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Scrivener K, Ball E, Dean C, Glinsky J, Ada L, Graham P, Young N, Felton K, Lannin NA. A high-dose mobility booster program versus usual care for people after stroke: protocol for a pilot randomized trial. Pilot Feasibility Stud 2025; 11:31. [PMID: 40097961 PMCID: PMC11912660 DOI: 10.1186/s40814-025-01613-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/04/2025] [Indexed: 03/19/2025] Open
Abstract
BACKGROUND Maintaining mobility in the long term after stroke can be challenging. Furthermore, access to ongoing physiotherapy or exercise programs is limited. There is a need to investigate new models of service delivery to improve mobility in the longer term after stroke. A mobility booster program may be a solution, facilitating short-term access to physiotherapy on an as-needed basis. The aim of this project is to determine the feasibility of conducting a clinical trial of a short-term, high-dose mobility booster program (HiWalk) and measure clinical outcomes in order to estimate the power for a future efficacy trial. METHOD A multi-site, assessor-blinded pilot randomized trial will be undertaken to compare HiWalk in addition to usual care with usual care alone in 50 participants. Feasibility outcomes include recruitment, adherence, and safety. Clinical outcomes include walking speed, capacity and self-efficacy at 1-month and 6-months. DISCUSSION A mobility booster program may be a successful way to deliver mobility training in the longer term after stroke. This pilot trial will progress the investigation of this model and assist in planning a future definitive trial. Most importantly, it will confirm the feasibility of delivering a novel high-dose, short-term booster program. TRIAL REGISTRATION ANZCTR (ACTRN: ACTRN12623000316606p).
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Affiliation(s)
- Katharine Scrivener
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Elisha Ball
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Catherine Dean
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Joanne Glinsky
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Louise Ada
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Petra Graham
- Department of Mathematics and Statistics, Macquarie University, Sydney, Australia
| | | | - Karen Felton
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Natasha A Lannin
- Brain Recovery and Rehabilitation Group, Department of Neurosciences, Monash University, Allied Health, Alfred Health, 99 Commercial Road, Melbourne, Victoria, Australia.
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Todhunter-Brown A, Sellers CE, Baer GD, Choo PL, Cowie J, Cheyne JD, Langhorne P, Brown J, Morris J, Campbell P. Physical rehabilitation approaches for the recovery of function and mobility following stroke. Cochrane Database Syst Rev 2025; 2:CD001920. [PMID: 39932103 PMCID: PMC11812092 DOI: 10.1002/14651858.cd001920.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2025]
Abstract
BACKGROUND Various approaches to physical rehabilitation to improve function and mobility are used after stroke. There is considerable controversy around the relative effectiveness of approaches, and little known about optimal delivery and dose. Some physiotherapists base their treatments on a single approach; others use components from several different approaches. OBJECTIVES Primary objective: To determine whether physical rehabilitation is effective for recovery of function and mobility in people with stroke, and to assess if any one physical rehabilitation approach is more effective than any other approach. SECONDARY OBJECTIVE To explore factors that may impact the effectiveness of physical rehabilitation approaches, including time after stroke, geographical location of study, intervention dose/duration, intervention provider, and treatment components. Stakeholder involvement: Key aims were to clarify the focus of the review, inform decisions about subgroup analyses, and co-produce statements relating to key implications. SEARCH METHODS For this update, we searched the Cochrane Stroke Trials Register (last searched November 2022), CENTRAL (2022, Issue 10), MEDLINE (1966 to November 2022), Embase (1980 to November 2022), AMED (1985 to November 2022), CINAHL (1982 to November 2022), and the Chinese Biomedical Literature Database (to November 2022). SELECTION CRITERIA Inclusion criteria: Randomised controlled trials (RCTs) of physical rehabilitation approaches aimed at promoting the recovery of function or mobility in adult participants with a clinical diagnosis of stroke. EXCLUSION CRITERIA RCTs of upper limb function or single treatment components. PRIMARY OUTCOMES measures of independence in activities of daily living (IADL) and motor function. SECONDARY OUTCOMES balance, gait velocity, and length of stay. DATA COLLECTION AND ANALYSIS Two independent authors selected studies according to pre-defined eligibility criteria, extracted data, and assessed the risk of bias in the included studies. We used GRADE to assess the certainty of evidence. MAIN RESULTS In this review update, we included 267 studies (21,838 participants). Studies were conducted in 36 countries, with half (133/267) in China. Generally, studies were heterogeneous, and often poorly reported. We judged only 14 studies in meta-analyses as at low risk of bias for all domains and, on average, we considered 33% of studies in analyses of primary outcomes at high risk of bias. Is physical rehabilitation more effective than no (or minimal) physical rehabilitation? Compared to no physical rehabilitation, physical rehabilitation may improve IADL (standardised mean difference (SMD) 1.32, 95% confidence interval (CI) 1.08 to 1.56; 52 studies, 5403 participants; low-certainty evidence) and motor function (SMD 1.01, 95% CI 0.80 to 1.22; 50 studies, 5669 participants; low-certainty evidence). There was evidence of long-term benefits for these outcomes. Physical rehabilitation may improve balance (MD 4.54, 95% CI 1.36 to 7.72; 9 studies, 452 participants; low-certainty evidence) and likely improves gait velocity (SMD 0.23, 95% CI 0.05 to 0.42; 18 studies, 1131 participants; moderate-certainty evidence), but with no evidence of long-term benefits. Is physical rehabilitation more effective than attention control? The evidence is very uncertain about the effects of physical rehabilitation, as compared to attention control, on IADL (SMD 0.91, 95% CI 0.06 to 1.75; 2 studies, 106 participants), motor function (SMD 0.13, 95% CI -0.13 to 0.38; 5 studies, 237 participants), and balance (MD 6.61, 95% CI -0.45 to 13.66; 4 studies, 240 participants). Physical rehabilitation likely improves gait speed when compared to attention control (SMD 0.34, 95% CI 0.14 to 0.54; 7 studies, 405 participants; moderate-certainty evidence). Does additional physical rehabilitation improve outcomes? Additional physical rehabilitation may improve IADL (SMD 1.26, 95% CI 0.82 to 1.71; 21 studies, 1972 participants; low-certainty evidence) and motor function (SMD 0.69, 95% CI 0.46 to 0.92; 22 studies, 1965 participants; low-certainty evidence). Very few studies assessed these outcomes at long-term follow-up. Additional physical rehabilitation may improve balance (MD 5.74, 95% CI 3.78 to 7.71; 15 studies, 795 participants; low-certainty evidence) and gait velocity (SMD 0.59, 95% CI 0.26 to 0.91; 19 studies, 1004 participants; low-certainty evidence). Very few studies assessed these outcomes at long-term follow-up. Is any one approach to physical rehabilitation more effective than any other approach? Compared to other approaches, those that focus on functional task training may improve IADL (SMD 0.58, 95% CI 0.29 to 0.87; 22 studies, 1535 participants; low-certainty evidence) and motor function (SMD 0.72, 95% CI 0.21 to 1.22; 20 studies, 1671 participants; very low-certainty evidence) but the evidence in the latter is very uncertain. The benefit was sustained long-term. The evidence is very uncertain about the effect of functional task training on balance (MD 2.16, 95% CI -0.24 to 4.55) and gait velocity (SMD 0.28, 95% CI -0.01 to 0.56). Compared to other approaches, neurophysiological approaches may be less effective than other approaches in improving IADL (SMD -0.34, 95% CI -0.63 to -0.06; 14 studies, 737 participants; low-certainty evidence), and there may be no difference in improving motor function (SMD -0.60, 95% CI -1.32 to 0.12; 13 studies, 663 participants; low-certainty evidence), balance (MD -0.60, 95% CI -5.90 to 6.03; 9 studies, 292 participants; low-certainty evidence), and gait velocity (SMD -0.17, 95% CI -0.62 to 0.27; 16 studies, 630 participants; very low-certainty evidence), but the evidence is very uncertain about the effect on gait velocity. For all comparisons, the evidence is very uncertain about the effects of physical rehabilitation on adverse events and length of hospital stay. AUTHORS' CONCLUSIONS Physical rehabilitation, using a mix of different treatment components, likely improves recovery of function and mobility after stroke. Additional physical rehabilitation, delivered as an adjunct to 'usual' rehabilitation, may provide added benefits. Physical rehabilitation approaches that focus on functional task training may be useful. Neurophysiological approaches to physical rehabilitation may be no different from, or less effective than, other physical rehabilitation approaches. Certainty in this evidence is limited due to substantial heterogeneity, with mainly small studies and important differences between study populations and interventions. We feel it is unlikely that any studies published since November 2022 would alter our conclusions. Given the size of this review, future updates warrant consensus discussion amongst stakeholders to ensure the most relevant questions are explored for optimal decision-making.
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Affiliation(s)
- Alex Todhunter-Brown
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Ceri E Sellers
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Gillian D Baer
- Department of Physiotherapy, Queen Margaret University, Edinburgh, UK
| | - Pei Ling Choo
- Health & Social Sciences, Singapore Institute of Technology, Singapore, Singapore
| | - Julie Cowie
- Yunus Centre, Glasgow Caledonian University, Glasgow, UK
| | - Joshua D Cheyne
- UWS Library Services, University of the West of Scotland, Paisley, UK
| | - Peter Langhorne
- Academic Section of Geriatric Medicine, ICAMS, University of Glasgow, Glasgow, UK
| | | | - Jacqui Morris
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Pauline Campbell
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
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Noguchi KS, Moncion K, Wiley E, Morgan A, Huynh E, Balbim GM, Elliott B, Harris-Blake C, Krysa B, Koetsier B, Pinili K, Beauchamp MK, Phillips SM, Thabane L, Tang A. Prescribing strength training for stroke recovery: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med 2025; 59:185-197. [PMID: 39406459 DOI: 10.1136/bjsports-2024-108476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2024] [Indexed: 01/03/2025]
Abstract
OBJECTIVE To examine the effects of strength training on patient-important outcomes of stroke recovery and to quantify the influence of the exercise prescription on treatment effects. DESIGN Systematic review and meta-analysis. DATA SOURCES Eight electronic databases (MEDLINE, EMBASE, EMCARE, AMED, PsycINFO, CINAHL, SPORTDiscus, and Web of Science) and two clinical trial registries (ClinicalTrials.gov and WHO International Clinical Trials Registry Platform) were searched from inception to 19 June 2024. ELIGIBILITY CRITERIA Randomised controlled trials were eligible if they examined the effects of strength training compared with no exercise or usual care and reported at least one exercise prescription parameter. An advisory group of community members with lived experience of stroke helped inform outcomes most relevant to stroke recovery. RESULTS Forty-two randomised trials (N=2204) were included. Overall risk of bias was high across most outcomes. Strength training improved outcomes rated as 'critical for decision-making' by the advisory group, including walking capacity (standardised mean difference (SMD)=0.95 (95% CI 0.34-1.56)), balance (SMD=1.13 (0.51-1.75)), functional ability and mobility (SMD=0.61 (0.09-1.14)), and habitual (mean difference (MD)=0.05 m/s (0.02-0.09)) and fast-paced walking speed (MD=0.09 m/s (0.01-0.17)), with very low to moderate certainty of evidence, mainly due to risk of bias and inconsistency. More frequent strength training, traditional strength training programmes and power-focused intensities (ie, emphasis on movement velocity) were positively associated with walking capacity, health-related quality of life and fast-paced walking speed. CONCLUSION Strength training alone or combined with usual care improves stroke recovery outcomes that are important for decision-making. More frequent strength training, power-focused intensities and traditional programme designs may best support stroke recovery. PROSPERO REGISTRATION NUMBER CRD42023414077.
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Affiliation(s)
- Kenneth S Noguchi
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kevin Moncion
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Elise Wiley
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Ashley Morgan
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Eric Huynh
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Guilherme Moraes Balbim
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Brent Krysa
- MacStroke Canada Lab, Hamilton, Ontario, Canada
| | | | | | - Marla K Beauchamp
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Stuart M Phillips
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence & Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
- Biostatistics Unit, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Krause AA, Reimold NK, Embry AE, Knight HL, Jacobs CJ, Boan AD, Dean JC. Effect of mediolateral leg perturbations on walking balance in people with chronic stroke: A randomized controlled trial. PLoS One 2024; 19:e0311727. [PMID: 39378234 PMCID: PMC11460716 DOI: 10.1371/journal.pone.0311727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 09/18/2024] [Indexed: 10/10/2024] Open
Abstract
Many people with chronic stroke (PwCS) exhibit deficits in step width modulation, an important strategy for walking balance. A single exposure to swing leg perturbations can temporarily strengthen this modulation. The objective of this parallel, double-blinded, randomized controlled trial was to investigate whether repeated perturbations cause sustained increases in step modulation (NCT02964039; funded by the VA). 54 PwCS at the Medical University of South Carolina were randomly assigned to one of three intervention groups: Control (n = 18), with minimal forces; Assistive (n = 18), pushing the swing leg toward a mechanically appropriate location; Perturbing (n = 18), pushing the swing leg away from a mechanically appropriate location. All intervention groups included 24 training sessions over 12-weeks with up to 30-minutes of treadmill walking while interfaced with a novel force-field and a 12-week follow-up period, with five interspersed assessment sessions. Our primary outcome measure was paretic step width modulation, the partial correlation between step width and pelvis displacement (ρSW). Secondarily, we quantified swing and stance leg contributions to step modulation, clinical assessments of walking balance and confidence, and real-world falls. Outcomes were analyzed for participants who completed all assessment sessions (n = 44). Only the Perturbing group exhibited significant increases in paretic ρSW, which were present after 4-weeks of training and sustained through follow-up (t = 2.42-3.17). These changes were due to improved control of paretic swing leg positioning. However, perturbation-induced changes in step modulation were not always significantly greater than those in the Control group, and clinical assessments were similar across intervention groups. Participants in the Perturbing group experienced a lower fall rate than those in the Control group (incidence rate ratio = 0.53), although our small sample size warrants caution. The present results indicate that perturbations can cause sustained modifications of targeted biomechanical characteristics of post-stroke gait, although such changes alone may be insufficient to change more complex clinical assessments.
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Affiliation(s)
- Alexa A. Krause
- Medical University of South Carolina, Charleston, SC, United States of America
| | - Nicholas K. Reimold
- Medical University of South Carolina, Charleston, SC, United States of America
| | - Aaron E. Embry
- Medical University of South Carolina, Charleston, SC, United States of America
- Ralph H. Johnson VA Health Care System, Charleston, SC, United States of America
| | - Heather L. Knight
- Medical University of South Carolina, Charleston, SC, United States of America
| | - Camden J. Jacobs
- Medical University of South Carolina, Charleston, SC, United States of America
| | - Andrea D. Boan
- Medical University of South Carolina, Charleston, SC, United States of America
| | - Jesse C. Dean
- Medical University of South Carolina, Charleston, SC, United States of America
- Ralph H. Johnson VA Health Care System, Charleston, SC, United States of America
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Sengupta N, Begg R, Rao AS, Bajelan S, Said CM, Palaniswami M. Predicting improvement in biofeedback gait training using short-term spectral features from minimum foot clearance data. Front Bioeng Biotechnol 2024; 12:1417497. [PMID: 39262630 PMCID: PMC11387987 DOI: 10.3389/fbioe.2024.1417497] [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: 04/15/2024] [Accepted: 08/13/2024] [Indexed: 09/13/2024] Open
Abstract
Stroke rehabilitation interventions require multiple training sessions and repeated assessments to evaluate the improvements from training. Biofeedback-based treadmill training often involves 10 or more sessions to determine its effectiveness. The training and assessment process incurs time, labor, and cost to determine whether the training produces positive outcomes. Predicting the effectiveness of gait training based on baseline minimum foot clearance (MFC) data would be highly beneficial, potentially saving resources, costs, and patient time. This work proposes novel features using the Short-term Fourier Transform (STFT)-based magnitude spectrum of MFC data to predict the effectiveness of biofeedback training. This approach enables tracking non-stationary dynamics and capturing stride-to-stride MFC value fluctuations, providing a compact representation for efficient processing compared to time-domain analysis alone. The proposed STFT-based features outperform existing wavelet, histogram, and Poincaré-based features with a maximum accuracy of 95%, F1 score of 96%, sensitivity of 93.33% and specificity of 100%. The proposed features are also statistically significant (p < 0.001) compared to the descriptive statistical features extracted from the MFC series and the tone and entropy features extracted from the MFC percentage index series. The study found that short-term spectral components and the windowed mean value (DC value) possess predictive capabilities regarding the success of biofeedback training. The higher spectral amplitude and lower variance in the lower frequency zone indicate lower chances of improvement, while the lower spectral amplitude and higher variance indicate higher chances of improvement.
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Affiliation(s)
- Nandini Sengupta
- Department of Electrical and Electronic Engineering, The University of Melbourne, Parkville, VIC, Australia
| | - Rezaul Begg
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Aravinda S Rao
- Department of Electrical and Electronic Engineering, The University of Melbourne, Parkville, VIC, Australia
| | - Soheil Bajelan
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Catherine M Said
- Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, VIC, Australia
- Physiotherapy Department, Western Health, St Albans, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Melbourne, VIC, Australia
- Physiotherapy Department, Austin Health, Heidelberg, VIC, Australia
| | - Marimuthu Palaniswami
- Department of Electrical and Electronic Engineering, The University of Melbourne, Parkville, VIC, Australia
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Ringsten M, Ivanic B, Iwarsson S, Lexell EM. Interventions to improve outdoor mobility among people living with disabilities: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1407. [PMID: 38882933 PMCID: PMC11177337 DOI: 10.1002/cl2.1407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 06/18/2024]
Abstract
Background Around 15% of the global population live with some form of disabilities and experience worse health outcomes, less participation in the community and are part of fewer activities outside the home. Outdoor mobility interventions aim to improve the ability to move, travel and orient outside the home and could influence the number of activities outside the home, participation and quality of life. However, outdoor mobility interventions may also lead to harm like falls or injuries or have unforeseen effects which could lead to mortality or hospitalization. Objectives To assess the efficacy of interventions aiming to improve outdoor mobility for adults living with disabilities and to explore if the efficacy varies between different conditions and different intervention components. Search Methods Standard, extensive Campbell search methods were used, including a total of 12 databases searched during January 2023, including trial registries. Selection Criteria Only randomized controlled trials were included, focusing on people living with disabilities, comparing interventions to improve outdoor mobility to control interventions as well as comparing different types of interventions to improve outdoor mobility. Data Collection and Analysis Standard methodological procedures expected by Campbell were used. The following important outcomes were 1. Activity outside the home; 2. Engagement in everyday life activities; 3. Participation; 4. Health-related Quality of Life; 5. Major harms; 6. Minor harms. The impact of the interventions was evaluated in the shorter (≤6 months) and longer term (≥7 months) after starting the intervention. Results are presented using risk ratios (RR), risk difference (RD), and standardized mean differences (SMD), with the associated confidence intervals (CI). The risk of bias 2-tool and the GRADE-framework were used to assess the certainty of the evidence. Main Results The screening comprised of 12.894 studies and included 22 studies involving 2.675 people living with disabilities and identified 12 ongoing studies. All reported outcomes except one (reported in one study, some concerns of bias) had overall high risk of bias. Thirteen studies were conducted in participants with disabilities due to stroke, five studies with older adults living with disabilities, two studies with wheelchair users, one study in participants with disabilities after a hip fracture, and one study in participants with cognitive impairments. Skill training interventions versus control interventions (16 studies) The evidence is very uncertain about the benefits and harms of skill training interventions versus control interventions not aimed to improve outdoor mobility among all people living with disabilities both in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Skill training interventions may improve engagement in everyday life activities among people with disabilities in the shorter term (RR: 1.46; 95% CI: 1.16 to 1.84; I 2 = 7%; RD: 0.15; 95% CI: -0.02 to 0.32; I 2 = 71%; 692 participants; three studies; low certainty evidence), but the evidence is very uncertain in the longer term, based on very low certainty evidence. Subgroup analysis of skill training interventions among people living with disabilities due to cognitive impairments suggests that such interventions may improve activity outside the home in the shorter term (SMD: 0.44; 95% CI: 0.07 to 0.81; I 2 = NA; 118 participants; one study; low certainty evidence). Subgroup analysis of skill training interventions among people living with cognitive impairments suggests that such interventions may improve health-related quality of life in the shorter term (SMD: 0.49; 95% CI: 0.12 to 0.88; I 2 = NA; 118 participants; one study; low certainty evidence). Physical training interventions versus control interventions (five studies) The evidence is very uncertain about the benefits and harms of physical training interventions versus control interventions not aimed to improve outdoor mobility in the shorter term (≤6 months) and longer term (≥7 months) for: Engagement in everyday life activities; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Physical training interventions may improve activity outside the home in the shorter (SMD: 0.35; 95% CI: 0.08 to 0.61; I 2 = NA; 228 participants; one study; low certainty evidence) and longer term (≥7 months) (SMD: 0.27; 95% CI: 0.00 to 0.54; I 2 = NA; 216 participants; one study; low certainty evidence). Comparison of different outdoor mobility interventions (one study) The evidence is very uncertain about the benefits and harms of outdoor mobility interventions of different lengths in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Engagement in everyday life activities; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. No studies explored the efficacy of other types of interventions. Authors’ Conclusions Twenty-two studies of interventions to improve outdoor mobility for people living with disabilities were identified, but the evidence still remains uncertain about most benefits and harms of these interventions, both in the short- and long term. This is primarily related to risk of bias, small underpowered studies and limited reporting of important outcomes for people living with disabilities. For people with disabilities, skill training interventions may improve engagement in everyday life in the short term, and improve activity outside the home and health-related quality of life for people with cognitive impairments in the short term. Still, this is based on low certainty evidence from few studies and should be interpreted with caution. One study with low certainty evidence suggests that physical training interventions may improve activity outside the home in the short term. In addition, the effect sizes across all outcomes were considered small or trivial, and could be of limited relevance to people living with disabilities. The evidence is currently uncertain if there are interventions that can improve outdoor mobility for people with disabilities, and can improve other important outcomes, while avoiding harms. To guide decisions about the use of interventions to improve outdoor mobility, future studies should use more rigorous design and report important outcomes for people with disabilities to reduce the current uncertainty.
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Affiliation(s)
- Martin Ringsten
- Cochrane Sweden, Research and Development Skåne University Hospital Lund Sweden
- Department of Health Sciences Lund University Lund Sweden
| | | | | | - Eva Månsson Lexell
- Department of Health Sciences Lund University Lund Sweden
- Department of Neurology, Rehabilitation Medicine, Cognitive Medicine and Geriatrics Skåne University Hospital Lund-Malmö Sweden
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Oliveira SG, Ribeiro JAM, Silva ÉSM, Uliam NR, Silveira AF, Araújo PN, Camargo AI, Urruchia VRR, Nogueira SL, Russo TL. Interventions to Change Movement Behaviors After Stroke: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024; 105:381-410. [PMID: 37541356 DOI: 10.1016/j.apmr.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVE This systematic review aimed to determine which interventions increase physical activity (PA) and decrease sedentary behavior (SB) based on objective measures of movement behavior in individuals with stroke. DATA SOURCES The PubMed (Medline), EMBASE, Scopus, CINAHL (EBSCO), and Web of Science databases were searched for articles published up to January 3, 2023. STUDY SELECTION The StArt 3.0.3 BETA software was used to screen titles, abstracts, and full texts for studies with randomized controlled trial designs; individuals with stroke (≥18 years of age); interventions aimed at increasing PA or decreasing SB; and objective measurement instruments. DATA EXTRACTION Data extraction was standardized, considering participants and assessments of interest. The risk of bias and quality of evidence of the included studies were assessed. DATA SYNTHESIS Twenty-eight studies involving 1855 patients were included. Meta-analyses revealed that in the post-stroke acute/subacute phase, exercise interventions combined with behavior change techniques (BCTs) increased both daily steps (standardized mean difference [SMD]=0.65, P=.0002) and time spent on moderate-to-vigorous intensity physical activities (MVPAs) duration of PA (SMD=0.68, P=.0004) with moderate-quality evidence. In addition, interventions based only on BCTs increased PA levels with very low-quality evidence (SMD (low-intensity physical activity)=0.36, P=.02; SMD (MVPA)=0.56, P=.0004) and decreased SB with low-quality evidence (SMD=0.48, P=.03). In the post-stroke chronic phase, there is statistical significance in favor of exercise-only interventions in PA frequency (steps/day) with moderate-quality evidence (SMD=0.68, P=.002). In general, the risk of bias in the included studies was low. CONCLUSIONS In the acute/subacute phase after stroke, the use of BCTs combined with exercise can increase the number of daily steps and time spent on MVPA. In contrast, in the post-stroke chronic phase, exercise-only interventions resulted in a significant increase in daily steps.
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Affiliation(s)
| | | | | | - Nicoly Ribeiro Uliam
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Ana Flávia Silveira
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | | | - Ana Isabela Camargo
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | | | | | - Thiago Luiz Russo
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.
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Goncalves S, Le Bourvellec M, Mandigout S, Duclos NC. Impact of Active Physiotherapy on Physical Activity Level in Stroke Survivors: A Systematic Review and Meta-Analysis. Stroke 2023; 54:3097-3106. [PMID: 37909205 DOI: 10.1161/strokeaha.123.043629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/05/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Stroke survivors are frequently physically inactive. However, evidence of the effectiveness of active physiotherapy on physical activity level in stroke survivors is scarce. METHODS We conducted a systematic review and meta-analysis of randomized controlled trials according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement, covering electronic searches from inception to March 16, 2022. Participants: Stroke survivors living in the community. Intervention: Any active physiotherapy, that is, involving exercises that require voluntary effort. Outcome measure: Objective and subjective physical activity level. RESULTS Of 5590 identified references, 25 randomized controlled trials were eligible, and 21 had available data. The random-effects meta-analysis resulted in a small, significant effect size in favor of active physiotherapy measured using objective or subjective tools (21 studies, 1834 participants, standardized mean difference, 0.22 [95% CI, 0.04-0.40]; heterogeneity I2=65%), and a medium significant effect when objective tools were used (9 studies, 424 participants, standardized mean differences, 0.48 [95% CI, 0.03-0.92]; I2=73%). Meta-regression showed that 35% of the variance in trial outcome was explained by the measurement tool (objective or subjective) and 23% by age. None of the variances were associated with a specific dosage in terms of frequency, time, exercise duration, or the severity of the disability. CONCLUSIONS Active physiotherapy seems to increase objective physical activity in community-dwelling stroke survivors. However, the evidence is of very low certainty. REGISTRATION URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42022315639.
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Affiliation(s)
- Stéphanie Goncalves
- HAVAE, Limoges University, Department of Physical Activity and Sport Sciences, UR20217, F-87000, France (S.G., S.M.)
| | - Morgane Le Bourvellec
- MOVE, Poitiers University, Faculty of Sport Sciences, UR20296, F-86000, France (M.L.B.)
| | - Stéphane Mandigout
- HAVAE, Limoges University, Department of Physical Activity and Sport Sciences, UR20217, F-87000, France (S.G., S.M.)
- ILFOMER, Limoges University, F-87000, France (S.M.)
| | - Noémie C Duclos
- Bordeaux University, INSERM, BPH, U1219, Team ACTIVE, F-33000, France (N.C.D.)
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Bhatt T, Dusane S, Gangwani R, Wang S, Kannan L. Motor adaptation and immediate retention to overground gait-slip perturbation training in people with chronic stroke: an experimental trial with a comparison group. Front Sports Act Living 2023; 5:1195773. [PMID: 37780126 PMCID: PMC10533933 DOI: 10.3389/fspor.2023.1195773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/21/2023] [Indexed: 10/03/2023] Open
Abstract
Background Perturbation-based training has shown to be effective in reducing fall-risk in people with chronic stroke (PwCS). However, most evidence comes from treadmill-based stance studies, with a lack of research focusing on training overground perturbed walking and exploring the relative contributions of the paretic and non-paretic limbs. This study thus examined whether PwCS could acquire motor adaptation and demonstrate immediate retention of fall-resisting skills following bilateral overground gait-slip perturbation training. Methods 65 PwCS were randomly assigned to either (i) a training group, that received blocks of eight non-paretic (NP-S1 to NP-S8) and paretic (P-S1 to P-S8) overground slips during walking followed by a mixed block (seven non-paretic and paretic slips each interspersed with unperturbed walking trials) (NP-S9/P-S9 to NP-S15/P-S15) or (ii) a control group, that received a single non-paretic and paretic slip in random order. The assessor and training personnel were not blinded. Immediate retention was tested for the training group after a 30-minute rest break. Primary outcomes included laboratory-induced slip outcomes (falls and balance loss) and center of mass (CoM) state stability. Secondary outcomes to understand kinematic contributors to stability included recovery strategies, limb kinematics, slipping kinematics, and recovery stride length. Results PwCS within the training group showed reduced falls (p < 0.01) and improved post-slip stability (p < 0.01) from the first trial to the last trial of both paretic and non-paretic slip blocks (S1 vs. S8). During the mixed block training, there was no further improvement in stability and slipping kinematics (S9 vs. S15) (p > 0.01). On comparing the first and last training trial (S1 vs. S15), post-slip stability improved on both non-paretic and paretic slips, however, pre-slip stability improved only on the non-paretic slip (p < 0.01). On the retention trials, the training group had fewer falls and greater post-slip stability than the control group on both non-paretic and paretic slips (p < 0.01). Post-slip stability on the paretic slip was lower than that on the non-paretic slip for both groups on retention trials (p < 0.01). Conclusion PwCS can reduce laboratory-induced slip falls and backward balance loss outcomes by adapting their post-slip CoM state stability after bilateral overground gait-slip perturbation training. Such reactive adaptations were better acquired and retained post-training in PwCS especially on the non-paretic slips than paretic slips, suggesting a need for higher dosage for paretic slips. Clinical registry number NCT03205527.
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Affiliation(s)
- Tanvi Bhatt
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
| | - Shamali Dusane
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
- Ph.D. program in Rehabilitation Sciences, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
| | - Rachana Gangwani
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
- MS program in Rehabilitation Sciences, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
| | - Shuaijie Wang
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
| | - Lakshmi Kannan
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
- Ph.D. program in Rehabilitation Sciences, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
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10
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Feng F, Xu H, Sun Y, Zhang X, Li N, Sun X, Tian X, Zhao R. Exercise for prevention of falls and fall-related injuries in neurodegenerative diseases and aging-related risk conditions: a meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1187325. [PMID: 37534209 PMCID: PMC10393124 DOI: 10.3389/fendo.2023.1187325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/21/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction Neurodegenerative diseases often cause motor and cognitive deterioration that leads to postural instability and motor impairment, while aging-associated frailty frequently results in reduced muscle mass, balance, and mobility. These conditions increase the risk of falls and injuries in these populations. This study aimed to determine the effects of exercise on falls and consequent injuries among individuals with neurodegenerative diseases and frail aging people. Methods Electronic database searches were conducted in PubMed, Cochrane Library, SportDiscus, and Web of Science up to 1 January 2023. Randomized controlled trials that reported the effects of exercise on falls and fall-related injuries in neurodegenerative disease and frail aging people were eligible for inclusion. The intervention effects for falls, fractures, and injuries were evaluated by calculating the rate ratio (RaR) or risk ratio (RR) with 95% confidence interval (CI). Results Sixty-four studies with 13,241 participants met the inclusion criteria. Exercise is effective in reducing falls for frail aging people (RaR, 0.75; 95% CI, 0.68-0.82) and participants with ND (0.53, 0.43-0.65) [dementia (0.64, 0.51-0.82), Parkinson's disease (0.49, 0.39-0.69), and stroke survivors (0.40, 0.27-0.57)]. Exercise also reduced fall-related injuries in ND patients (RR, 0.66; 95% CI, 0.48-0.90) and decreased fractures (0.63, 0.41-0.95) and fall-related injuries (0.89, 0.84-0.95) among frail aging people. For fall prevention, balance and combined exercise protocols are both effective, and either short-, moderate-, or long-term intervention duration is beneficial. More importantly, exercise only induced a very low injury rate per participant year (0.007%; 95% CI, 0-0.016) and show relatively good compliance with exercise (74.8; 95% CI, 69.7%-79.9%). Discussion Exercise is effective in reducing neurodegenerative disease- and aging-associated falls and consequent injuries, suggesting that exercise is an effective and feasible strategy for the prevention of falls.
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Affiliation(s)
- Feifei Feng
- College of Physical Education, Yangzhou University, Yangzhou, China
- School of Humanities and Education, Guangzhou Nanyang Polytechnic College, Guangzhou, China
| | - Haocheng Xu
- College of Physical Education, Yangzhou University, Yangzhou, China
| | - Yu Sun
- College of Physical Education, Yangzhou University, Yangzhou, China
| | - Xin Zhang
- College of Physical Education, Yangzhou University, Yangzhou, China
| | - Nan Li
- College of Physical Education, Yangzhou University, Yangzhou, China
| | - Xun Sun
- College of Physical Education, Yangzhou University, Yangzhou, China
| | - Xin Tian
- College of Physical Education, Yangzhou University, Yangzhou, China
| | - Renqing Zhao
- College of Physical Education, Yangzhou University, Yangzhou, China
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Geller D, Winterbottom L, Goldberg C, Nilsen DM, Mahoney D, Gillen G. Exercise for Adults With Stroke to Improve ADL and/or Functional Mobility Performance (2012-2019). Am J Occup Ther 2023; 77:24093. [PMID: 37093617 DOI: 10.5014/ajot.2023.77s10004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on interventions to improve activities of daily living (ADL) and functional mobility performance for people with stroke. This theme reports on exercise interventions.
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Affiliation(s)
- Daniel Geller
- Daniel Geller, EdD, MPH, OTR/L, is Assistant Professor, Programs in Occupational Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center
| | - Lauren Winterbottom
- Lauren Winterbottom, MS, OTR/L, is Research Occupational Therapist, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center; and Instructor, Programs in Occupational Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center
| | - Carly Goldberg
- Carly Goldberg, MS, OTR/L, is Advanced Clinician, Inpatient Rehabilitation Unit, New York Presbyterian-Columbia University Irving Medical Center; and Instructor, Programs in Occupational Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center
| | - Dawn M Nilsen
- Dawn M. Nilsen, EdD, OTR/L, FAOTA, is Professor and Interim Program Director, Programs in Occupational Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center; and Per Diem Occupational Therapist, New York Presbyterian-Columbia University Irving Medical Center
| | - Danielle Mahoney
- Danielle Mahoney, OTD, OTR/L, is Assistant Professor, Programs in Occupational Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center
| | - Glen Gillen
- Glen Gillen EdD, OTR/L, FAOTA, is Professor, Programs in Occupational Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center
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Williams G, Hassett L, Clark R, Bryant AL, Morris ME, Olver J, Ada L. Ballistic resistance training has a similar or better effect on mobility than non-ballistic exercise rehabilitation in people with a traumatic brain injury: a randomised trial. J Physiother 2022; 68:262-268. [PMID: 36253280 DOI: 10.1016/j.jphys.2022.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/01/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022] Open
Abstract
QUESTIONS In people recovering from traumatic brain injury, is a 3-month ballistic resistance training program targeting three lower limb muscle groups more effective than non-ballistic exercise rehabilitation for improving mobility, strength and balance? Does improved mobility translate to better health-related quality of life? DESIGN A prospective, multicentre, randomised trial with concealed allocation, intention-to-treat analysis and blinded measurement. PARTICIPANTS A total of 144 people with a neurological movement disorder affecting mobility as a result of traumatic brain injury. INTERVENTION For 3 months, the experimental group had three 60-minute sessions of non-ballistic exercise rehabilitation per week replaced by ballistic resistance training. The control group had non-ballistic exercise rehabilitation of equivalent time. The non-ballistic exercise rehabilitation consisted of balance exercises, lower limb stretching, conventional strengthening exercises, cardiovascular fitness training and gait training. OUTCOME MEASURES The primary outcome was mobility measured using the High-Level Mobility Assessment Tool (HiMAT). Secondary outcomes were walking speed, strength, balance and quality of life. They were measured at baseline (0 months), after completion of the 3-month intervention (3 months) and 3 months after cessation of intervention (6 months). RESULTS After 3 months of ballistic resistance training, the experimental group scored 3 points (95% CI 0 to 6) higher on the 54-point HiMAT than the control group and remained 3 points (95% CI -1 to 6) higher at 6 months. Although there was a transient decrement in balance at 3 months in the experimental group, the interventions had similar effects on all secondary outcomes by 6 months. Participants with a baseline HiMAT < 27 gained greater benefit from ballistic training: 6 points (1 to 10) on the HiMAT. CONCLUSION This randomised trial shows that ballistic resistance training has a similar or better effect on mobility than non-ballistic training in people with traumatic brain injury. It may be better targeted towards those with more severe mobility limitations. TRIAL REGISTRATION ACTRN12611001098921.
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Affiliation(s)
- Gavin Williams
- Physiotherapy Department, Epworth Healthcare, Melbourne, Australia; School of Physiotherapy, Faulty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.
| | - Leanne Hassett
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Institute for Musculoskeletal Health, The University of Sydney, Sydney Local Health District, Sydney, Australia
| | - Ross Clark
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia
| | - Adam L Bryant
- School of Physiotherapy, Faulty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Meg E Morris
- The Victorian Rehabilitation Centre Healthscope & Academic and Research Collaborative in Health (ARCH), La Trobe University, Melbourne, Australia
| | - John Olver
- Rehabilitation Medicine, Epworth Healthcare, Melbourne, Australia
| | - Louise Ada
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Greiman L, Ravesloot C, S Goddard K, Ward B. Effects of a consumer driven home modification intervention on community participation for people with mobility disabilities. Disabil Health J 2022; 15:101210. [PMID: 34521604 PMCID: PMC10798581 DOI: 10.1016/j.dhjo.2021.101210] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Community participation has become a key outcome measure for people with disabilities. This has resulted in a shift in researchers focus from the individual to the environment. However, research has focused primarily on participation barriers in the community with limited research examining the role of the home environment. For people with mobility disabilities the home environment is the starting place for community participation and research is needed to understand the relationship between the home and participation outcomes. OBJECTIVE This study explores the effects of a consumer-driven home modification intervention on community participation for people with mobility disabilities. METHODS We conducted a randomized control trial (from June 2017-April 2019) of the effects of a consumer-directed home modification intervention on community participation. The intervention, the Home Usability Program, was implemented with consumers at two different Centers for Independent Living (N = 195) and included a self-assessment of their home environment and implementation of a home usability change. RESULTS The Home Usability program positively affected the community participation of people with mobility disabilities. Overall, intervention participants reported a 39.5% (p < .05) increase in social and recreational activities immediately following the intervention relative to the control group after controlling for health status and month when outcome data were collected. Six months after the intervention, this effect returned to baseline. CONCLUSIONS Community-based, consumer-driven home modification programs show promise for improving community participation outcomes among people with disabilities, however, more research is needed to understand why results did not persist.
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Affiliation(s)
- Lillie Greiman
- The University of Montana Research and Training Center on Disability in Rural Communities, United States.
| | - Craig Ravesloot
- The University of Montana Research and Training Center on Disability in Rural Communities, United States
| | - Kelsey S Goddard
- The University of Kansas Research and Training Center on Independent Living (KU-RTCIL), United States
| | - Bryce Ward
- The University of Montana Research and Training Center on Disability in Rural Communities, United States
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Peniche PDC, Pinto APDS, Ribeiro RLMN, Martins JC, Faria CDCDM. Recruitment, retention, attendance, and adherence of a randomized controlled trial to evaluate the effects of task-specific training with individuals post stroke. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/20008529012022en] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Individuals who suffered stroke benefit from different therapeutic strategies whose efficacy has been proved by well-designed randomized controlled trials (RCTs). Understanding study steps may assist researchers in conducting future RCTs. Thus, the objective of this study was to describe the process of recruitment, retention, attendance, and adherence in conducting RCTs with individuals in the chronic phase of stroke in the municipality of Belo Horizonte/MG/Brazil, with the purpose of investigating the efficacy of specific task training for both lower and upper limbs in improving patients’ physical activity and mobility. Results showed that, of the 674 potential participants, it was impossible to contact 240 individuals and 384 were excluded from our sample for failing to meet eligibility criteria. In total, 50 individuals participated in clinical evaluations and 14 were excluded from the study for the same reason. Overall, 36 individuals started the interventions, a 5.3% recruitment rate. An 80.6% retention rate was observed. In total, seven individuals left the study, mainly due to lack of interest in the activities. We found an 80.9% attendance rate, and the main reason for missing medical appointments was incompatibility with treatment schedule. We also observed an 82.7% adherence rate. Of these, 180 interrupted sessions were mainly due to patients leaving early. These results indicate some difficulties found in conducting RCTs with individuals in the chronic phase of stroke, especially regarding specific task training. Despite these difficulties, the proposed intervention can be considered feasible.
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Peniche PDC, Pinto APDS, Ribeiro RLMN, Martins JC, Faria CDCDM. Recrutamento, retenção, presença e adesão de um ensaio clínico aleatorizado para avaliar os efeitos do treino específico da tarefa em indivíduos pós-acidente vascular encefálico. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/20008529012022pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Indivíduos acometidos pelo acidente vascular encefálico (AVE) se beneficiam de diferentes estratégias terapêuticas que apresentam comprovação da eficácia por meio da condução de ensaios clínicos aleatorizados (ECA) bem delineados. Compreender as etapas do estudo pode auxiliar os pesquisadores na realização de futuros ensaios clínicos. Dessa forma, o objetivo deste estudo foi descrever o processo de recrutamento, retenção, presença e adesão na condução de um ECA realizado com indivíduos pós-AVE na fase crônica na cidade de Belo Horizonte (MG), Brasil, com o propósito de investigar a eficácia do treino específico da tarefa para membros superiores e inferiores na melhora do nível de atividade física e mobilidade. Nos resultados, foi observado que dos 674 potenciais participantes, não foi possível contatar 240; 384 não foram avaliados por não atenderem aos critérios de elegibilidade. Participaram da avaliação presencial 50 indivíduos e 14 não fizeram parte do estudo pelo mesmo motivo. Apenas 36 indivíduos iniciaram as intervenções (taxa de recrutamento de 5,3%). Uma taxa de retenção de 80,6% foi observada. Sete indivíduos abandonaram o estudo, principalmente por desinteresse pelas atividades. A taxa de presença foi de 80,9%, e o principal motivo para ausência nas sessões foi incompatibilidade de horário com as consultas médicas. A taxa de adesão foi de 82,7%, com 180 interrupções durante as sessões, sendo sair mais cedo o motivo mais comum. Esses resultados indicam algumas dificuldades no processo de condução do ECA com indivíduos na fase crônica do AVE envolvendo treino específico da tarefa. Apesar dessas dificuldades, a intervenção proposta pode ser considerada viável.
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Alayat MSM, Almatrafi NA, El Fiky AAR, Elsodany AM, Shousha TM, Basuodan R. The Effectiveness of Perturbation-Based Training in the Treatment of Patients With Stroke: A Systematic Review and Meta-Analysis. Neurosci Insights 2022; 17:26331055221114818. [PMID: 35910084 PMCID: PMC9329815 DOI: 10.1177/26331055221114818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: To investigate the effectiveness of perturbation-based training (PBT) on balance and balance confidence in patients with stroke. Methods: Systematic searching was performed from inception to November 2021. The inclusion criteria were RCTs assessed the effectiveness of PBT in patients with stroke. Data regarding participants, intervention parameters, outcome measures, follow-up, and main results were extracted. The outcomes were balance and balance confidence. Methodological quality and quality of evidence were assessed using the Physiotherapy Evidence Database (PEDro) scale and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system; respectively. Data analysis: A total of 7 articles )271 patients) were included. A meta-analysis using a random-effect model was performed on 6 studies. Standardized mean difference (SMD) with a 95% confidence interval was calculated for balance and balance confidence. Results: PEDro scale revealed 5 good-quality and 2 fair-quality studies. The currently available evidence showed significant effect of PBT in improving balance (SMD 0.60 [95% CI 0.15-1.06]; P = .01; very low-quality evidence) and non-significant in improving balance confidence (SMD 0.11 [95% CI −0.24 to 0.45]; P = .55; low-quality evidence). Conclusion: PBT may improve balance in patients with stroke, however its effect on balance confidence was limited. The quality of the evidence was low or very low with little confidence in the effect estimate, which suggests further high-quality trials are required. Registration: PROSPERO registration number (CRD42021291474).
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Affiliation(s)
- Mohamed Salaheldien Mohamed Alayat
- Physiotherapy and Rehabilitation Department, Faculty of Applied Medical Science, Umm Al-Qura University, Makkah, Saudi Arabia
- Department of Basic Science, Faculty of Physical Therapy, Cairo University, Egypt
| | - Nahla Ahmad Almatrafi
- Physiotherapy and Rehabilitation Department, Faculty of Applied Medical Science, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Amir Abdel Raouf El Fiky
- Department of Physical Therapy for Neurological Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | | | - Tamer Mohamed Shousha
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Reem Basuodan
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University Riyadh, Saudi Arabia
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Miller A, Reisman DS, Billinger SA, Dunning K, Doren S, Ward J, Wright H, Wagner E, Carl D, Gerson M, Awosika O, Khoury J, Kissela B, Boyne P. Moderate-intensity exercise versus high-intensity interval training to recover walking post-stroke: protocol for a randomized controlled trial. Trials 2021; 22:457. [PMID: 34271979 PMCID: PMC8284012 DOI: 10.1186/s13063-021-05419-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 07/02/2021] [Indexed: 12/12/2022] Open
Abstract
Background Stroke results in neurologic impairments and aerobic deconditioning that contribute to limited walking capacity which is a major barrier post-stroke. Current exercise recommendations and stroke rehabilitation guidelines recommend moderate-intensity aerobic training post-stroke. Locomotor high-intensity interval training is a promising new strategy that has shown significantly greater improvements in aerobic fitness and motor performance than moderate-intensity aerobic training in other populations. However, the relative benefits and risks of high-intensity interval training and moderate-intensity aerobic training remain poorly understood following stroke. In this study, we hypothesize that locomotor high-intensity interval training will result in greater improvements in walking capacity than moderate-intensity aerobic training. Methods Using a single-blind, 3-site randomized controlled trial, 50 chronic (> 6 months) stroke survivors are randomly assigned to complete 36 locomotor training sessions of either high-intensity interval training or moderate-intensity aerobic training. Main eligibility criteria are age 40–80 years, single stroke for which the participant received treatment (experienced 6 months to 5 years prior to consent), walking speed ≤ 1.0 m/s, able to walk at least 3 min on the treadmill at ≥ 0.13 m/s (0.3 mph), stable cardiovascular condition (American Heart Association class B), and the ability to walk 10 m overground without continuous physical assistance. The primary outcome (walking capacity) and secondary outcomes (self-selected and fast gait speed, aerobic fitness, and fatigue) are assessed prior to initiating training and after 4 weeks, 8 weeks, and 12 weeks of training. Discussion This study will provide fundamental new knowledge to inform the selection of intensity and duration dosing parameters for gait recovery and optimization of aerobic training interventions in chronic stroke. Data needed to justify and design a subsequent definitive trial will also be obtained. Thus, the results of this study will inform future stroke rehabilitation guidelines on how to optimally improve walking capacity following stroke. Trial registration ClinicalTrials.govNCT03760016. Registered on November 30, 2018.
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Affiliation(s)
- Allison Miller
- Department of Biomechanics and Movement Sciences Program, University of Delaware, Newark, DE, 19713, USA
| | - Darcy S Reisman
- Department of Biomechanics and Movement Sciences Program, University of Delaware, Newark, DE, 19713, USA.,Department of Physical Therapy, University of Delaware, Newark, DE, 19713, USA
| | - Sandra A Billinger
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA
| | - Sarah Doren
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA
| | - Jaimie Ward
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Henry Wright
- Department of Physical Therapy, University of Delaware, Newark, DE, 19713, USA
| | - Erin Wagner
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA
| | - Daniel Carl
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA
| | - Myron Gerson
- Departments of Cardiology and Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Oluwole Awosika
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Jane Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brett Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA.
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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: 15] [Impact Index Per Article: 3.8] [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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Ali A, Tabassum D, Baig SS, Moyle B, Redgrave J, Nichols S, McGregor G, Evans K, Totton N, Cooper C, Majid A. Effect of Exercise Interventions on Health-Related Quality of Life After Stroke and Transient Ischemic Attack: A Systematic Review and Meta-Analysis. Stroke 2021; 52:2445-2455. [PMID: 34039033 DOI: 10.1161/strokeaha.120.032979] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Exercise interventions have been shown to help physical fitness, walking, and balance after stroke, but data are lacking on whether such interventions lead to improvements in health-related quality of life (HRQoL). In this systematic review and meta-analysis, 30 randomized controlled trials (n=1836 patients) were found from PubMed, OVID MEDLINE, Web of Science, CINAHL, SCOPUS, The Cochrane Library, and TRIP databases when searched from 1966 to February 2020 that examine the effects of exercise interventions on HRQoL after stroke or transient ischemic attack. Exercise interventions resulted in small to moderate beneficial effects on HRQoL at intervention end (standardized mean difference, -0.23 [95% CI, -0.40 to -0.07]) that appeared to diminish at longer-term follow-up (standardized mean difference, -0.11 [95% CI, -0.26 to 0.04]). Exercise was associated with moderate improvements in physical health (standardized mean difference, -0.33 [95% CI, -0.61 to -0.04]) and mental health (standardized mean difference, -0.29 [95% CI, -0.49 to -0.09]) domains of HRQoL while effects on social or cognitive composites showed little difference. Interventions that were initiated within 6 months, lasted at least 12 weeks in duration, involved at least 150 minutes per week, and included resistance training appeared most effective. Exercise can lead to moderate beneficial effects on HRQoL and should be considered an integral part of stroke rehabilitation.
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Affiliation(s)
- Ali Ali
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience, Sheffield NIHR Biomedical Research Centre, United Kingdom (A.A.)
| | - Dina Tabassum
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (D.T., S.S.B., B.M., J.R., A.M.), University of Sheffield, United Kingdom
| | - Sheharyar S Baig
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (D.T., S.S.B., B.M., J.R., A.M.), University of Sheffield, United Kingdom
| | - Bethany Moyle
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (D.T., S.S.B., B.M., J.R., A.M.), University of Sheffield, United Kingdom
| | - Jessica Redgrave
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (D.T., S.S.B., B.M., J.R., A.M.), University of Sheffield, United Kingdom
| | - Simon Nichols
- Centre for Sports and Exercise Science, Sheffield Hallam University, United Kingdom (S.N.)
| | - Gordon McGregor
- Cardiac Rehabilitation, University Hospitals Coventry and Warwickshire NHS Trust, University of Coventry, United Kingdom (G.M.)
| | - Katherine Evans
- Department of Geriatrics and Stroke, Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom (K.E.)
| | - Nikki Totton
- School of Health and Related Research (N.K., C.C.), University of Sheffield, United Kingdom
| | - Cindy Cooper
- School of Health and Related Research (N.K., C.C.), University of Sheffield, United Kingdom
| | - Arshad Majid
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (D.T., S.S.B., B.M., J.R., A.M.), University of Sheffield, United Kingdom
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Ambulatory activity in stroke survivors associated with functional outcome and quality of life: an observational cohort study. Ann Phys Rehabil Med 2021; 65:101540. [PMID: 33984539 DOI: 10.1016/j.rehab.2021.101540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 02/19/2021] [Accepted: 04/05/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Physical activity is beneficial in stroke prevention and recovery. Understanding activity dynamics and its effect on outcome after stroke is important to improve recommendations and develop interventions. OBJECTIVES We examined serial changes in daily ambulatory activity (AA) averaged over 1 week in people with subacute to chronic stroke and its association with functional outcome (modified Rankin scale [mRS]) and quality of life (EQ-5D-3L). METHODS This observational study examined AA in stroke survivors with no to moderate disability (US National Institute of Stroke Scale [NIHSS] score) who were mostly community dwelling and had cryptogenic stroke based on data from the Continuous Cardiac Monitoring to Assess Atrial Fibrillation After Cryptogenic Stroke study. The participants underwent long-term AA monitoring by accelerometric activity data obtained from an insertable cardiac monitor without receiving any specific encouragement regarding physical activity. We analysed AA changes and assessed the association between baseline AA and mRS/EQ-5D-3L scores. A small group of participants had follow-up data for 2 years, which allowed for analysing long-term serial changes. RESULTS We included 186 participants (mean [SD] age 61.3 [11.2] years, 67% male, mean 39 [28] days after stroke). AA increased during the subacute phase in individuals with mild (NIHSS score 1-4, p<0.001) and moderate (NIHSS score 5-10, p=0.013) disability but not in the non-impaired group. Baseline AA was inversely associated with NIHSS score (p<0.001) and was associated with mRS score (p=0.001) and weakly correlated with EQ-5D-3L score at 6 months (p=0.032, r=0.22). For the 45 participants with follow-up data (mean age 64.5 [9.7] years, 80% male, mean 34 [21] days after stroke), AA remained stable. CONCLUSION AA increased in stroke survivors with impairments but remained stable in those whose symptoms had resolved. AA during the early subacute period was associated with mRS and EQ-5D-3L scores at 6 months. Insertable cardiac monitoring offers a feasible method for monitoring activity over prolonged periods in people after stroke. Its increased use may offer an opportunity to overcome the limited reliability and validity of many existing measures. TRIAL REGISTRATION ClinicalTrials.gov (NCT00924638).
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21
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Safety and Effectiveness of Long-Term Exercise Interventions in Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Sports Med 2021; 50:1095-1106. [PMID: 32020543 DOI: 10.1007/s40279-020-01259-y] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Physical exercise is beneficial to reduce the risk of several conditions associated with advanced age, but to our knowledge, no previous study has examined the association of long-term exercise interventions (≥ 1 year) with the occurrence of dropouts due to health issues and mortality, or the effectiveness of physical exercise versus usual primary care interventions on health-related outcomes in older adults (≥ 65 years old). OBJECTIVE To analyze the safety and effectiveness of long-term exercise interventions in older adults. METHODS We conducted a systematic review with meta-analysis examining the association of long-term exercise interventions (≥ 1 year) with dropouts from the corresponding study due to health issues and mortality (primary endpoint), and the effects of these interventions on health-related outcomes (falls and fall-associated injuries, fractures, physical function, quality of life, and cognition) (secondary endpoints). RESULTS Ninety-three RCTs and six secondary studies met the inclusion criteria and were included in the analyses (n = 28,523 participants, mean age 74.2 years). No differences were found between the exercise and control groups for the risk of dropouts due to health issues (RR = 1.05, 95% CI 0.95-1.17) or mortality (RR = 0.93, 95% CI 0.83-1.04), although a lower mortality risk was observed in the former group when separately analyzing clinical populations (RR = 0.67, 95% CI 0.48-0.95). Exercise significantly reduced the number of falls and fall-associated injuries, and improved physical function and cognition. These results seemed independent of participants' baseline characteristics (age, physical function, and cognitive status) and exercise frequency. CONCLUSIONS Long-term exercise training does not overall influence the risk of dropouts due to health issues or mortality in older adults, and results in a reduced mortality risk in clinical populations. Moreover, exercise reduces the number of falls and fall-associated injuries, and improves physical function and cognition in this population.
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22
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Forster A, Ozer S, Crocker TF, House A, Hewison J, Roberts E, Dickerson J, Carter G, Hulme C, Fay M, Richardson G, Wright A, McKevitt C, McEachan R, Foy R, Barnard L, Moreau L, Prashar A, Clarke D, Hardicre N, Holloway I, Brindle R, Hall J, Burton LJ, Atkinson R, Hawkins RJ, Brown L, Cornwall N, Dawkins B, Meads D, Schmitt L, Fletcher M, Speed M, Grenfell K, Hartley S, Young J, Farrin A. Longer-term health and social care strategies for stroke survivors and their carers: the LoTS2Care research programme including cluster feasibility RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
It is reported that the longer-term outcomes for stroke survivors are poor, with a range of unmet needs identified.
Objectives
The aims were to develop and test a longer-term stroke care strategy focused on improving the quality of life of stroke survivors and their carers by addressing unmet needs, and maintenance and enhancement of participation (i.e. involvement in life situations).
Design
Five overlapping workstreams were undertaken – (1) refinement of content by semistructured interviews with stroke survivors and their carers and by a review of the literature to inform content and delivery of the care strategy; (2) exploration of service models by national survey and focus groups with purposely selected services; (3) intervention development by interaction with a reference group of stroke survivors, carers, and health and social care professionals; (4) refinement and pilot implementation of the developed intervention in three stroke services (case studies); and (5) a cluster randomised controlled feasibility trial in 10 stroke services across England and Wales.
Setting
The intervention development work and feasibility trial were in stroke services (inclusive of primary, secondary, community and social care provision) across England and Wales.
Participants
Participants were stroke survivors resident in the community and their carers, and health and social care professionals in the included stroke services.
Data sources
Interviews with 28 stroke survivors and their carers at least 9 months post stroke ascertained their needs and the barriers to and facilitators of addressing those needs. Additional literature reviews identified 23 needs. No evidence-based interventions to address these needs were reported; self-management was highlighted as a possible delivery mechanism. In workstream 2, a national survey revealed that the most common model of stroke service provision was care up to 12 months post stroke, reported by 46 (40%) services. Thirty-five (30%) services provided care up to 6 months post stroke and 35 (30%) provided care beyond 12 months, thus identifying 6 months post stroke as an appropriate delivery point for a new intervention. Through focus groups in a range of services, stroke survivors’ perceived unmet needs and the barriers to and enablers of service provision were identified.
Intervention
Using information obtained in workstreams 1 and 2 and working closely with a stakeholder reference group, we developed an intervention based on the unmet needs prioritised by stroke survivors and their carers (workstream 3). In workstream 4, action groups (clinicians, stroke survivors and researchers) were established in three stroke services that led implementation in their service and contributed to the iterative refinement of the intervention, associated training programme and implementation materials. The intervention (called New Start) was delivered at 6 months post stroke. Key components were problem-solving self-management with survivors and carers, help with obtaining usable information, and helping survivors and their carers build sustainable, flexible support networks.
Results
A cluster randomised feasibility trial (workstream 5) was successfully implemented in 10 stroke services across England and Wales, with associated process and health economic evaluations. Five services were randomised to provide New Start, while five continued with usual care; 269 participants were recruited. Progression criteria – in terms of our pre-determined (red, amber, green) criteria for progress to a full trial: target stroke survivor recruitment rates were achieved, on average, across sites (24.1 per site over 6 months, green); 216 (80.3%) registered stroke survivors returned follow-up questionnaires at 9 months (84.1% in the intervention arm and 75.8% in the usual care arm, green); according to data reported by sites, overall, 95.2% of registered stroke survivors were offered at least one session of the intervention (green); all five intervention sites had at least two facilitators deemed competent, delivered the New Start intervention and provided it to stroke survivors (green). However, at some sites, there were concerns regarding the number of stroke survivors being offered, accepting and receiving the intervention. Only small differences in outcomes and costs were observed between the New Start and usual care groups, and considerable uncertainty around the cost-effectiveness remains.
Conclusions
We report a complex programme of work that has described the longer-term needs of stroke survivors and highlighted evidence and service gaps. Working closely with stroke survivors, an intervention was developed that has been refined in three services and feasibility tested in a cluster randomised controlled trial. Further refinement of the target population and optimisation of the intervention materials is required prior to a full randomised controlled trial evaluation.
Future work
Optimisation of the intervention, and clearer specification of recipients, are required prior to a full trial evaluation.
Trial registration
Current Controlled Trials ISRCTN38920246.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Anne Forster
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Seline Ozer
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Thomas F Crocker
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Allan House
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Jenny Hewison
- Division of Health Services Research, School of Medicine, University of Leeds, Leeds, UK
| | | | - Josie Dickerson
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Gill Carter
- Patient and public involvement contributor, York, UK
| | - Claire Hulme
- College of Medicine and Health, University of Exeter, Exeter, UK
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | | | | | - Alan Wright
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Christopher McKevitt
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Rosemary McEachan
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Robbie Foy
- Division of Primary Care, Palliative Care and Public Health, School of Medicine, University of Leeds, Leeds, UK
| | - Lorna Barnard
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Lauren Moreau
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Arvin Prashar
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - David Clarke
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Natasha Hardicre
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ivana Holloway
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Richard Brindle
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jessica Hall
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Louisa-Jane Burton
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ross Atkinson
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rebecca J Hawkins
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Lesley Brown
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Nicola Cornwall
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Bryony Dawkins
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - Laetitia Schmitt
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - Marie Fletcher
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Michael Speed
- Patient and public involvement contributor, York, UK
| | - Katie Grenfell
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - John Young
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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Baba Y, Ooyama C, Tazawa Y, Kohzuki M. Effects of Adachi Rehabilitation Programme on older adults under long-term care: A multi-centre controlled trial. PLoS One 2021; 16:e0245646. [PMID: 33577618 PMCID: PMC7880461 DOI: 10.1371/journal.pone.0245646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/19/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We developed the Adachi Rehabilitation Programme (ARP), a community rehabilitation program. Under the supervision of professional caregivers, older adults cleaned and planted flowers in the park and they walked and shopped in the community. We examined the effects of ARP on individuals receiving small-group multifunctional at-home care at community facilities. METHODS This was a multi-centre controlled trial at thirteen small multifunctional at-home care facilities in Adachi, Tokyo. The primary outcomes of the study were daily step counts and timed up & go (TUG). Secondary outcomes included gait speed, step length, Barthel Index for Activities of Daily Living, Functional Independence Measure, Mini-Mental State Examination (MMSE) and EuroQOL 5 Dimension. RESULTS Ninety-six individuals at thirteen small multifunctional at-home care facilities were recruited for participation in December 2017. They were allocated to intervention (38) and control (40) groups. The average daily step count of the control group decreased from 852 to 727, but it increased by approximately 650 steps, from 990 to 1635, for the intervention group. Average TUG decreased from 16.1 s to 14.0 s and MMSE score increased from 15.9 to 16.3 for the intervention group, but a significant interaction was not found. On non-intervention home days, the daily step counts of the intervention group increased significantly from 908 steps to 1485 steps, while those of the control group decreased from 865 steps to 722 steps. CONCLUSIONS ARP may have effectively increased the physical activity of older adults under long-term care by increasing motivation and changing behaviour.
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Affiliation(s)
- Yoshihiko Baba
- Faculty of Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Chika Ooyama
- Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan
| | | | - Masahiro Kohzuki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan
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24
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Dean C, Clemson L, Ada L, Scrivener K, Lannin N, Mikolaizak S, Day S, Cusick A, Gardner B, Heller G, Isbel S, Jones T, Mumford V, Preston E. Home-based, tailored intervention for reducing falls after stroke (FAST): Protocol for a randomized trial. Int J Stroke 2021; 16:1053-1058. [PMID: 33568018 DOI: 10.1177/1747493021991990] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
RATIONALE People with stroke experience falls at more than twice the rate of the general older population resulting in high fall-related injuries. However, there are currently no effective interventions that prevent falls after stroke. AIMS To determine the effect and cost-benefit of an innovative, home-based, tailored intervention to reduce falls after stroke. SAMPLE SIZE ESTIMATE A total of 370 participants will be recruited in order to be able to detect a clinically important between-group difference of a 30% lower rate of falls with 80% power at a two-tailed significance level of 0.05. METHODS AND DESIGN Falls after stroke trial (FAST) is a multistate, Phase III randomized trial with concealed allocation, blinded assessment, and intention-to-treat analysis. Ambulatory stroke survivors within five years of stroke who have been discharged from formal rehabilitation to the community and who have no significant language impairment will be randomly allocated to receive habit-forming exercise, home safety, and community mobility training or usual care. STUDY OUTCOMES The primary outcome is the rate of falls over the previous 12 months. Secondary outcomes are the risk of falling (proportion of fallers), community participation, self-efficacy, balance, mobility, physical activity, depression, and health-related quality of life. Health care utilization will be collected retrospectively at baseline and prospectively to 6 and 12 months. DISCUSSION The results of FAST are anticipated to directly influence intervention for stroke survivors in the community.Trial Registration: ANZCTR 12619001114134.
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Affiliation(s)
- Catherine Dean
- Faculty of Medicine, Health and Human Sciences, 7788Macquarie University, Sydney, Australia
| | - Lindy Clemson
- Faculty of Medicine and Health, 4334The University of Sydney, Sydney, Australia
| | - Louise Ada
- Faculty of Medicine and Health, 4334The University of Sydney, Sydney, Australia
| | - Katherine Scrivener
- Faculty of Medicine, Health and Human Sciences, 7788Macquarie University, Sydney, Australia
| | - Natasha Lannin
- Department of Neuroscience, Monash University, Melbourne, Australia
| | - Stefanie Mikolaizak
- Faculty of Medicine and Health, 4334The University of Sydney, Sydney, Australia
| | - Sally Day
- Faculty of Medicine and Health, 4334The University of Sydney, Sydney, Australia
| | - Anne Cusick
- Faculty of Medicine and Health, 4334The University of Sydney, Sydney, Australia
| | | | - Gillian Heller
- Faculty of Medicine and Health, 4334The University of Sydney, Sydney, Australia
| | - Stephen Isbel
- Faculty of Health, University of Canberra, Canberra, Australia
| | - Taryn Jones
- Faculty of Medicine, Health and Human Sciences, 7788Macquarie University, Sydney, Australia
| | - Virginia Mumford
- Faculty of Medicine, Health and Human Sciences, 7788Macquarie University, Sydney, Australia
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Interventions for preventing falls in people post-stroke: A meta-analysis of randomized controlled trials. Gait Posture 2021; 84:377-388. [PMID: 33476831 DOI: 10.1016/j.gaitpost.2020.12.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/22/2020] [Accepted: 12/31/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Falls are a serious challenge facing individuals post-stroke. In the past decades, various fall prevention interventions have been developed. It remains unknown if any of these interventions are effective in reducing falls in this population. Such a knowledge gap could impede the effort of preventing falls in people post-stroke. RESEARCH QUESTIONS 1) Are there effective interventions to prevent falls among people in the post-acute and chronic stages of stroke? and 2) How do fall prevention interventions change three key fall risk factors in this population: balance, mobility, and lower limb strength? METHODS Eleven databases were searched for randomized controlled trials which included falls in people post-stroke as an outcome measure. Information on the participants, training protocol, and outcome measures were collected for each study. The primary outcome is the number of fallers and the explanatory variables included mean difference and standard deviation for fall risk factors. Studies were quality appraised using the Physiotherapy Evidence Database scale and the funnel plot. RESULTS Thirteen studies enrolling 1352 participants were identified. Effect size quantified by the odds ratio (OR) for falls and standardized mean difference (SMD) for fall risk factors were calculated. Overall no intervention appears to be significantly more effective in preventing falls than placebo training (OR = 0.88 with a range of [0.23 3.66]; 95 % confidence interval = [0.64 1.21], p = 0.44). All interventions showed little effect in improving the fall risk factors (SMD = -0.01 to 0.06 and p-value = 0.38-0.86), except one (the combined treadmill and overground walking) which significantly improved mobility. SIGNIFICANCE Currently no program is effective in reducing falls in people post-stroke. Future studies should measure falls as a primary outcome based on a consistent definition of falls and reliable approaches to collect falls data.
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Lee M, Eun SD, Cho TH, Shin YI, Song J, Ho SH. Development and Evaluation of a Classified and Tailored Community-Based Exercise Program According to the Mobility Level of People with Stroke Using the Knowledge to Action Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249364. [PMID: 33327571 PMCID: PMC7765039 DOI: 10.3390/ijerph17249364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022]
Abstract
Attempts to classify the mobility levels of people with stroke (PWS) for a tailored exercise program in community settings have been few. We developed and evaluated a classified and tailored community-based (CTC) exercise program according to the mobility level of PWS. Forty-two PWS were classified into the Supine and Sitting, Sitting and Standing, and Standing and Gait groups, based on a newly developed classification model and participated in a group-based CTC exercise program for 1 h/day twice/week for 10 weeks. The health outcome measures were blood pressure, lipid profile, glucose control, body composition, ventilatory capacity, and physical and psychological function. The rate of agreement on classification results among the physiotherapists was analysed. For all participants, significant improvements were noted in the blood pressure, lipid profile, body composition, ventilatory capacity, and physical and psychological function. The lower mobility groups showed significant improvements in a greater number of health outcomes than the higher mobility group. The physiotherapists’ agreement regarding the classification results was 91.16 ± 5.14%, verifying the model’s possible high relevance to the community. The effective improvement in participant health implied that the CTC exercise program was well tailored to the participants’ mobility levels, particularly the lower mobility groups.
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Affiliation(s)
- Minyoung Lee
- Department of Healthcare and Public Health Research, National Rehabilitation Research Institute, Seoul 01022, Korea; (M.L.); (T.H.C.)
| | - Seon-Deok Eun
- Department of Clinical Research for Rehabilitation, National Rehabilitation Research Institute, Seoul 01022, Korea;
| | - Tae Hyun Cho
- Department of Healthcare and Public Health Research, National Rehabilitation Research Institute, Seoul 01022, Korea; (M.L.); (T.H.C.)
| | - Young-Il Shin
- Department of Prosthetics and Orthotics, Korea National College of Welfare, Pyeongtaek 17738, Korea;
| | - Jiyeon Song
- Seoul Junggu Community Health Center, Seoul 04611, Korea;
| | - Seung Hee Ho
- Department of Healthcare and Public Health Research, National Rehabilitation Research Institute, Seoul 01022, Korea; (M.L.); (T.H.C.)
- Correspondence: ; Tel.: +82-1020303415
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Martins JC, Nadeau S, Aguiar LT, Scianni AA, Teixeira-Salmela LF, De Morais Faria CDC. Efficacy of task-specific circuit training on physical activity levels and mobility of stroke patients: A randomized controlled trial. NeuroRehabilitation 2020; 47:451-462. [PMID: 33136078 DOI: 10.3233/nre-203207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Impaired mobility is related to low physical activity (PA) levels observed after stroke. Therapeutic approaches, such as task-specific circuit training (TSCT), used to improve mobility in individuals with stroke, could also improve PA levels. OBJECTIVE To investigate the efficacy of TSCT, focused on both upper (UL) and lower (LL) limbs, in improving PA levels and mobility (primary outcomes), as well as muscle strength, exercise capacity, and quality of life (secondary outcomes) in subjects with stroke. METHODS A randomized controlled trial with 36 subjects with chronic stroke was conducted. Experimental group: TSCT, involving both UL and LL. CONTROL GROUP global stretching, memory exercises, and education sessions. Both groups received 60 minute sessions/week over 12 weeks. Outcomes were measured at baseline, post-intervention and 16 week follow-up. RESULTS No changes were found for primary and secondary outcomes (0.11≤p≤0.99), except for quality of life, which improved in the experimental group post-intervention and 16 week follow-up (p = 0.02). CONCLUSION TSCT focused on both UL and LL was not effective on PA levels and mobility of individuals with chronic stroke, however, improvements in quality of life were observed. Since this is the first study to investigate this combined training aimed at improving PA levels, future studies are necessary to better understand the impact of this type of intervention.
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Affiliation(s)
- Júlia Caetano Martins
- Universidade Federal de Minas Gerais (UFMG), Department of Physical Therapy, Belo Horizonte, Brazil
| | - Sylvie Nadeau
- Université de Montreal (UdeM), Centre de recherche interdisciplinaire en réadaptation (CRIR), Institut de réadaptation Gingras-Lindsay de Montréal (IRGLM), CIUSSS Centre-Sud-de-l'île-de-Montréal, Montréal, Canada
| | - Larissa Tavares Aguiar
- Universidade Federal de Minas Gerais (UFMG), Department of Physical Therapy, Belo Horizonte, Brazil
| | - Aline Alvim Scianni
- Universidade Federal de Minas Gerais (UFMG), Department of Physical Therapy, Belo Horizonte, Brazil
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Lu R, Lloyd-Randolfi D, Jones H, Connor LT, AlHeresh R. Assessing adherence to physical activity programs post-stroke at home: A systematic review of randomized controlled trials. Top Stroke Rehabil 2020; 28:207-218. [PMID: 32787644 DOI: 10.1080/10749357.2020.1803573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Physical activity at home provides significant benefits post-stroke. Adherence assessments contribute to objective evaluation of treatment effectiveness across settings. OBJECTIVES The aims of this study were to (1) conduct a systematic review with focus on analyzing the reporting quality of RCTs that incorporate home physical activity interventions among people post-stroke, and utilize a physical activity adherence assessment and to: (2) identify, group, and critically appraise physical activity adherence assessments within the identified studies. METHODS A literature search for RCTs was conducted. Articles needed to (1) study adult, post-stroke participants, (2) include a physical activity intervention at home, (3) utilize a physical activity adherence assessment, (4) be published in English in a peer reviewed journal. Two independent reviewers assessed the reporting quality of each RCT for conformity to 39 Consolidated Standards of Reporting Trials (CONSORT) items, followed by an evaluation of adherence assessment methods. RESULTS Eleven studies met the inclusion criteria and none of them reported all CONSORT items. The median number of "fully reported" items was 7 out of 39. Ten of the 11 RCTs employed the adherence diary as an assessment method. The adherence parameters of frequency and duration were applied with greater frequency than intensity and accuracy. No evidence of an objective method of adherence assessment was found. CONCLUSIONS This systematic review revealed suboptimal reporting of RCTs of physical activity interventions. The use of a diary with the post-stroke population at home was common, despite the lack of an objective method of adherence assessment. Stricter compliance to CONSORT guidelines and complementary direct adherence measurement is advised to improve activity adherence research.
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Affiliation(s)
- Richard Lu
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Dominic Lloyd-Randolfi
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Heather Jones
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Lisa Tabor Connor
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Rawan AlHeresh
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
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29
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Donoso Brown EV, Nolfi D, Wallace SE, Eskander J, Hoffman JM. Home program practices for supporting and measuring adherence in post-stroke rehabilitation: a scoping review. Top Stroke Rehabil 2020; 27:377-400. [PMID: 31891554 DOI: 10.1080/10749357.2019.1707950] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/15/2019] [Accepted: 11/02/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND After stroke, individuals face a variety of impairments that impact function. Increasingly, rehabilitation for these impairments has moved into the community and home settings through the use of home programs. However, adherence to these programs is often low, limiting effectiveness. OBJECTIVE This scoping review investigated home program implementation and measurement of adherence with persons post-stroke to identify commonly reported practices and determine areas for further research. METHODS The electronic databases of PubMed, CINAHL, Scopus, Cochrane Database of Systematic Reviews, and PEDro were searched. Studies focused on post-stroke rehabilitation with an independent home program were selected. Qualitative studies, commentaries, and single-case studies were excluded. Title and abstract screenings were completed by two reviewers with a third for tie-breaking. The full-text review was completed by two reviewers using consensus to resolve any differences. Of the 1,197 articles initially found only 6% (n = 70) met criteria for data extraction. Elements for data extraction included: type of study, area of intervention, description of home program, presence of strategies to support adherence, methods to measure adherence and reported adherence. RESULTS Most commonly reported strategies to support home practice were the use of technology, personalization, and written directions. Only 20 studies reported achieving adherence at or greater than 75% and 18 studies did not report adherence outcomes. CONCLUSIONS Future investigations that directly compare and identify the most effective strategies to support adherence to home programs for this population are warranted. The implementation of guidelines for reporting adherence to home programs is recommended.
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Affiliation(s)
| | - David Nolfi
- Gumberg Library, Duquesne University , Pittsburgh, USA
| | - Sarah E Wallace
- Department of Speech Language Pathology, Duquesne University , Pittsburgh, PA, USA
| | - Joanna Eskander
- Department of Occupational Therapy, Duquesne University , Pittsburgh, PA, USA
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington , Seattle, WA, USA
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Ekechukwu END, Olowoyo P, Nwankwo KO, Olaleye OA, Ogbodo VE, Hamzat TK, Owolabi MO. Pragmatic Solutions for Stroke Recovery and Improved Quality of Life in Low- and Middle-Income Countries-A Systematic Review. Front Neurol 2020; 11:337. [PMID: 32695058 PMCID: PMC7336355 DOI: 10.3389/fneur.2020.00337] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/07/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Given the limited healthcare resources in low and middle income countries (LMICs), effective rehabilitation strategies that can be realistically adopted in such settings are required. Objective: A systematic review of literature was conducted to identify pragmatic solutions and outcomes capable of enhancing stroke recovery and quality of life of stroke survivors for low- and middle- income countries. Methods: PubMed, HINARI, and Directory of Open Access Journals databases were searched for published Randomized Controlled Trials (RCTs) till November 2018. Only completed trials published in English with non-pharmacological interventions on adult stroke survivors were included in the review while published protocols, pilot studies and feasibility analysis of trials were excluded. Obtained data were synthesized thematically and descriptively analyzed. Results: One thousand nine hundred and ninety six studies were identified while 347 (65.22% high quality) RCTs were found to be eligible for the review. The most commonly assessed variables (and outcome measure utility) were activities of daily living [75.79% of the studies, with Barthel Index (37.02%)], motor function [66.57%; with Fugl Meyer scale (71.88%)], and gait [31.12%; with 6 min walk test (38.67%)]. Majority of the innovatively high technology interventions such as robot therapy (95.24%), virtual reality (94.44%), transcranial direct current stimulation (78.95%), transcranial magnetic stimulation (88.0%) and functional electrical stimulation (85.00%) were conducted in high income countries. Several traditional and low-cost interventions such as constraint-induced movement therapy (CIMT), resistant and aerobic exercises (R&AE), task oriented therapy (TOT), body weight supported treadmill training (BWSTT) were reported to significantly contribute to the recovery of motor function, activity, participation, and improvement of quality of life after stroke. Conclusion: Several pragmatic, in terms of affordability, accessibility and utility, stroke rehabilitation solutions, and outcome measures that can be used in resource-limited settings were found to be effective in facilitating and enhancing post-stroke recovery and quality of life.
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Affiliation(s)
- Echezona Nelson Dominic Ekechukwu
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu, Nigeria
- LANCET Physiotherapy and Wellness and Research Centre, Enugu, Nigeria
| | - Paul Olowoyo
- Department of Medicine, Federal Teaching Hospital, Ido Ekiti, Nigeria
- College of Medicine and Health Sciences, Afe Babalola University, Ado Ekiti, Nigeria
| | - Kingsley Obumneme Nwankwo
- Stroke Control Innovations Initiative of Nigeria, Abuja, Nigeria
- Fitness Global Consult Physiotherapy Clinic, Abuja, Nigeria
| | - Olubukola A Olaleye
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Talhatu Kolapo Hamzat
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mayowa Ojo Owolabi
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- University College Hospital, Ibadan, Nigeria
- Blossom Specialist Medical Centre, Ibadan, Nigeria
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Gross JMS, Monroe‐Gulick A, Nye C, Davidson‐Gibbs D, Dedrick D. Multifaceted interventions for supporting community participation among adults with disabilities: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2020; 16:e1092. [PMID: 37131415 PMCID: PMC8356358 DOI: 10.1002/cl2.1092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Judith M. S. Gross
- Center on Community Living and Careers, Indiana Institute on Disability and CommunityIndiana UniversityBloomingtonIndiana
| | | | - Chad Nye
- American Institutes for ResearchLakelandFlorida
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32
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Peng QF, Zhou J, Jiang H. Effect of Community Exercise for Patients with Stroke: A Systematic Review and
Meta-analysis. PHYSIKALISCHE MEDIZIN, REHABILITATIONSMEDIZIN, KURORTMEDIZIN 2020. [DOI: 10.1055/a-0979-4114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Background Community exercise might be beneficial to stroke recovery. However, the
results remained controversial. We conducted a systematic review and meta-analysis to explore
the effect of community exercise on stroke patients.
Methods PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were
systematically searched. Randomized controlled trials (RCTs) assessing the effect of community
exercise vs. usual care on stroke were included. Two investigators independently searched
articles, extracted data, and assessed the quality of included studies. The primary outcome
were 6-Minute walk test and walking speed. Metaanalysis was performed using random-effect
model.
Results Four RCTs involving 497 patients were included in the metaanalysis. Overall,
compared with control intervention, community exercise intervention was found to significantly
improve 6-Minute walk distance (Std. mean difference=0.48; 95% CI=0.22
to 0.74; P=0.0003), and walking speed (Std. mean difference=0.40; 95%
CI=0.10 to 0.70; P=0.009) in stroke patients, but resulted in no influence on
Berg Balance Scale (Std. mean difference=0.39; 95% CI=−0.29 to
1.07; P=0.26), muscle strength (Std. mean difference=0.05; 95%
CI=-0.34 to 0.43; P=0.82) and mental quality of life (Std. mean
difference=0.04; 95% CI=−0.25 to 0.34; P=0.77).
Conclusions Compared to control intervention, community exercise was found to
significantly increase 6-Minute walk test, walking speed and Berg Balance Scale, but showed no
influence on Berg Balance Scale, muscle strength and mental quality of life.
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Affiliation(s)
- Qi-feng Peng
- Department of Rehabilitation, Chongqing Hospital of Traditional Chinese
Medicine
| | - Jie Zhou
- Department of Rehabilitation, Chongqing Hospital of Traditional Chinese
Medicine
| | - Heng Jiang
- Department of Rehabilitation, Chongqing Hospital of Traditional Chinese
Medicine
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33
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Frame HB, Finetto C, Dean JC, Neptune RR. The influence of lateral stabilization on walking performance and balance control in neurologically-intact and post-stroke individuals. Clin Biomech (Bristol, Avon) 2020; 73:172-180. [PMID: 32004909 PMCID: PMC7183884 DOI: 10.1016/j.clinbiomech.2020.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 11/19/2019] [Accepted: 01/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals post-stroke have an increased risk of falling, which can lead to injuries and reduced quality of life. This increased fall risk can be partially attributed to poorer balance control, which has been linked to altered post-stroke gait kinematics (e.g. an increased step width). The application of lateral stabilization to the pelvis reduces step width among neurologically-intact young and older adults, suggesting that lateral stabilization reduces the need for active frontal plane balance control. This study sought to determine if lateral stabilization is effective at improving common measures of gait performance and dynamic balance in neurologically-intact and post-stoke individuals who responded to the stabilization by reducing their step width. METHODS Gait performance was assessed by foot placement and propulsion symmetry while dynamic balance was assessed by peak-to-peak range of frontal plane whole body angular momentum (HR) and pelvis and trunk sway. FINDINGS Controls and post-stroke Responders who reduced their step width in response to stabilization also reduced their mediolateral pelvis sway, but did not exhibit changes in gait performance. Contrary to expectations, both groups exhibited an increased HR, possibly indicative of decreased balance control. This increase was the result of increased relative velocity between the pelvis and head, arms and trunk segment. INTERPRETATION These results suggest that a reduction in pelvis motion alone, as opposed to relative motion between the pelvis and upper body, may increase HR, decrease balance control and diminish gait performance. This finding has important implications for locomotor therapies that may seek to reduce pelvis motion.
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Affiliation(s)
- Hannah B Frame
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Christian Finetto
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
| | - Jesse C Dean
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
| | - Richard R Neptune
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA.
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34
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Zhao R, Bu W, Chen X. The efficacy and safety of exercise for prevention of fall-related injuries in older people with different health conditions, and differing intervention protocols: a meta-analysis of randomized controlled trials. BMC Geriatr 2019; 19:341. [PMID: 31795944 PMCID: PMC6892137 DOI: 10.1186/s12877-019-1359-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 11/19/2019] [Indexed: 12/21/2022] Open
Abstract
Background Whether exercise prevents fall-related injuries in different health conditions and with different training protocols is still unclear. This study aimed to determine the effect of exercise on fall-related injuries by participant characteristics and divergent exercise protocols. The safety and compliance of exercise were also examined. Methods Electronic database searches were conducted in PubMed, Web of Science, and EMBASE for randomised controlled trials that evaluated the influence of exercise on fall-induced injuries in older people. Results Twenty-five trials met the inclusion criteria. Exercise significantly reduced the risk of fall-related injuries in older adults, risk ratio (RR) 0.879 [95% confidence interval (CI) 0.832–0.928]. Among the injuries, events needing medical care or resulting fractures were also decreased by exercise intervention, with RR 0.681 (0.562–0.825) and 0.561 (0.366–0.860), respectively. When analysis was stratified by participant characteristics and exercise protocols, we found that participants at high risk of falling, or with osteoporosis, were sensitive to exercise intervention. Combined exercise protocols and balance training were the most effective exercise types in reducing fall-related injuries. Exercise-associated beneficial effects were even significant in very old people (≥80 years) and across the duration of interventions (< 6 months, 6 to 12 months and ≥ 12 months). Exercise only generated a very low injury rate per participant year (0.002, 95% CI 0–0.05) and showed relatively good compliance of exercise (as reported in the included papers) (78.5, 95% CI 72.8–84.2%). Conclusions Exercise is effective in preventing fall-induced injuries across a variety of baseline participant characteristics and exercise protocols. Exercise was associated with a low injury rate and had a good compliance, suggesting it is a feasible approach to managing fall-related injuries.
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Affiliation(s)
- Renqing Zhao
- College of Physical Education, Yangzhou University, 88 Daxue South Rd, Yangzhou, 225009, Jiangsu Province, China.
| | - Wenqian Bu
- College of Physical Education, Yangzhou University, 88 Daxue South Rd, Yangzhou, 225009, Jiangsu Province, China
| | - Xianghe Chen
- College of Physical Education, Yangzhou University, 88 Daxue South Rd, Yangzhou, 225009, Jiangsu Province, China
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Systematic Review and Meta-Analysis of Home-Based Rehabilitation on Improving Physical Function Among Home-Dwelling Patients With a Stroke. Arch Phys Med Rehabil 2019; 101:359-373. [PMID: 31689417 DOI: 10.1016/j.apmr.2019.10.181] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the effects of home-based rehabilitation on improving physical function in home-dwelling patients after a stroke. DATA SOURCES Various electronic databases, including PubMed, Cumulative Index to Nursing and Allied Health, Embase, the Cochrane Central Register of Controlled Trials, and 2 Chinese data sets (ie, Chinese Electronic Periodical Services and China Knowledge Resource Integrated) were searched for studies published before March 20, 2019. STUDY SELECTION Randomized controlled trials conducted to examine the effect of home-based rehabilitation on improving physical function in home-dwelling patients with a stroke and published in English or Chinese were included. In total, 49 articles in English (n=23) and Chinese (n=26) met the inclusion criteria. DATA EXTRACTION Data related to patient characteristics, study characteristics, intervention details, and outcomes were extracted by 2 independent reviewers. DATA SYNTHESIS A random-effects model with a sensitivity analysis showed that home-based rehabilitation exerted moderate improvements on physical function in home-dwelling patients with a stroke (g=0.58; 95% CI, 0.45∼0.70). Moderator analyses revealed that those patients with stroke of a younger age, of male sex, with a first-ever stroke episode, in the acute stage, and receiving rehabilitation training from their caregiver showed greater improvements in physical function. CONCLUSIONS Home rehabilitation can improve functional outcome in survivors of stroke and should be considered appropriate during discharge planning if continuation care is required.
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36
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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: 44] [Impact Index Per Article: 7.3] [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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Kringle EA, Barone Gibbs B, Campbell G, McCue M, Terhorst L, Kersey J, Skidmore ER. Influence of Interventions on Daily Physical Activity and Sedentary Behavior after Stroke: A Systematic Review. PM R 2019; 12:186-201. [DOI: 10.1002/pmrj.12222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 07/11/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Emily A. Kringle
- Department of Occupational Therapy, School of Health and Rehabilitation SciencesUniversity of Pittsburgh Pittsburgh PA
| | - Bethany Barone Gibbs
- Department of Health and Physical Activity, School of EducationUniversity of Pittsburgh Pittsburgh PA
- Department of Clinical and Translational ScienceUniversity of Pittsburgh Pittsburgh PA
| | - Grace Campbell
- Department of Acute and Tertiary Care, School of NursingUniversity of Pittsburgh Pittsburgh PA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation SciencesUniversity of Pittsburgh Pittsburgh PA
| | - Lauren Terhorst
- Department of Occupational Therapy, School of Health and Rehabilitation SciencesUniversity of Pittsburgh Pittsburgh PA
| | - Jessica Kersey
- Department of Occupational Therapy, School of Health and Rehabilitation SciencesUniversity of Pittsburgh Pittsburgh PA
| | - Elizabeth R. Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation SciencesUniversity of Pittsburgh Pittsburgh PA
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38
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Denissen S, Staring W, Kunkel D, Pickering RM, Lennon S, Geurts ACH, Weerdesteyn V, Verheyden GSAF, Cochrane Stroke Group. Interventions for preventing falls in people after stroke. Cochrane Database Syst Rev 2019; 10:CD008728. [PMID: 31573069 PMCID: PMC6770464 DOI: 10.1002/14651858.cd008728.pub3] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Falls are one of the most common complications after stroke, with a reported incidence ranging between 7% in the first week and 73% in the first year post stroke. This is an updated version of the original Cochrane Review published in 2013. OBJECTIVES To evaluate the effectiveness of interventions aimed at preventing falls in people after stroke. Our primary objective was to determine the effect of interventions on the rate of falls (number of falls per person-year) and the number of fallers. Our secondary objectives were to determine the effects of interventions aimed at preventing falls on 1) the number of fall-related fractures; 2) the number of fall-related hospital admissions; 3) near-fall events; 4) economic evaluation; 5) quality of life; and 6) adverse effects of the interventions. SEARCH METHODS We searched the trials registers of the Cochrane Stroke Group (September 2018) and the Cochrane Bone, Joint and Muscle Trauma Group (October 2018); the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 9) in the Cochrane Library; MEDLINE (1950 to September 2018); Embase (1980 to September 2018); CINAHL (1982 to September 2018); PsycINFO (1806 to August 2018); AMED (1985 to December 2017); and PEDro (September 2018). We also searched trials registers and checked reference lists. SELECTION CRITERIA Randomised controlled trials of interventions where the primary or secondary aim was to prevent falls in people after stroke. DATA COLLECTION AND ANALYSIS Two review authors (SD and WS) independently selected studies for inclusion, assessed trial quality and risk of bias, and extracted data. We resolved disagreements through discussion, and contacted study authors for additional information where required. We used a rate ratio and 95% confidence interval (CI) to compare the rate of falls (e.g. falls per person-year) between intervention and control groups. For risk of falling we used a risk ratio and 95% CI based on the number of people falling (fallers) in each group. We pooled results where appropriate and applied GRADE to assess the quality of the evidence. MAIN RESULTS We included 14 studies (of which six have been published since the first version of this review in 2013), with a total of 1358 participants. We found studies that investigated exercises, predischarge home visits for hospitalised patients, the provision of single lens distance vision glasses instead of multifocal glasses, a servo-assistive rollator and non-invasive brain stimulation for preventing falls.Exercise compared to control for preventing falls in people after strokeThe pooled result of eight studies showed that exercise may reduce the rate of falls but we are uncertain about this result (rate ratio 0.72, 95% CI 0.54 to 0.94, 765 participants, low-quality evidence). Sensitivity analysis for single exercise interventions, omitting studies using multiple/multifactorial interventions, also found that exercise may reduce the rate of falls (rate ratio 0.66, 95% CI 0.50 to 0.87, 626 participants). Sensitivity analysis for the effect in the chronic phase post stroke resulted in little or no difference in rate of falls (rate ratio 0.58, 95% CI 0.31 to 1.12, 205 participants). A sensitivity analysis including only studies with low risk of bias found little or no difference in rate of falls (rate ratio 0.88, 95% CI 0.65 to 1.20, 462 participants). Methodological limitations mean that we have very low confidence in the results of these sensitivity analyses.For the outcome of number of fallers, we are very uncertain of the effect of exercises compared to the control condition, based on the pooled result of 10 studies (risk ratio 1.03, 95% CI 0.90 to 1.19, 969 participants, very low quality evidence). The same sensitivity analyses as described above gives us very low certainty that there are little or no differences in number of fallers (single interventions: risk ratio 1.09, 95% CI 0.93 to 1.28, 796 participants; chronic phase post stroke: risk ratio 0.94, 95% CI 0.73 to 1.22, 375 participants; low risk of bias studies: risk ratio 0.96, 95% CI 0.77 to 1.21, 462 participants).Other interventions for preventing falls in people after strokeWe are very uncertain whether interventions other than exercise reduce the rate of falls or number of fallers. We identified very low certainty evidence when investigating the effect of predischarge home visits (rate ratio 0.85, 95% CI 0.43 to 1.69; risk ratio 1.48, 95% CI 0.71 to 3.09; 85 participants), provision of single lens distance glasses to regular wearers of multifocal glasses (rate ratio 1.08, 95% CI 0.52 to 2.25; risk ratio 0.74, 95% CI 0.47 to 1.18; 46 participants) and a servo-assistive rollator (rate ratio 0.44, 95% CI 0.16 to 1.21; risk ratio 0.44, 95% CI 0.16 to 1.22; 42 participants).Finally, transcranial direct current stimulation (tDCS) was used in one study to examine the effect on falls post stroke. We have low certainty that active tDCS may reduce the number of fallers compared to sham tDCS (risk ratio 0.30, 95% CI 0.14 to 0.63; 60 participants). AUTHORS' CONCLUSIONS At present there exists very little evidence about interventions other than exercises to reduce falling post stroke. Low to very low quality evidence exists that this population benefits from exercises to prevent falls, but not to reduce number of fallers.Fall research does not in general or consistently follow methodological gold standards, especially with regard to fall definition and time post stroke. More well-reported, adequately-powered research should further establish the value of exercises in reducing falling, in particular per phase, post stroke.
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Affiliation(s)
- Stijn Denissen
- KU LeuvenDepartment of Rehabilitation SciencesLeuvenBelgium
- Vrije Universiteit BrusselCIME Cognition and Modeling group, Center For Neurosciences (C4N)BrusselsBelgium1050
| | - Wouter Staring
- Radboud University Medical CentreDepartment of Rehabilitation, Donders Institute for Brain, Cognition and BehaviourNijmegenNetherlands
| | - Dorit Kunkel
- University of SouthamptonFaculty of Health SciencesSouthampton General HospitalMP 886, Tremona RoadSouthamptonUKSO16 6YD
| | - Ruth M Pickering
- University of SouthamptonDepartment of Public Health Sciences and Medical StatisticsSouthampton General Hospital, MP 805Tremona RoadSouthamptonUKSO16 6YD
| | - Sheila Lennon
- Flinders UniversityPhysiotherapy, College of Nursing & Health SciencesAdelaideAustralia
| | - Alexander CH Geurts
- Radboud University Medical CentreDepartment of Rehabilitation, Donders Institute for Brain, Cognition and BehaviourNijmegenNetherlands
- Sint Maartenskliniek ResearchNijmegenNetherlands
| | - Vivian Weerdesteyn
- Radboud University Medical CentreDepartment of Rehabilitation, Donders Institute for Brain, Cognition and BehaviourNijmegenNetherlands
- Sint Maartenskliniek ResearchNijmegenNetherlands
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Stuart M, Dromerick AW, Macko R, Benvenuti F, Beamer B, Sorkin J, Chard S, Weinrich M. Adaptive Physical Activity for Stroke: An Early-Stage Randomized Controlled Trial in the United States. Neurorehabil Neural Repair 2019; 33:668-680. [PMID: 31296113 DOI: 10.1177/1545968319862562] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background. As stroke survival improves, there is an increasing need for effective, low-cost programs to reduce deconditioning and improve mobility. Objective. To conduct a phase II trial examining whether the community-based Italian Adaptive Physical Activity exercise program for stroke survivors (APA-Stroke) is safe, effective, and feasible in the United States. Methods. In this single-blind, randomized controlled trial, 76 stroke survivors with mild to moderate hemiparesis >6 months were randomized to either APA-Stroke (N = 43) or Sittercise (N = 33). APA-Stroke is a progressive group exercise regimen tailored to hemiparesis that includes walking, strength, and balance training. Sittercise, a seated, nonprogressive aerobic upper body general exercise program, served as the control. Both interventions were 1 hour, 3 times weekly, in 5 community locations, supervised by exercise instructors. Results. A total of 76 participants aged 63.9 ± 1.2 years, mean months poststroke 61.8 ± 9.3, were included. There were no serious adverse events; completion rates were 58% for APA-Stroke, 70% for Sittercise. APA-Stroke participants improved significantly in walking speed. Sample size was inadequate to demonstrate significant between-group differences. Financial and logistical feasibility of the program has been demonstrated. Ongoing APA classes have been offered to >200 participants in county Senior Centers since study completion. Conclusion. APA-Stroke shows great promise as a low-cost, feasible intervention. It significantly increased walking speed. Safety and feasibility in the US context are demonstrated. A pivotal clinical trial is required to determine whether APA-Stroke should be considered standard of care.
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Affiliation(s)
- Mary Stuart
- 1 University of Maryland Baltimore County, Baltimore, MD, USA.,2 VA Health System, Baltimore, MD, USA.,3 University of Maryland, Baltimore, MD, USA
| | - Alexander W Dromerick
- 4 Georgetown University, Washington, DC, USA.,5 VA Health System, Washington, DC, USA.,6 Medstar National Rehabilitation Hospital, Washington, DC, USA
| | - Richard Macko
- 2 VA Health System, Baltimore, MD, USA.,3 University of Maryland, Baltimore, MD, USA
| | | | - Brock Beamer
- 2 VA Health System, Baltimore, MD, USA.,3 University of Maryland, Baltimore, MD, USA
| | | | - Sarah Chard
- 1 University of Maryland Baltimore County, Baltimore, MD, USA
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40
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Ingram LA, Butler AA, Walsh LD, Brodie MA, Lord SR, Gandevia SC. The upper limb Physiological Profile Assessment: Description, reliability, normative values and criterion validity. PLoS One 2019; 14:e0218553. [PMID: 31247034 PMCID: PMC6597070 DOI: 10.1371/journal.pone.0218553] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/03/2019] [Indexed: 11/18/2022] Open
Abstract
A progressive decline in upper limb function is associated with ageing and disease. In this cross-sectional study we assessed the performance of 367 healthy individuals aged of 20 to 95 years across a battery of upper limb clinical tests, which we have termed the upper limb Physiological Profile Assessment (PPA). The upper limb PPA was designed to quantify the performance of the multiple physiological domains important for adequate function in the upper extremities. Included are tests of muscle strength, unilateral movement and dexterity, position sense, skin sensation, bimanual coordination, arm stability, along with a functional task. We report age and gender normative values for each test. Test-retest reliability ranged from good to excellent in all tests (intra-class correlation coefficients from 0.65 to 0.98) with the exception of position sense (0.31). Ten of the thirteen tests revealed differences in performance between males and females, twelve showed a decline in performance with increasing age, and eight discriminated between older people with and without upper limb functional impairment. Furthermore, most tests showed good external validity with respect to age, an upper limb functional test and self-reported function. This profiling approach provides a reference range for clinical groups with upper limb sensory and motor impairments and may assist in identifying undiagnosed deficits in the general population. Furthermore, the tests are sufficiently reliable to detect motor impairments in people with compromised upper limb function and evaluate the effectiveness of interventions.
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Affiliation(s)
- Lewis A Ingram
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Annie A Butler
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Lee D Walsh
- Platypus Technical Consultants Pty Ltd, Canberra, Australia
| | - Matthew A Brodie
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
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41
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Begg R, Galea MP, James L, Sparrow WAT, Levinger P, Khan F, Said CM. Real-time foot clearance biofeedback to assist gait rehabilitation following stroke: a randomized controlled trial protocol. Trials 2019; 20:317. [PMID: 31151480 PMCID: PMC6545011 DOI: 10.1186/s13063-019-3404-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/06/2019] [Indexed: 12/11/2022] Open
Abstract
Background The risk of falling is significantly higher in people with chronic stroke and it is, therefore, important to design interventions to improve mobility and decrease falls risk. Minimum toe clearance (MTC) is the key gait cycle event for predicting tripping-falls because it occurs mid-swing during the walking cycle where forward velocity of the foot is maximum. High forward velocity coupled with low MTC increases the probability of unanticipated foot-ground contacts. Training procedures to increase toe-ground clearance (MTC) have potential, therefore, as a falls-prevention intervention. The aim of this project is to determine whether augmented sensory information via real-time visual biofeedback during gait training can increase MTC. Methods Participants will be aged > 18 years, have sustained a single stroke (ischemic or hemorrhagic) at least six months previously, able to walk 50 m independently, and capable of informed consent. Using a secure web-based application (REDCap), 150 participants will be randomly assigned to either no-feedback (Control) or feedback (Experimental) groups; all will receive 10 sessions of treadmill training for up to 10 min at a self-selected speed over 5–6 weeks. The intervention group will receive real-time, visual biofeedback of MTC during training and will be asked to modify their gait pattern to match a required “target” criterion. Biofeedback is continuous for the first six sessions then progressively reduced (faded) across the remaining four sessions. Control participants will walk on the treadmill without biofeedback. Gait assessments are conducted at baseline, immediately following the final training session and then during follow-up, at one, three, and six months. The primary outcome measure is MTC. Monthly falls calendars will also be collected for 12 months from enrolment. Discussion The project will contribute to understanding how stroke-related changes to sensory and motor processes influence gait biomechanics and associated tripping risk. The research findings will guide our work in gait rehabilitation following stroke and may reduce falls rates. Treadmill training procedures incorporating continuous real-time feedback may need to be modified to accommodate stroke patients who have greater difficulties with treadmill walking. Trial registration Australia New Zealand Clinical Trials Registry, ACTRN12617000250336. Registered on 17 February 2017.
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Affiliation(s)
- Rezaul Begg
- Institute for Health and Sport (IHES), Victoria University, Footscray Park Campus (Room PB307), PO Box 14428, Melbourne, VIC, 8001, Australia.
| | - Mary P Galea
- Royal Melbourne Hospital, Australian Rehabilitation Research Centre, Parkville, Victoria, 3010, Australia.,The University of Melbourne, Department of Medicine, Melbourne, Australia
| | - Lisa James
- Institute for Health and Sport (IHES), Victoria University, Footscray Park Campus (Room PB307), PO Box 14428, Melbourne, VIC, 8001, Australia
| | - W A Tony Sparrow
- Institute for Health and Sport (IHES), Victoria University, Footscray Park Campus (Room PB307), PO Box 14428, Melbourne, VIC, 8001, Australia
| | - Pazit Levinger
- National Ageing Research Institute Ltd., Clinical Gerontology Division, Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia
| | - Fary Khan
- Royal Melbourne Hospital, Australian Rehabilitation Research Centre, Parkville, Victoria, 3010, Australia
| | - Catherine M Said
- The University of Melbourne, Department of Physiotherapy, 34-54 Poplar Road, Parkville, Victoria, 3052, Australia.,Austin Health, Heidelberg Repatriation Hospital, PO Box 5444, Heidelberg West, Victoria, 3084, Australia.,Western Centre for Health Research and Education, Sunshine Hospital, Western Health, Furlong Rd, St Albans, VIC, 3021, Australia.,Australian Institute of Musculoskeletal Science, St Albans, Australia
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Liu TW, Ng SSM. Assessing the fall risks of community-dwelling stroke survivors using the Short-form Physiological Profile Assessment (S-PPA). PLoS One 2019; 14:e0216769. [PMID: 31112580 PMCID: PMC6528978 DOI: 10.1371/journal.pone.0216769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 04/30/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Fall is common after stroke. The Short-form Physiological Profile Assessment (S-PPA) was developed to assess the fall risks and underlying physiological factors, and it has been used in healthy older adults and older adults with stroke. This study aimed to establish the psychometric properties of the S-PPA among cognitively intact and ambulant community-dwelling older adults with stroke. Methods The S-PPA, Chinese version of the Activities-specific Balance Confidence (ABC-C) scale and 3 balance measures, namely the Berg Balance Scale (BBS), Timed “Up & Go” (TUG) and Functional Reach Test (FRT), were administered. Inter- and intra-rater reliability were assessed at baseline and after a 1-week interval, respectively. The validity of the S-PPA was assessed through correlations with balance measures and the ABC-C and by comparing the S-PPA scores between the stroke and healthy groups and between fallers and non-fallers in the stroke group. A receiver operating characteristic (ROC) curve analysis was used to assess the ability of balance measures to distinguish fall status in the stroke group. Results The S-PPA yielded good inter-rater (intraclass correlation coefficient (ICC) = 0.83) and moderate intra-rater reliability (ICC = 0.74), correlated significantly with the 3 balance measures (rho = 0.49–0.70) and ABC-C (rho = 0.35) and revealed significant differences between stroke survivors and controls and between stroke survivors with and without a fall history. However, the ROC analysis revealed that the S-PPA had a poor ability to distinguish the fall statuses of community-dwelling stroke survivors. Conclusions The S-PPA is reliable and valid for evaluating fall risks but cannot adequately distinguish the fall statuses of stroke survivors.
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Affiliation(s)
- Tai-Wa Liu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (SAR)
- School of Nursing & Health Studies, The Open University of Hong Kong, Ho Man Tin, Hong Kong (SAR)
| | - Shamay S. M. Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (SAR)
- * E-mail:
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A single session of trip-specific training modifies trunk control following treadmill induced balance perturbations in stroke survivors. Gait Posture 2019; 70:222-228. [PMID: 30904789 PMCID: PMC6508877 DOI: 10.1016/j.gaitpost.2019.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with stroke are at significant risk of falling. Trip-specific training is a targeted training approach that has been shown to reduce falls in older adults and amputees by enhancing the compensatory stepping response required to prevent a fall. Still, individuals with stroke have unique deficits (e.g. spasticity) which draws into question if this type of training will be effective for this population. OBJECTIVE Evaluate if a single session of trip-specific training can modify the compensatory stepping response (trunk movement, step length/duration, reaction time) of individuals with chronic stroke. METHODS Sixteen individuals with unilateral chronic stroke participated in a single session of trip-specific training consisting of 15 treadmill perturbations. A falls assessment consisting of 3 perturbations was completed before and after training. Recovery step kinematics measured during the pre- and post-test were compared using a repeated measures design. Furthermore, Fallers (those who experienced at least one fall during the pre- or post-test) were compared to Non-fallers. RESULTS Trip-specific training decreased trunk movement post perturbation. Specifically following training, Trunk flexion was 48 and 19 percent smaller on the small and medium perturbations at the end of the first compensatory step. Fallers (9 out of 16 subjects) post-training resembled Non-Fallers pre-training. Specifically, Trunk flexion at the completion of the first step during small and medium perturbations was not different between Fallers post-training and Non-Fallers pre-training. Still enthusiasm was tempered because Trunk flexion at the largest perturbation (where most falls occurred) was not changed and therefore total falls were not reduced as a result of this training. SIGNIFICANCE Our results indicate that trip-specific training modifies the dynamic falls response immediately following trip-like treadmill perturbations. However, the incidence of falls was not reduced with a single training session. Further study of the implications and length of the observed intervention effect are warranted.
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McEwen D, O'Neil J, Miron-Celis M, Brosseau L. Content Reporting in Post-Stroke Therapeutic Circuit-Class Exercise Programs in randomized control trials. Top Stroke Rehabil 2019; 26:281-287. [PMID: 30888307 DOI: 10.1080/10749357.2019.1591687] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Therapeutic exercise in the form of group circuit-class training can improve mobility and gait while being cost-effective among patients who survived a stroke. Accurate clinical replication of interventions, especially when they are effective, is needed to advance research and treatment. However, replication is difficult when reporting is not detailed. OBJECTIVE The objective of this study was to assess the quality of reporting of interventions within the selected studies using three different scales and to assess the criterion validity between the scales. METHODS Two independent assessors used the CERT, the CONTENT scale, and TIDieR checklist to review the quality of reporting of 16 randomized controlled trials (RCTs) from a recent Cochrane Review. Assessments were done independently before a consensus was reached with an experienced third reviewer mediating any disagreements. Criterion validity between the three quality reporting tools was measured using weighted Cohen's kappa coefficients. RESULTS The mean (±SD) for the CERT was 9.31 (±1.66) out of 19 points; the TIDieR checklist was 8.81 (±1.33) out of 12 points; and the CONTENT was 4.82 (±1.22) out of 9 points for the 16 included RCTs. The CERT and CONTENT scale had a fair agreement (k = 0.455, p = 0.064), while both CERT and CONTENT had only slight agreement with TIDieR (k = 0.143, p = 0.267; k = 0.200, p = 0.182, respectively). CONCLUSIONS The results of this study indicate a lack of reporting from the 16 RCTs on post-stroke therapeutic circuit-class exercise programs. This presents a major barrier to knowledge translation and clinical implementation of effective exercise programs for stroke rehabilitation.
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Affiliation(s)
- Daniel McEwen
- a School of Rehabilitation Sciences, Faculty of Health Sciences , University of Ottawa , Ottawa , Ontario , Canada
| | - Jennifer O'Neil
- a School of Rehabilitation Sciences, Faculty of Health Sciences , University of Ottawa , Ottawa , Ontario , Canada.,b Bruyère Research Institute, Bruyère Continuing Care , Ottawa , Ontario , Canada
| | - Marcel Miron-Celis
- a School of Rehabilitation Sciences, Faculty of Health Sciences , University of Ottawa , Ottawa , Ontario , Canada.,b Bruyère Research Institute, Bruyère Continuing Care , Ottawa , Ontario , Canada
| | - Lucie Brosseau
- a School of Rehabilitation Sciences, Faculty of Health Sciences , University of Ottawa , Ottawa , Ontario , Canada
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Church G, Parker J, Powell L, Mawson S. The effectiveness of group exercise for improving activity and participation in adult stroke survivors: a systematic review. Physiotherapy 2019; 105:399-411. [PMID: 31003848 DOI: 10.1016/j.physio.2019.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Following post stroke rehabilitation, group exercise interventions can be used to continue improving cardiovascular fitness, activity levels, balance, gait, movement efficiency, and strengthening. However, little is known of the effectiveness of group exercise for improving activity and participation in stroke survivors. OBJECTIVES This review aims to assess the effectiveness of group exercise for improving activity and participation in adult stroke survivors. DATA SOURCES Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library. STUDY ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) of group exercise using validated outcome measures of activity and participation for post stroke rehabilitation. Two independent reviewers assessed all abstracts, extracted data, conducted a narrative synthesis and assessed the quality of all included articles. The Cochrane Risk of Bias Tool assessed methodological quality and included outcome measure quality was assessed. RESULTS 14 RCTs were included (n=624 chronic stroke survivors collectively). Studies ranged between 12 and 243 stroke participants with an average of left:right hemisphere lesions of 32:39 and average age was 66.7 years. Although intervention and control groups improved, no significant difference between group differences were evident. CONCLUSION and implications of key findings: The review found improvements are short-term and less evident at long-term follow up with little improvements in participation after 6months. However, this review was limited to the standard of intervention reporting. Further research should consider consistency in measuring underpinning mechanisms of group exercise interventions, which may explain the lack of activity changes in long-term follow-up. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42017078917.
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Affiliation(s)
- Gavin Church
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, South Yorkshire S14DA, United Kingdom.
| | - Jack Parker
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, South Yorkshire S14DA, United Kingdom.
| | - Lauren Powell
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, South Yorkshire S14DA, United Kingdom.
| | - Susan Mawson
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, South Yorkshire S14DA, United Kingdom.
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46
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Munford D, Gunn H. What are the perceptions and experiences of falls amongst people with stroke who live in the community? Disabil Rehabil 2018; 42:722-729. [DOI: 10.1080/09638288.2018.1510047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Danielle Munford
- School of Health Professions, University of Plymouth, Plymouth, UK
| | - Hilary Gunn
- School of Health Professions, University of Plymouth, Plymouth, UK
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Kunutsor SK, Leyland S, Skelton DA, James L, Cox M, Gibbons N, Whitney J, Clark EM. Adverse events and safety issues associated with physical activity and exercise for adults with osteoporosis and osteopenia: A systematic review of observational studies and an updated review of interventional studies. J Frailty Sarcopenia Falls 2018; 3:155-178. [PMID: 32300705 PMCID: PMC7155356 DOI: 10.22540/jfsf-03-155] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES We conducted a systematic review to identify adverse effects of physical activity and/or exercise for adults with osteoporosis/osteopenia. We synthesised evidence from observational studies, and updated three previously published systematic reviews. METHODS We searched MEDLINE, EMBASE, CINAHL, Web of Science, grey literature and reference lists of relevant studies. Selection criteria were: (1) observational studies in patients with osteoporosis/osteopenia; and (2) in accordance with the criteria used in the previous reviews. A narrative synthesis was conducted for the observational data. Random effects meta-analysis was undertaken for the review updates. RESULTS For the observational synthesis 14 studies were included. The majority of studies reported no adverse events, reduced incidence/improvement, or no significant change after physical activity or exercise. Activities that involved spinal flexion (certain yoga moves and sit-ups) were associated with a greater risk of vertebral fractures but these events were rare. For the update of reviews, 57 additional studies were identified. Exercise was generally associated with a greater number of minor adverse events including mild muscle/joint pain. Serious adverse events were rare and could not be attributed to the intervention. CONCLUSION Patients with osteoporosis/osteopenia can safely participate in structured exercise programmes, whether at home or in supervised facilities. Systematic review registration for observational studies: PROSPERO 2017: CRD42017070551.
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Affiliation(s)
- Setor K. Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, UK
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, UK
| | | | - Dawn A Skelton
- School of Health & Life Sciences, Centre for Living, Glasgow Caledonian University, Glasgow
| | - Laura James
- Department of Academic Physiotherapy, King’s College London, London, UK
| | - Matthew Cox
- Department of Academic Physiotherapy, King’s College London, London, UK
| | - Nicola Gibbons
- Department of Academic Physiotherapy, King’s College London, London, UK
| | - Julie Whitney
- Department of Academic Physiotherapy, King’s College London, London, UK
| | - Emma M. Clark
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Southmead Hospital, Bristol, UK
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Fini NA, Burge AT, Bernhardt J, Holland AE. Two Days of Measurement Provides Reliable Estimates of Physical Activity Poststroke: An Observational Study. Arch Phys Med Rehabil 2018; 100:883-890. [PMID: 31030730 DOI: 10.1016/j.apmr.2018.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The aim of this study was to determine the duration of physical activity (PA) monitoring required for reliable measurements following stroke. DESIGN Single-center, prospective, observational study. SETTING PA was measured in a community setting. PARTICIPANTS Adults (N=70) poststroke. MAIN OUTCOME MEASURES The SenseWear armband was used to monitor PA for 5 days (≥10 hours wear per day). DATA ANALYSIS Variance among 2, 3, 4, and 5 days of consecutive measurements for PA variables was examined using intraclass correlation coefficients (ICCs). The minimum number of days to achieve acceptable reliability (ICC ≥0.8) was calculated. Differences between weekdays and weekend days were investigated using paired t tests and Wilcoxon signed rank tests. RESULTS Two days of measurement was sufficient to achieve an ICC ≥0.8 for daily averages of total energy expenditure, step count, and time spent sedentary (≤1.5 metabolic equivalent tasks [METs]) and in light (1.5-3 METs) and moderate- to vigorous-intensity (>3 METs) PA. At least 3 days were required to achieve an ICC ≥0.8 when investigating the number of and time spent in bouts (≥10 minutes) of moderate to vigorous PA and sedentary behavior. Participants took significantly more steps (P=.03) and spent more time in light PA (P=.03) on weekdays than weekends. CONCLUSION Following stroke, 2 days of measurement appears sufficient to represent habitual PA for many simple variables. Three or more days may be necessary for reliable estimates of bouts of PA and sedentary behavior. Consistent inclusion or exclusion of a weekend day is recommended for measuring step count and light PA. Short periods of monitoring provide reliable PA information and may make PA measurement more feasible in the clinical setting.
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Affiliation(s)
- Natalie A Fini
- Physiotherapy Department, Caulfield Hospital, Alfred Health, Melbourne, Australia; Physiotherapy Department, La Trobe University, Melbourne, Australia; Physiotherapy Department, University of Melbourne, Melbourne, Australia.
| | - Angela T Burge
- Physiotherapy Department, La Trobe University, Melbourne, Australia
| | - Julie Bernhardt
- Stroke Division, Florey Institute of Neurosciences and Mental Health, University of Melbourne, Melbourne, Australia
| | - Anne E Holland
- Physiotherapy Department, Caulfield Hospital, Alfred Health, Melbourne, Australia; Physiotherapy Department, La Trobe University, Melbourne, Australia
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de Sousa DG, Harvey LA, Dorsch S, Glinsky JV. Interventions involving repetitive practice improve strength after stroke: a systematic review. J Physiother 2018; 64:210-221. [PMID: 30245180 DOI: 10.1016/j.jphys.2018.08.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 07/31/2018] [Accepted: 08/09/2018] [Indexed: 12/29/2022] Open
Abstract
QUESTIONS Do interventions involving repetitive practice improve strength after stroke? Are any improvements in strength accompanied by improvements in activity? DESIGN Systematic review of randomised trials with meta-analysis. PARTICIPANTS Adults who have had a stroke. INTERVENTION Any intervention involving repetitive practice compared with no intervention or a sham intervention. OUTCOME MEASURES The primary outcome was voluntary strength in muscles trained as part of the intervention. The secondary outcomes were measures of lower limb and upper limb activity. RESULTS Fifty-two studies were included. The overall SMD of repetitive practice on strength was examined by pooling post-intervention scores from 46 studies involving 1928 participants. The SMD of repetitive practice on strength when the upper and lower limb studies were combined was 0.25 (95% CI 0.16 to 0.34, I2=44%) in favour of repetitive practice. Twenty-four studies with a total of 912 participants investigated the effects of repetitive practice on upper limb activity after stroke. The SMD was 0.15 (95% CI 0.02 to 0.29, I2=50%) in favour of repetitive practice on upper limb activity. Twenty studies with a total of 952 participants investigated the effects of repetitive practice on lower limb activity after stroke. The SMD was 0.25 (95% CI 0.12 to 0.38, I2=36%) in favour of repetitive practice on lower limb activity. CONCLUSION Interventions involving repetitive practice improve strength after stroke, and these improvements are accompanied by improvements in activity. REVIEW REGISTRATION PROSPERO CRD42017068658. [de Sousa DG, Harvey LA, Dorsch S, Glinsky JV (2018) Interventions involving repetitive practice improve strength after stroke: a systematic review. Journal of Physiotherapy 64: 210-221].
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Affiliation(s)
- Davide G de Sousa
- Graythwaite Rehabilitation Centre, Ryde Hospital; John Walsh Centre for Rehabilitation Research, Kolling Institute; Sydney Medical School Northern, University of Sydney
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Kolling Institute; Sydney Medical School Northern, University of Sydney
| | - Simone Dorsch
- Faculty of Health Sciences, Australian Catholic University, Sydney, Australia
| | - Joanne V Glinsky
- John Walsh Centre for Rehabilitation Research, Kolling Institute; Sydney Medical School Northern, University of Sydney
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Mansfield A, Aqui A, Danells CJ, Knorr S, Centen A, DePaul VG, Schinkel-Ivy A, Brooks D, Inness EL, Mochizuki G. Does perturbation-based balance training prevent falls among individuals with chronic stroke? A randomised controlled trial. BMJ Open 2018; 8:e021510. [PMID: 30121600 PMCID: PMC6104758 DOI: 10.1136/bmjopen-2018-021510] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/06/2018] [Accepted: 07/17/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES No intervention has been shown to prevent falls poststroke. We aimed to determine if perturbation-based balance training (PBT) can reduce falls in daily life among individuals with chronic stroke. DESIGN Assessor-blinded randomised controlled trial. SETTING Two academic hospitals in an urban area. INTERVENTIONS Participants were allocated using stratified blocked randomisation to either 'traditional' balance training (control) or PBT. PBT focused on improving responses to instability, whereas traditional balance training focused on maintaining stability during functional tasks. Training sessions were 1 hour twice/week for 6 weeks. Participants were also invited to complete 2 'booster' training sessions during the follow-up. PARTICIPANTS Eighty-eight participants with chronic stroke (>6 months poststroke) were recruited and randomly allocated one of the two interventions. Five participants withdrew; 42 (control) and 41 (PBT group) were included in the analysis. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was rate of falls in the 12 months post-training. Negative binomial regression was used to compare fall rates between groups. Secondary outcomes were measures of balance, mobility, balance confidence, physical activity and social integration. RESULTS PBT participants reported 53 falls (1.45 falls/person-year) and control participants reported 64 falls (1.72 falls/person-year; rate ratio: 0.85(0.42 to 1.69); p=0.63). Per-protocol analysis included 32 PBT and 34 control participants who completed at least 10/12 initial training sessions and 1 booster session. Within this subset, PBT participants reported 32 falls (1.07 falls/person-year) and control participants reported 57 falls (1.75 falls/person-year; rate ratio: 0.62(0.29 to 1.30); p=0.20). PBT participants had greater improvement in reactive balance control than the control group, and these improvements were sustained 12 months post-training. There were no intervention-related serious adverse effects. CONCLUSIONS The results are inconclusive. PBT may help to prevent falls in daily life poststroke, but ongoing training may be required to maintain the benefits. TRIAL REGISTRATION NUMBER ISRCTN05434601; Results.
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Affiliation(s)
- Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Anthony Aqui
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Cynthia J Danells
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Svetlana Knorr
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Andrew Centen
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Vincent G DePaul
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Alison Schinkel-Ivy
- Schulich School of Education – School of Physical and Health Education, Nipissing University, North Bay, Ontario, Canada
| | - Dina Brooks
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth L Inness
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - George Mochizuki
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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