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Johnson L, Burridge J, Ewings S, Westcott E, Gayton M, Demain S. Principles into Practice: An Observational Study of Physiotherapists use of Motor Learning Principles in Stroke Rehabilitation. Physiotherapy 2023; 118:20-30. [PMID: 36306569 PMCID: PMC9907222 DOI: 10.1016/j.physio.2022.06.002] [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: 07/25/2021] [Revised: 03/21/2022] [Accepted: 06/14/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE(S) To describe a) how motor learning principles are applied during post stroke physiotherapy, with a focus on lower limb rehabilitation; and b) the context in which these principles are used, in relation to patient and/or task characteristics. DESIGN Direct non-participation observation of routine physiotherapy sessions, with data collected via video recording. A structured analysis matrix and pre-agreed definitions were used to identify, count and record: type of activity; repetitions; instructional and feedback statements (frequency and type); strategies such as observational learning and augmented feedback. Data was visualised using scatter plots, and analysed descriptively. SETTING 6 UK Stroke Units PARTICIPANTS: 89 therapy sessions were observed, involving 55 clinicians and 57 patients. RESULTS Proportion of time spent active within each session ranged from 26% to 98% (mean 85, SD 19). The frequency of task repetition varied widely, with a median of 3.7 repetitions per minute (IQR 2.1-8.6). Coaching statements were common (mean 6.46 per minute), with 52% categorised as instructions, 14% as feedback, and 34% as verbal cues/motivational statements. 13% of instructions and 6% of feedback statements were externally focussed. Examining the use of different coaching behaviours in relation to patient characteristics found no associations. Overall, practice varied widely across the dataset. CONCLUSIONS To optimise the potential for motor skill learning, therapists must manipulate features of their coaching language (what they say, how much and when) and practice design (type, number, difficulty and variability of task). There is an opportunity to implement motor learning principles more consistently, to benefit motor skill recovery following stroke. TRIAL REGISTRATION NUMBER Clinicaltrials.gov (NCT03792126). CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Louise Johnson
- University Hospitals Dorset NHS Foundation Trust, Castle Lane East, Bournemouth, Dorset, UK; School of Health Sciences, Faculty of Environmental and Life Sciences, Building 45, University of Southampton, Southampton SO17 1BJ.
| | - Jane Burridge
- School of Health Sciences, Faculty of Environmental and Life Sciences, Building 45, University of Southampton, Southampton SO17 1BJ
| | - Sean Ewings
- Southampton Clinical Trials Unit, University of Southampton, University Road, Southampton, SO17 1BJ
| | - Ellie Westcott
- University Hospitals Dorset NHS Foundation Trust, Castle Lane East, Bournemouth, Dorset, UK
| | - Marianne Gayton
- University Hospitals Dorset NHS Foundation Trust, Castle Lane East, Bournemouth, Dorset, UK
| | - Sara Demain
- School of Health Sciences, Faculty of Environmental and Life Sciences, Building 45, University of Southampton, Southampton SO17 1BJ
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Crozier A, Watson PM, Graves LEF, George K, Naylor L, Green DJ, Rosenberg M, Jones H. Clinical exercise provision in the UK: comparison of staff job titles, roles and qualifications across five specialised exercise services. BMJ Open Sport Exerc Med 2022; 8:e001152. [PMID: 35136656 PMCID: PMC8788312 DOI: 10.1136/bmjsem-2021-001152] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/14/2022] Open
Abstract
Objectives In the UK, the National Health Service long-term plan advocates exercise as a key component of clinical services, but there is no clearly defined workforce to deliver the plan. We aimed to provide an overview of current UK clinical exercise services, focusing on exercise staff job titles, roles and qualifications across cardiovascular, respiratory, stroke, falls and cancer services. Methods Clinical exercise services were identified electronically between May 2020 and September 2020 using publicly available information from clinical commissioning groups, national health boards and published audit data. Data relating to staff job titles, roles, qualifications and exercise delivery were collected via electronic records and telephone/email contact with service providers. Results Data were obtained for 731 of 890 eligible clinical services (216 cardiac, 162 respiratory, 129 stroke, 117 falls, 107 cancer). Cardiac rehabilitation services provided both clinical (phase III) and community (phase IV) exercise interventions delivered by physiotherapists, exercise physiologists (exercise specific BSc/MSc) and exercise instructors (vocationally qualified with or without BSc/MSc). Respiratory, stroke and falls services provided a clinical exercise intervention only, mostly delivered by physiotherapists and occupational therapists. Cancer services provided a community exercise service only, delivered by vocationally qualified exercise instructors. Job titles of ‘exercise physiologists’ (n=115) bore little alignment to their qualifications, with a large heterogeneity across services. Conclusion In the UK, clinical exercise services job titles, roles and qualifications were inconsistent. Regulation of exercise job titles and roles is required to remove the current disparities in this area.
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Affiliation(s)
- Anthony Crozier
- Sport & Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Paula Mary Watson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Lee E F Graves
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Keith George
- RISES, Liverpool John Moores University, Liverpool, UK
| | - Louise Naylor
- School of Sport Science, Exercise and Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Daniel J Green
- School of Sport Science, Exercise and Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Michael Rosenberg
- Sport Science, Exercise and Health, University of Western Australia, Perth, Western Australia, Australia
| | - Helen Jones
- Sport & Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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James J, McGlinchey MP. How active are stroke patients in physiotherapy sessions and is this associated with stroke severity? Disabil Rehabil 2021; 44:4408-4414. [PMID: 33794718 DOI: 10.1080/09638288.2021.1907459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Exercise improves functional outcome post-stroke, but how long patients with differing severity spend undertaking active exercise within physiotherapy sessions is unknown. We aimed to investigate if stroke severity is associated with time undertaking active exercise in physiotherapy sessions, and if any differences between planned and actual physiotherapy session length existed. MATERIALS AND METHODS A prospective observational study of 107 stroke rehabilitation sessions in a UK acute stroke unit. Data recorded included patient demographics (age, gender, time post-stroke and Barthel Index score) and session attributes (planned and actual session length, time undertaking active exercise, grade of treating therapist). RESULTS There was a significant negative association between increasing stroke severity and percentage of time undertaking active exercise in physiotherapy sessions (p < 0.001). No other observed factors were associated with time undertaking active exercise. Mean session length across all levels of stroke severity was 32 min (SD 9.26) which was significantly less than planned (p < 0.05). There was no difference in mean session length or between planned and actual physiotherapy session length between patients of differing severity. CONCLUSIONS Patients with greater stroke severity participate in less active exercise in physiotherapy sessions than those with lesser stroke severity. Reasons for this disparity warrant further investigation.Implications for rehabilitationStroke patients with higher levels of severity engage in less active exercise during rehabilitation.A discrepancy exists between patients' planned physiotherapy session lengths and actual session lengths during stroke rehabilitation.Physiotherapists should be mindful in how to adapt their sessions (particularly with severe stroke patients) to maximise the amount of activity they undertake.Physiotherapists should be flexible in their delivery of rehabilitation to ensure that the length of patient sessions reflect patients' needs.
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Affiliation(s)
- Jimmy James
- Department of Physiotherapy, St. Thomas' Hospital, London, UK
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Stewart C, McCluskey A, Ada L, Kuys S. Structure and feasibility of extra practice during stroke rehabilitation: A systematic scoping review. Aust Occup Ther J 2017; 64:204-217. [DOI: 10.1111/1440-1630.12351] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Claire Stewart
- Faculty of Health Sciences; The University of Sydney; Lidcombe New South Wales Australia
| | - Annie McCluskey
- Faculty of Health Sciences; The University of Sydney; Lidcombe New South Wales Australia
| | - Louise Ada
- Faculty of Health Sciences; The University of Sydney; Lidcombe New South Wales Australia
| | - Suzanne Kuys
- School of Physiotherapy; Australian Catholic University; Brisbane Queensland Australia
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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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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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Hayward KS, Brauer SG. Dose of arm activity training during acute and subacute rehabilitation post stroke: a systematic review of the literature. Clin Rehabil 2015; 29:1234-43. [PMID: 25568073 DOI: 10.1177/0269215514565395] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 12/01/2014] [Indexed: 11/16/2022]
Abstract
AIM To determine the dose of activity-related arm training undertaken by stroke survivors during acute and subacute rehabilitation. METHODS A systematic review of PubMed, CINAHL and EMBASE up to December 2014 was completed. Studies were eligible if they defined the dose (time or repetitions) of activity-related arm training using observational methods for a cohort of adult stroke survivors receiving acute or subacute rehabilitation. All studies were quality appraised using an evidence-based learning critical appraisal checklist. Data was analysed by method of documented dose per session (minutes, repetitions), environment (acute or subacute rehabilitation) and therapy discipline (physiotherapy, occupational therapy). RESULTS Ten studies were included: two observed stroke survivors during acute rehabilitation and eight during subacute rehabilitation. During acute rehabilitation, one study reported 4.1 minutes per session during physiotherapy and 11.2 minutes during occupational therapy, while another study reported 5.7 minutes per session during physiotherapy only. During inpatient rehabilitation, activity-related arm training was on average undertaken for 4 minutes per session (range 0.9 to 7.9, n = 4 studies) during physiotherapy and 17 minutes per session (range 9.3 to 28.9, n = 3 studies) during occupational therapy. Repetitions per session were reported by two studies only during subacute rehabilitation. One study reported 23 repetitions per session during physiotherapy and occupational therapy, while another reported 32 repetitions per session across both disciplines. CONCLUSION The dose of activity-related arm training during acute and subacute rehabilitation after stroke is limited.
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Affiliation(s)
- Kathryn S Hayward
- Division of Physiotherapy, The University of Queensland, Brisbane, Australia
| | - Sandra G Brauer
- Division of Physiotherapy, The University of Queensland, Brisbane, Australia
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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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Fini NA, Holland AE, Keating J, Simek J, Bernhardt J. How is physical activity monitored in people following stroke? Disabil Rehabil 2014; 37:1717-31. [DOI: 10.3109/09638288.2014.978508] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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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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Kaur G, English C, Hillier S. How physically active are people with stroke in physiotherapy sessions aimed at improving motor function? A systematic review. Stroke Res Treat 2012; 2012:820673. [PMID: 22567542 PMCID: PMC3337516 DOI: 10.1155/2012/820673] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 12/19/2011] [Accepted: 01/12/2012] [Indexed: 01/19/2023] Open
Abstract
Background. Targeted physical activity drives functional recovery after stroke. This review aimed to determine the amount of time stroke survivors spend physically active during physiotherapy sessions. Summary of Review. A systematic search was conducted to identify published studies that investigated the use of time by people with stroke during physiotherapy sessions. Seven studies were included; six observational and one randomised controlled trial. People with stroke were found to be physically active for an average of 60 percent of their physiotherapy session duration. The most common activities practiced in a physiotherapy session were walking, sitting, and standing with a mean (SD) practice time of 8.7 (4.3), 4.5 (4.0), and 8.3 (2.6) minutes, respectively. Conclusion. People with stroke were found to spend less than two-thirds of their physiotherapy sessions duration engaged in physical activity. In light of dosage studies, practice time may be insufficient to drive optimal motor recovery.
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Affiliation(s)
- Gurpreet Kaur
- School of Health Sciences, University of South Australia, P.O. Box 2471, Adelaide, SA 5001, Australia
| | - Coralie English
- School of Health Sciences, University of South Australia, P.O. Box 2471, Adelaide, SA 5001, Australia
- International Centre for Allied Health Evidence, School of Health Sciences, University of South Australia, P.O. Box 2471, Adelaide, SA 5001, Australia
| | - Susan Hillier
- School of Health Sciences, University of South Australia, P.O. Box 2471, Adelaide, SA 5001, Australia
- International Centre for Allied Health Evidence, School of Health Sciences, University of South Australia, P.O. Box 2471, Adelaide, SA 5001, Australia
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West T, Bernhardt J. Physical activity in hospitalised stroke patients. Stroke Res Treat 2011; 2012:813765. [PMID: 21966599 PMCID: PMC3182066 DOI: 10.1155/2012/813765] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Revised: 07/06/2011] [Accepted: 07/10/2011] [Indexed: 01/19/2023] Open
Abstract
The aim of this paper was to examine the amount and type of physical activity engaged in by people hospitalised after stroke. Method. We systematically reviewed the literature for observational studies describing the physical activity of stroke patients. Results. Behavioural mapping, video recording and therapist report are used to monitor activity levels in hospitalised stroke patients in the 24 included studies. Most of the patient day is spent inactive (median 48.1%, IQR 39.6%-69.3%), alone (median 53.7%, IQR 44.2%-60.6%) and in their bedroom (median 56.5%, IQR 45.2%-72.5%). Approximately one hour per day is spent in physiotherapy (median 63.2 minutes, IQR 36.0-79.5) and occupational therapy (median 57.0 minutes, IQR 25.1-58.5). Even in formal therapy sessions limited time is spent in moderate to high level physical activity. Low levels of physical activity appear more common in patients within 14 days post-stroke and those admitted to conventional care. Conclusions. Physical activity levels are low in hospitalised stroke patients. Improving the description and classification of post stroke physical activity would enhance our ability to pool data across observational studies. The importance of increasing activity levels and the effectiveness of interventions to increase physical activity after stroke need to be tested further.
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Affiliation(s)
- Tanya West
- School of Health Sciences, La Trobe University, Melbourne, VIC 3086, Australia
- Physiotherapy Department, Royal Perth Hospital, Perth, WA 6000, Australia
| | - Julie Bernhardt
- School of Health Sciences, La Trobe University, Melbourne, VIC 3086, Australia
- Stroke Division, Florey Neuroscience Institutes (formerly National Stroke Research Institute), Heidelberg Heights, VIC 3084, Australia
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Rose D, Paris T, Crews E, Wu SS, Sun A, Behrman AL, Duncan P. Feasibility and effectiveness of circuit training in acute stroke rehabilitation. Neurorehabil Neural Repair 2010; 25:140-8. [PMID: 21051764 DOI: 10.1177/1545968310384270] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Task-specificity, repetition and progression are key variables in the acquisition of motor skill however they have not been consistently implemented in post-stroke rehabilitation. OBJECTIVE To evaluate the effectiveness of a stroke rehabilitation plan of care that incorporated task-specific practice, repetition and progression to facilitate functional gain compared to standard physical therapy for individuals admitted to an inpatient stroke unit. METHODS Individuals participated in either a circuit training (CTPT) model (n = 72) or a standard (SPT) model (n = 108) of physical therapy, 5 days/week. Each 60 minute circuit training session, delivered according to severity level, consisted of four functional mobility tasks. Daily exercise logs documented both task repetition and progression. RESULTS The CTPT model was successfully implemented in an acute rehabilitation setting. The CTPT group showed a significantly greater improved change in gait speed from hospital admission to discharge than the SPT group (0.21 ± 0.25 m/sec vs. 0.13 ± 0.22 m/sec; p = 0.03). The difference between groups occurred primarily among those who were ambulatory upon admission. There were no significant differences between the two cohorts at 90 days post-stroke as measured by the FONE-FIM, SF-36 and living location. CONCLUSIONS Therapy focused on systematically progressed functional tasks can be successfully implemented in an inpatient rehabilitation stroke program. This circuit-training model resulted in greater gains in gait velocity over the course of inpatient rehabilitation compared to the standard model of care. Community-based services following hospital discharge to maintain these gains should be included in the continuum of post-stroke care.
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Affiliation(s)
- Dorian Rose
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
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Books. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2009. [DOI: 10.12968/ijtr.2009.16.3.40071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The second edition of Wellbeing in Dementia has been produced to reflect our increasing knowledge about the nature of dementia, and the developments in assessment and practice that now exist and exert an influence on dementia care. The book aims to provide a sound theoretical and conceptual framework that supports a perspective on wellbeing as a key outcome of dementia care.
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