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Logan A, Freeman J, Kent B, Pooler J, Creanor S, Enki D, Vickery J, Barton A, Marsden J. Functional standing frame programme early after severe sub-acute stroke (SPIRES): a randomised controlled feasibility trial. Pilot Feasibility Stud 2022; 8:50. [PMID: 35241176 PMCID: PMC8892736 DOI: 10.1186/s40814-022-01012-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 02/20/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Early mobilisation (> 24 h post-stroke) is recommended for people with stroke. However, there is a paucity of evidence about how to implement early mobilisation for people who have had a severe stroke. Prolonged standing and task-specific training (sit-to-stand repetitions) have separately been evaluated in the literature; however, these functionally linked tasks have not been evaluated in combination for people with severe sub-acute stroke. METHODS The objective was to determine the feasibility of conducting a randomised controlled trial (RCT) of a functional standing frame programme compared with usual physiotherapy for people with severe sub-acute stroke. An assessor-blinded feasibility RCT with nested qualitative component (interviews and focus group) and process evaluation was adopted. Participants were aged ≥ 18 years with new diagnosis of severe sub-acute stroke (modified Rankin Scale (mRS) 4/5) from four Stroke Rehabilitation Units across South West England. Participants were randomised to receive either: (1) functional standing frame programme (30 min. standing plus sit-to-stand repetitions) plus 15 min of usual physiotherapy daily (intervention); (2) usual physiotherapy (45 min) daily (control). Both programmes were protocolised to be undertaken a minimum of five sessions per week for 3 weeks. Feasibility indicators included process, resource, management, and safety. Adherence, fidelity, and acceptability of the trial and intervention were evaluated using data recorded by therapists, observation of intervention and control sessions, interviews and one focus group. Patient measures of motor impairment, activities/participation, and quality of life were carried out by blinded assessors at baseline, 3, 15, 29, and 55 weeks post-randomisation. RESULTS Forty-five participants (51-96 years; 42% male, mRS 4 = 80% 5 = 20%) were randomised (n = 22 to intervention). Twenty-seven (60%) participants were followed-up at all time points. Twelve participants (27%) died during the trial; no deaths were related to the trial. Adherence to the minimum number of sessions was low: none of the participants completed all 21 sessions, and only 8 participants (18%) across both groups completed ≥ 15 sessions, over the 3 weeks; 39% intervention; 51% control sessions were completed; mean session duration 39 min (SD 19) control, 37 min intervention (SD 11). Intervention group: mean standing time 13 min (SD 9); mean sit-to-stand repetitions/session 5 (SD 4). Interviews were conducted with 10 participants, four relatives and six physiotherapists. Five physiotherapists attended a focus group. CONCLUSIONS The majority of progression criteria for this feasibility trial were met. However, adherence to the interventions was unacceptably low. This aspect of the trial design needs to be addressed prior to moving to a definitive RCT of this standing frame intervention in people with severe sub-acute stroke. Solutions have been identified to address these concerns. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number ISRCTN15412695 . Registration 19 December 2016.
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Affiliation(s)
- Angela Logan
- Faculty of Health, School of Health Professions, University of Plymouth, Plymouth, UK. .,Stroke Rehabilitation Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
| | - Jennifer Freeman
- Faculty of Health, School of Health Professions, University of Plymouth, Plymouth, UK
| | - Bridie Kent
- Faculty of Health, School of Health Professions, University of Plymouth, Plymouth, UK
| | - Jill Pooler
- Faculty of Health, School of Health Professions, University of Plymouth, Plymouth, UK
| | - Siobhan Creanor
- Peninsula Clinical Trials Unit, Faculty of Health, University of Plymouth, Plymouth, UK.,Medical Statistics, Faculty of Health, University of Plymouth, Plymouth, UK.,Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Doyo Enki
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Jane Vickery
- Peninsula Clinical Trials Unit, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Andrew Barton
- NIHR Research Design Service, Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Jonathan Marsden
- Faculty of Health, School of Health Professions, University of Plymouth, Plymouth, UK
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Sato K, Inoue T, Maeda K, Shimizu A, Murotani K, Ueshima J, Ishida Y, Ogawa T, Suenaga M. Early Wearing of Knee-Ankle-Foot Orthosis Improves Functional Prognosis in Patients after Stroke. J Stroke Cerebrovasc Dis 2022; 31:106261. [PMID: 35032757 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106261] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES Knee-ankle-foot orthosis (KAFO) is sometimes used for gait training in stroke patients. The impact of the time of wearing KAFO on activities of daily living (ADL) recovery has not been clarified. This study aimed to examine the relationship between the days from onset to KAFO wearing and functional prognosis in patients after stroke. MATERIALS AND METHODS This retrospective, observational study was conducted with stroke patients who were prescribed a KAFO. Patients were divided into early and delayed groups according to the median days from onset to KAFO wearing. Baseline characteristics were evaluated at the initiation of KAFO wearing. The primary outcome was the Functional Independence Measure (FIM) gain, which was scored by the nurse at baseline and discharge. RESULTS 112 participants (mean age 67.9 ± 14.0 years, 51.8% male) were included. The time period measure from day of onset to KAFO wearing for the early group was significantly shorter than the delayed group (35.8 ± 6.6 days vs. 73.5 ± 28.9 days). The early group had a higher FIM at discharge (84.9 ± 28.0% vs. 65.1 ± 29.0%, P < 0.001) and higher FIM gain (36.9 ± 19.8% vs. 26.8 ± 22.3, P = 0.013) than did the delayed group. Multiple regression analysis showed that the early group was associated with FIM gain (coefficient = 8.607, P = 0.032). CONCLUSIONS Early wearing of KAFO, irrespective of the difference in ADL at the time of KAFO wearing, may have a positive impact on the improvement of ADL in patients after stroke.
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Affiliation(s)
- Keisuke Sato
- Okinawa Chuzan Clinical Research Center, Chuzan Hospital, Okinawa, Japan
| | - Tatsuro Inoue
- Department of Physical Therapy Niigata University of Health and Welfare, Niigata, Japan
| | - Keisuke Maeda
- Okinawa Chuzan Clinical Research Center, Chuzan Hospital, Okinawa, Japan; Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan.; Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan..
| | - Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | | | - Junko Ueshima
- Department of Clinical Nutrition and Food Service, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yuria Ishida
- Department of Nutrition, Aichi Medical University, Nagakute, Japan
| | - Takahiro Ogawa
- Okinawa Chuzan Clinical Research Center, Chuzan Hospital, Okinawa, Japan; Department of Rehabilitation Medicine, Chuzan Hospital, Okinawa, Japan
| | - Masaki Suenaga
- Department of Rehabilitation Medicine, Chuzan Hospital, Okinawa, Japan
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Manabe K. Development and Clinical Evaluation of Bed with Standing-Up Function. JOURNAL OF ROBOTICS AND MECHATRONICS 2021. [DOI: 10.20965/jrm.2021.p0887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The risk of disuse syndrome caused by prolonged supine posture in hemiplegic stroke in- and outpatients has become a social problem. This study aimed to develop a new bed with a standing-up function, allowing medical caregivers and patients to freely take a standing position on the bed to reduce the amount of time spent in the supine position and to clarify its effectiveness through evaluation of its usability and clinical use. In addition to the Gatch function of the developed bed, it allows transition from a supine position to a chair-sitting or standing position on the bed, and from a standing position to walking action. In addition, as with the tilt table used for standing-position training, the bed’s tilt angle can be adjusted, reducing the load on the lower limbs and allowing appropriate rehabilitation to be carried out anytime, consequently reducing the burden of nursing care. The bed was developed with the cooperation of a specialized bed manufacturer and supported by public funds, and clinical evaluation was conducted after confirming its safety. We evaluated the physical and physiological functions of two hemiplegic patients after 4 weeks of standing training using a prototype bed, to which results from the six-item test showed no significant improvement. However, medical professionals, such as doctors, nurses, and physical therapists, who participated in the clinical evaluation indicated that the bed can safely replace the tilt table for standing-position rehabilitation, and it is effective in eliminating related human and time burdens.
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Saunders DH, Mead GE, Fitzsimons C, Kelly P, van Wijck F, Verschuren O, Backx K, English C. Interventions for reducing sedentary behaviour in people with stroke. Cochrane Database Syst Rev 2021; 6:CD012996. [PMID: 34184251 PMCID: PMC8238669 DOI: 10.1002/14651858.cd012996.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Stroke survivors are often physically inactive as well as sedentary,and may sit for long periods of time each day. This increases cardiometabolic risk and has impacts on physical and other functions. Interventions to reduce or interrupt periods of sedentary time, as well as to increase physical activity after stroke, could reduce the risk of secondary cardiovascular events and mortality during life after stroke. OBJECTIVES To determine whether interventions designed to reduce sedentary behaviour after stroke, or interventions with the potential to do so, can reduce the risk of death or secondary vascular events, modify cardiovascular risk, and reduce sedentary behaviour. SEARCH METHODS In December 2019, we searched the Cochrane Stroke Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, Conference Proceedings Citation Index, and PEDro. We also searched registers of ongoing trials, screened reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing interventions to reduce sedentary time with usual care, no intervention, or waiting-list control, attention control, sham intervention or adjunct intervention. We also included interventions intended to fragment or interrupt periods of sedentary behaviour. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and performed 'Risk of bias' assessments. We analyzed data using random-effects meta-analyses and assessed the certainty of the evidence with the GRADE approach. MAIN RESULTS We included 10 studies with 753 people with stroke. Five studies used physical activity interventions, four studies used a multicomponent lifestyle intervention, and one study used an intervention to reduce and interrupt sedentary behaviour. In all studies, the risk of bias was high or unclear in two or more domains. Nine studies had high risk of bias in at least one domain. The interventions did not increase or reduce deaths (risk difference (RD) 0.00, 95% confidence interval (CI) -0.02 to 0.03; 10 studies, 753 participants; low-certainty evidence), the incidence of recurrent cardiovascular or cerebrovascular events (RD -0.01, 95% CI -0.04 to 0.01; 10 studies, 753 participants; low-certainty evidence), the incidence of falls (and injuries) (RD 0.00, 95% CI -0.02 to 0.02; 10 studies, 753 participants; low-certainty evidence), or incidence of other adverse events (moderate-certainty evidence). Interventions did not increase or reduce the amount of sedentary behaviour time (mean difference (MD) +0.13 hours/day, 95% CI -0.42 to 0.68; 7 studies, 300 participants; very low-certainty evidence). There were too few data to examine effects on patterns of sedentary behaviour. The effect of interventions on cardiometabolic risk factors allowed very limited meta-analysis. AUTHORS' CONCLUSIONS Sedentary behaviour research in stroke seems important, yet the evidence is currently incomplete, and we found no evidence for beneficial effects. Current World Health Organization (WHO) guidelines recommend reducing the amount of sedentary time in people with disabilities, in general. The evidence is currently not strong enough to guide practice on how best to reduce sedentariness specifically in people with stroke. More high-quality randomised trials are needed, particularly involving participants with mobility limitations. Trials should include longer-term interventions specifically targeted at reducing time spent sedentary, risk factor outcomes, objective measures of sedentary behaviour (and physical activity), and long-term follow-up.
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Affiliation(s)
- David H Saunders
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, Edinburgh, UK
| | - Gillian E Mead
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Claire Fitzsimons
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, Edinburgh, UK
| | - Paul Kelly
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, Edinburgh, UK
| | - Frederike van Wijck
- Institute for Applied Health Research and the School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Karianne Backx
- Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Coralie English
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research Institute, Melbourne and Newcastle, Australia
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Riberholt CG, Wagner V, Lindschou J, Gluud C, Mehlsen J, Møller K. Early head-up mobilisation versus standard care for patients with severe acquired brain injury: A systematic review with meta-analysis and Trial Sequential Analysis. PLoS One 2020; 15:e0237136. [PMID: 32790771 PMCID: PMC7425882 DOI: 10.1371/journal.pone.0237136] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/20/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND There is increasing focus on earlier rehabilitation in patients with traumatic or hypoxic brain injury or stroke. This systematic review evaluates the benefits and harms of early head-up mobilisation versus standard care in patients with severe acquired brain injury. METHODS We searched Medline, CENTRAL, EMBASE, four other databases and 13 selected clinical trial registries until April 2020. Eligible randomised clinical trials compared early head-up mobilisation versus standard care in patients with severe acquired brain injury and were analysed conducting random- and fixed-effects meta-analyses and Trial Sequential Analysis (TSA). Certainty of evidence was assessed by GRADE. MAIN RESULTS We identified four randomised clinical trials (total n = 385 patients) with severe acquired brain injury (stroke 86% and traumatic brain injury 13%). Two trials were at low risk and two at high risk of bias. We found no evidence of a difference between early mobilisation vs. standard care on mortality or poor functional outcome at end of the intervention (relative risk (RR) 1.19, 95% CI 0.93 to 1.53; I2 0%; very low certainty) or at maximal follow-up (RR 1.03, 95% CI 0.89 to 1.21; I2 0%; very low certainty). We found evidence against an effect on quality of life at maximal follow-up. The proportion of patients with at least one serious adverse event did not differ at end of intervention or at maximal follow-up. For most comparisons, TSA suggested that further trials are needed. CONCLUSIONS We found no evidence of a difference between early mobilisation versus standard care for patients with severe acquired brain injury. Early mobilisation appeared not to exert a major impact on quality of life. This systematic review highlights the insufficient evidence in patients with severe brain injury, and no firm conclusions can be drawn from these data. TRIAL REGISTRATION Protocol uploaded to PROSPERO: April 2018 (revised October 2018, CRD42018088790).
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Affiliation(s)
- Christian Gunge Riberholt
- Department of Neurorehabilitation, Traumatic Brain Injury, Rigshospitalet, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Healthcare Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Wagner
- Department of Neurorehabilitation, Traumatic Brain Injury, Rigshospitalet, Copenhagen University Hospital, Hvidovre, Denmark
| | - Jane Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper Mehlsen
- Surgical Pathophysiology Unit, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirsten Møller
- Department of Clinical Medicine, Faculty of Healthcare Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neuroanaesthesiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Three-Fourths of ICU Physical Therapists Report Use of Assistive Equipment and Technology in Practice: Results of an International Survey. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chen L, Xiong S, Liu Y, Lin M, Zhu L, Zhong R, Zhao J, Liu W, Wang J, Shang X. Comparison of Motor Relearning Program versus Bobath Approach for Prevention of Poststroke Apathy: A Randomized Controlled Trial. J Stroke Cerebrovasc Dis 2019; 28:655-664. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/26/2018] [Accepted: 11/06/2018] [Indexed: 02/05/2023] Open
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Ota T, Hashidate H, Shimizu N, Yatsunami M. Early effects of a knee-ankle-foot orthosis on static standing balance in people with subacute stroke. J Phys Ther Sci 2019; 31:127-131. [PMID: 30858650 PMCID: PMC6382479 DOI: 10.1589/jpts.31.127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/02/2018] [Indexed: 01/23/2023] Open
Abstract
[Purpose] The purpose of this study was to evaluate the early effects of a
knee-ankle-foot orthosis on static standing balance in people with subacute stroke.
[Participants and Methods] Timed static standing balance in four standing conditions (feet
apart with eyes open, feet apart with eyes closed, feet together with eyes open, and
tandem stance with eyes open) was assessed in 29 inpatients (mean age: 67.3 ± 13.3 years)
with subacute stroke with and without a knee-ankle-foot orthosis on the paretic lower
limb. [Results] In the group of participants who were unable to stand without a
knee-ankle-foot orthosis, the proportion of participants who were able to stand with a
knee-ankle-foot orthosis was significantly increased in the following conditions: feet
apart with eyes open and feet apart with eyes closed. In the group of participants who
were able to stand without a knee-ankle-foot orthosis, the mean duration of time for which
the participants with a knee-ankle-foot orthosis were able to stand was significantly
longer than that for those without a knee-ankle-foot orthosis for all standing conditions.
[Conclusion] A knee-ankle-foot orthosis may be a useful assistive device to support static
standing balance for people with subacute stroke.
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Affiliation(s)
- Tomohiro Ota
- Department of Health Science, Graduate School, Kyorin University: 5-4-1 Shimorenjaku, Mitaka, Tokyo 181-8612, Japan.,Hatsudai Rehabilitation Hospital, Japan
| | - Hiroyuki Hashidate
- Department of Physical Therapy, School of Health Science, Kyorin University, Japan
| | - Natsuki Shimizu
- Department of Health Science, Graduate School, Kyorin University: 5-4-1 Shimorenjaku, Mitaka, Tokyo 181-8612, Japan.,Hatsudai Rehabilitation Hospital, Japan
| | - Mitsunobu Yatsunami
- Department of Physical Therapy, School of Health Science, Kyorin University, Japan
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