Erwin van Wegen
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Roland van Peppen
- Department of Physiotherapy, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Philip Jan van der Wees
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Erik Hendriks
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Marc Rietberg
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- Department of Neurorehabilitation, Reade Center for Rehabilitation and Rheumatology, Amsterdam, The Netherlands
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Harvey N, Ada L. Suitability of Nintendo Wii Balance Board for rehabilitation of standing after stroke. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x12y.0000000032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
QUESTION Is biofeedback during the practice of lower limb activities after stroke effective in improving performance of those activities, and are any benefits maintained after intervention ceases? DESIGN Systematic review with meta-analysis of randomised trials. PARTICIPANTS People who have had a stroke. INTERVENTION Biofeedback during practice of sitting, standing up, standing, or walking. OUTCOME MEASURES Continuous measures of activity congruent with the activity trained. RESULTS 22 trials met the inclusion criteria and 19 contained data suitable for analysis. Effect sizes were calculated as standardised mean differences because different outcome measures were used. Since inclusion of all trials produced substantial statistical heterogeneity, only trials with a PEDro score >4 (11 trials) were included in the final analysis (mean PEDro score 5.7). In the short-term, biofeedback improved lower limb activities compared with usual therapy/placebo (SMD=0.49, 95% CI 0.22 to 0.75). Lower limb activities were still improved compared with usual therapy/placebo 1 to 5 months after the cessation of intervention (SMD=0.41, 95% CI 0.06 to 0.75). CONCLUSION Augmenting feedback through the use of biofeedback is superior to usual therapy/placebo at improving lower limb activities in people following stroke. Furthermore, these benefits are largely maintained in the longer term. Given that many biofeedback machines are relatively inexpensive, biofeedback could be utilised more widely in clinical practice.
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Abdul Latif L, Daud Amadera JE, Pimentel D, Pimentel T, Fregni F. Sample size calculation in physical medicine and rehabilitation: a systematic review of reporting, characteristics, and results in randomized controlled trials. Arch Phys Med Rehabil 2011; 92:306-15. [PMID: 21272730 DOI: 10.1016/j.apmr.2010.10.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Revised: 09/02/2010] [Accepted: 10/01/2010] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To assess systematically the reporting of sample size calculation in randomized controlled trials (RCTs) in 5 leading journals in the field of physical medicine and rehabilitation (PM&R). DATA SOURCES The data source was full reports of RCTs in 5 leading PM&R journals (Journal of Rehabilitation Medicine, Archives of Physical Medicine and Rehabilitation, American Journal of Physical Medicine and Rehabilitation, Clinical Rehabilitation, and Disability and Rehabilitation) between January and December of 1998 and 2008. Articles were identified in Medline. STUDY SELECTION A total of 111 articles met our inclusion criteria, which include RCTs of human studies in the 5 selected journals. DATA EXTRACTION Sample size calculation reporting and trial characteristics were collected for each trial by independent investigators. DATA SYNTHESIS In 2008, 57.3% of articles reported sample size calculation as compared with only 3.4% in 1998. The parameters that were commonly used were a power of 80% and alpha of 5%. Articles often failed to report effect size or effect estimates for sample size calculation. Studies reporting sample size calculation were more likely to describe the main outcome and to have a sample size greater than 50 subjects. The study outcome (positive vs negative) was not associated with the likelihood of sample size reporting. Trial characteristics of the 2 periods (1998 vs 2008) were similar except that in 1998 there were more negative studies compared with 2008. CONCLUSIONS Although sample size calculation reporting has improved dramatically in 10 years and is comparable with other fields in medicine, it is still not adequate given current publication guidelines.
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Affiliation(s)
- Lydia Abdul Latif
- Laboratory of Neuromodulation, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA
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The effect of balance training on balance performance in individuals poststroke: a systematic review. J Neurol Phys Ther 2010; 34:127-37. [PMID: 20716987 DOI: 10.1097/npt.0b013e3181ef764d] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Stroke is a leading cause of long-term disability, and impaired balance after stroke is strongly associated with future function and recovery. Until recently there has been limited evidence to support the use of balance training to improve balance performance in this population. Information about the optimum exercise dosage has also been lacking. This review evaluated recent evidence related to the effect of balance training on balance performance among individuals poststroke across the continuum of recovery. On the basis of this evidence, we also provide recommendations for exercise prescription in such programs. METHODS A systematic search was performed on literature published between January 2006 and February 2010, using multiple combinations of intervention (eg, "exercise"), population (eg, "stroke"), and outcome (eg, "balance"). Criteria for inclusion of a study was having at least 1 standing balance exercise in the intervention and 1 study outcome to evaluate balance. RESULTS Twenty-two published studies met the inclusion criteria. We found moderate evidence that balance performance can be improved following individual, "one-on-one" balance training for participants in the acute stage of stroke, and either one-on-one balance training or group therapy for participants with subacute or chronic stroke. Moderate evidence also suggests that in the acute stage, intensive balance training for 2 to 3 times per week may be sufficient, whereas exercising for 90 minutes or more per day, 5 times per week may be excessive. DISCUSSION AND CONCLUSIONS This review supports the use of balance training exercises to improve balance performance for individuals with moderately severe stroke. Future high-quality, controlled studies should investigate the effects of balance training for individuals poststroke who have severe impairment, additional complications/comorbidities, or specific balance lesions (eg, cerebellar or vestibular). Optimal training dosage should also be further explored. Studies with long-term follow-up are needed to assess outcomes related to participation in the community and reduction of fall risk.
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