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Lee NP, Pearson ES, Sanzo P, Klarner T. Exploring the personal stroke and rehabilitation experiences of older adults with chronic stroke during the COVID-19 pandemic: a qualitative descriptive study. Int J Qual Stud Health Well-being 2024; 19:2331431. [PMID: 38511399 PMCID: PMC10962289 DOI: 10.1080/17482631.2024.2331431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 03/13/2024] [Indexed: 03/22/2024] Open
Abstract
PURPOSE The purpose of this study was to explore the personal stroke and rehabilitation experiences of older adults with chronic stroke living in a mid-sized Northwestern Ontario city in Canada during the COVID-19 pandemic. METHODS A qualitative descriptive approach with a constructivist worldview was used. In addition, a semi-structured interview guide was used to gather the participants' perspectives on their experiences throughout stroke recovery. Ten participants were interviewed, including six males and four females. The interviews were completed, transcribed, and analysed using inductive and deductive content analysis. Multiple steps were taken to enhance data trustworthiness. RESULTS Six main themes and eight related subthemes emerged. These included: getting help is complex, the effects of stroke are multifaceted, losing rehabilitation services during the COVID-19 pandemic, overcoming hardships but not alone, "If you don't use it, you lost it": rehabilitative success is based on one's actions, and "look at me now": the importance of taking pride in one's successes. CONCLUSIONS One unique finding was that the participants used this study as an opportunity to teach and advocate for future stroke survivors which is not often seen in qualitative stroke rehabilitation research. Future stroke research should place emphasis on both the positive and negative experiences of this population.
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Affiliation(s)
- Nicole P. Lee
- CONTACT Nicole P. Lee School of Kinesiology, Lakehead University, 955 Oliver Rd, Thunder Bay, OntarioP7B5E1, Canada
| | | | - Paolo Sanzo
- School of Kinesiology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Taryn Klarner
- School of Kinesiology, Lakehead University, Thunder Bay, Ontario, Canada
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2
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Moreno-Mateos A, Barbero Iglesias FJ, Sánchez Muñoz A, Gutiérrez Díaz Y, Moreno Pascual C. Compared Block Periodized and Non-Periodized Physical Activity Programs in Older Adults. Sports (Basel) 2024; 12:119. [PMID: 38786988 PMCID: PMC11125595 DOI: 10.3390/sports12050119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND The periodization of physical exercise to optimize objectives is common in competitive sports. However, physical exercise programs for older adults only sometimes present periodization in their programming. Therefore, this article aims to research the results of applying the sports periodized method to older adults. METHODS A total of 137 participants over 60 years old performed a physical exercise program; 71 participated in a multi-component non-periodized program as the Control Group (CG), and 66 participated in a program periodized in blocks as the Experimental Group (EG). The block periodization program was oriented to the development of strength and was carried out in 86 sessions thrice weekly for eight months. Anthropometric assessments were made using weight, height, Body Mass Index, and electrical bioimpedance; and functional evaluations were made through standardized tests: Short Performance Physical Battery (SPPB), Timed Up & Go (TUG), handgrip, and a two-minute stair test. RESULTS After the intervention, the EG significantly improved TUG, weight, and BMI. On the other hand, the CG showed significant improvements in fat weight, BMI, and the 2 min stair test. The SPPB did not show changes after the intervention. CONCLUSION The periodization of physical exercise for older adults does not significantly impact functional capacity in this population group.
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Affiliation(s)
| | | | - Antonio Sánchez Muñoz
- Education College, Pontificia University of Salamanca-EGIIOFID, 37007 Salamanca, Spain;
| | | | - Carlos Moreno Pascual
- Department of Nursey and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain;
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3
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Sorbie GG, Williams AK, Carter SE, Campbell AK, Glen J, Lavallee D, Sculthorpe N, Murray A, Beaumont AJ. Improved Physical Health in Middle-Older Aged Golf Caddies Following 24 Weeks of High-Volume Physical Activity. J Phys Act Health 2024; 21:134-145. [PMID: 37939701 DOI: 10.1123/jpah.2023-0288] [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: 06/14/2023] [Revised: 08/28/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND The physical demands of golf caddying, including walking while carrying a golf bag, may potentially affect body composition, and markers of metabolic, cardiovascular, and musculoskeletal health. Therefore, this study examined the impact of 24 weeks of caddying on physical health in middle-older aged males. METHODS Eleven full-time experienced male caddies (age: 59 [8] y; caddying experience: 14 [12] y) were recruited from a local golf course. The following were assessed at preseason and after 24 weeks of caddying (March-September 2022): body composition, heart rate, blood pressure, blood lipids, and performance tests (static and dynamic balance, strength, and submaximal fitness). Physical activity (PA) levels were assessed at preseason and at the mid-point of the caddying season. Across the caddying season, participants completed a monthly average of 24.0 (3.8) rounds. RESULTS Following the caddying season, improvements in static balance (Δ = 13.5 s), dynamic balance (Δ = -1.8 s), and lower back absolute strength (Δ = 112.8 N), and muscle quality (Δ = 2.0 N·kg-1) were observed (all P < .05). Additionally, blood lipids, including total cholesterol (Δ = -0.6 mmol·L-1), high-density lipoprotein cholesterol (Δ = 0.1 mmol·L-1), low-density lipoprotein cholesterol (Δ = -0.6 mmol·L-1) (all P < .05), and body composition, including body mass (Δ = -2.7 kg), fat mass (Δ = -1.9 kg), fat percentage (Δ = -1.4%), fat-to-muscle ratio (Δ = -0.03), and body mass index (Δ = -0.9 kg·m-2) (all P < .05) improved. Caddying did not offer beneficial changes to cardiovascular variables or cardiorespiratory fitness (P > .05), while coronary heart disease risk score decreased (Δ = -3.3%) (P < .05). In relation to PA, light- (Δ = 145 min) and moderate-intensity (Δ = 71 min) PA, moderate to vigorous PA (Δ = 73 min), and total PA (Δ = 218 min) between preseason and the mid-point of the caddying season increased, while sedentary time (Δ = -172 min) decreased (all P < .05). CONCLUSION Golf caddying can provide several physical health benefits such as improvements in various markers of cardiometabolic health, lower back absolute strength, and static and dynamic balance. The physical health improvements that caddying offers is likely contributed to by increased PA volume and intensity through walking on the golf course. Therefore, caddying may represent a feasible model for increasing PA volume and intensity and achieve physical health-related benefits.
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Affiliation(s)
- Graeme G Sorbie
- Division of Sport and Exercise Sciences, School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | - Ashley K Williams
- Division of Sport and Exercise Sciences, School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | - Sophie E Carter
- School of Science, Technology and Health, York St John University, York, United Kingdom
| | - Amy K Campbell
- School of Science, Technology and Health, York St John University, York, United Kingdom
| | - Jonathan Glen
- Division of Sport and Exercise Sciences, School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | - David Lavallee
- Division of Sport and Exercise Sciences, School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | - Nicholas Sculthorpe
- Institute of Clinical Exercise and Health Sciences, School of Science and Sport, University of the West of Scotland, Lanarkshire, United Kingdom
| | - Andrew Murray
- Medical and Scientific Department, The R&A, St Andrews, United Kingdom
- Sport and Exercise, University of Edinburgh, Edinburgh, United Kingdom
| | - Alexander J Beaumont
- School of Science, Technology and Health, York St John University, York, United Kingdom
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Thompson ED, Pohlig RT, McCartney KM, Hornby TG, Kasner SE, Raser-Schramm J, Miller AE, Henderson CE, Wright H, Wright T, Reisman DS. Increasing Activity After Stroke: A Randomized Controlled Trial of High-Intensity Walking and Step Activity Intervention. Stroke 2024; 55:5-13. [PMID: 38134254 PMCID: PMC10752299 DOI: 10.1161/strokeaha.123.044596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/09/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Physical inactivity in people with chronic stroke profoundly affects daily function and increases recurrent stroke risk and mortality, making physical activity improvements an important target of intervention. We compared the effects of a high-intensity walking intervention (FAST), a step activity monitoring behavioral intervention (SAM), or a combined intervention (FAST+SAM) on physical activity (ie, steps/day). We hypothesized the combined intervention would yield the greatest increase in steps/day. METHODS This assessor-blinded multisite randomized controlled trial was conducted at 4 university/hospital-based laboratories. Participants were 21 to 85 years old, walking without physical assistance following a single, unilateral noncerebellar stroke of ≥6 months duration, and randomly assigned to FAST, SAM, or FAST+SAM for 12 weeks (2-3 sessions/week). FAST training consisted of walking-related activities at 70% to 80% heart rate reserve, while SAM received daily feedback and goal setting of walking activity (steps/day). Assessors and study statistician were masked to group assignment. The a priori-determined primary outcome and end point was a comparison of the change in steps/day between the 3 intervention groups from pre- to post-intervention. Adverse events were tracked after randomization. All randomized participants were included in the intent-to-treat analysis. RESULTS Participants were enrolled from July 18, 2016, to November 16, 2021. Of 2385 participants initially screened, 250 participants were randomized (mean [SE] age, 63 [0.80] years; 116 females/134 males), with 89 assigned to FAST, 81 to SAM, and 80 to FAST+SAM. Steps/day significantly increased in both the SAM (mean [SE], 1542 [267; 95% CI, 1014-2069] P<0.001) and FAST+SAM group (1307 [280; 95% CI, 752-1861] P<0.001) but not in the FAST group (406 [238; 95% CI, -63 to 876] P=0.09). There were no deaths or serious study-related adverse events. CONCLUSIONS Only individuals with chronic stroke who completed a step activity monitoring behavioral intervention with skilled coaching and goal progression demonstrated improvements in physical activity (steps/day). REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02835313.
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Affiliation(s)
- Elizabeth D Thompson
- Department of Physical Therapy (E.D.T., K.M.M., H.W., T.W., D.S.R.), University of Delaware, Newark
| | - Ryan T Pohlig
- Biostatistics Core (R.T.P.), University of Delaware, Newark
| | - Kiersten M McCartney
- Department of Physical Therapy (E.D.T., K.M.M., H.W., T.W., D.S.R.), University of Delaware, Newark
| | - T George Hornby
- Department of Physical Medicine and Rehabilitation, Indiana University, Indianapolis (T.G.H., C.E.H.)
| | - Scott E Kasner
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.E.K.)
| | | | - Allison E Miller
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO (A.E.M.)
| | - Christopher E Henderson
- Department of Physical Medicine and Rehabilitation, Indiana University, Indianapolis (T.G.H., C.E.H.)
| | - Henry Wright
- Department of Physical Therapy (E.D.T., K.M.M., H.W., T.W., D.S.R.), University of Delaware, Newark
| | - Tamara Wright
- Department of Physical Therapy (E.D.T., K.M.M., H.W., T.W., D.S.R.), University of Delaware, Newark
| | - Darcy S Reisman
- Department of Physical Therapy (E.D.T., K.M.M., H.W., T.W., D.S.R.), University of Delaware, Newark
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Thompson ED, Pohlig RT, McCartney KM, Hornby TG, Kasner SE, Raser-Schramm J, Miller AE, Henderson CE, Wright H, Wright T, Reisman DS. Increasing activity after stroke: a randomized controlled trial of highintensity walking and step activity intervention. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.11.23287111. [PMID: 37609269 PMCID: PMC10441496 DOI: 10.1101/2023.03.11.23287111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Background Physical inactivity in people with chronic stroke profoundly affects daily function and increases recurrent stroke risk and mortality, making physical activity improvements an important target of intervention. We compared the effects of a highintensity walking intervention (FAST), a step activity monitoring behavioral intervention (SAM), or a combined intervention (FAST+SAM) on physical activity (i.e., steps per day). We hypothesized the combined intervention would yield the greatest increase in steps per day. Methods This assessor-blinded multi-site randomized controlled trial was conducted at four university/hospital-based laboratories. Participants were 21-85 years old, walking without physical assistance following a single, unilateral non-cerebellar stroke of ≥6 months duration, and randomly assigned to FAST, SAM, or FAST+SAM for 12 weeks (2-3 sessions/week). FAST training consisted of walking-related activities for 40 minutes/session at 70-80% heart rate reserve, while SAM received daily feedback and goal-setting of walking activity (steps per day). Assessors and study statistician were masked to group assignment.The a priori-determined primary outcome and primary endpoint was change in steps per day from pre- to post-intervention. Adverse events (AEs) were tracked after randomization. All randomized participants were included in the intent-to-treat analysis.This study is registered at ClinicalTrials.gov, NCT02835313. Findings Participants were enrolled from July 18, 2016-November 16, 2021. Of 250 randomized participants (mean[SE] age 63[0.80], 116F/134M), 89 were assigned to FAST, 81 to SAM, and 80 to FAST+SAM. Steps per day significantly increased in both the SAM (mean[SE] 1542[267], 95%CI:1014-2069, p<0.001) and FAST+SAM groups (1307[280], 752-1861, p<0.001), but not in the FAST group (406[238], 63-876, p=0.09). There were no deaths or serious study-related AEs and all other minor AEs were similar between groups. Interpretation Only individuals with chronic stroke who completed a step activity monitoring behavioral intervention with skilled coaching and goal progression demonstrated improvements in physical activity (steps per day).
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Affiliation(s)
| | - Ryan T Pohlig
- University of Delaware, Biostatistics Core, Newark, DE, USA
| | - Kiersten M McCartney
- University of Delaware, Biomechanics and Movement Science (BIOMS) program, Newark, DE, USA
| | - T George Hornby
- Indiana University, Department of Physical Medicine and Rehabilitation, Indianapolis, IN, USA
| | - Scott E Kasner
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Allison E Miller
- Washington University School of Medicine, Program in Physical Therapy, St. Louis, MO, USA
| | - Christopher E Henderson
- Indiana University, Department of Physical Medicine and Rehabilitation, Indianapolis, IN, USA
| | - Henry Wright
- University of Delaware, Department of Physical Therapy, Newark, DE, USA
| | - Tamara Wright
- University of Delaware, Department of Physical Therapy, Newark, DE, USA
| | - Darcy S Reisman
- University of Delaware, Department of Physical Therapy, Newark, DE, USA
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Miller A, Collier Z, Reisman DS. Beyond steps per day: other measures of real-world walking after stroke related to cardiovascular risk. J Neuroeng Rehabil 2022; 19:111. [PMID: 36242083 PMCID: PMC9563761 DOI: 10.1186/s12984-022-01091-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/27/2022] [Indexed: 11/26/2022] Open
Abstract
Background Significant variability exists in how real-world walking has been measured in prior studies in individuals with stroke and it is unknown which measures are most important for cardiovascular risk. It is also unknown whether real-world monitoring is more informative than laboratory-based measures of walking capacity in the context of cardiovascular risk. The purpose of this study was to determine a subset of real-world walking activity measures most strongly associated with systolic blood pressure (SBP), a measure of cardiovascular risk, in people with stroke and if these measures are associated with SBP after accounting for laboratory-based measures of walking capacity. Methods This was a cross-sectional analysis of 276 individuals with chronic (≥ 6 months) stroke. Participants wore an activity monitor for ≥ 3 days. Measures of activity volume, activity frequency, activity intensity, and sedentary behavior were calculated. Best subset selection and lasso regression were used to determine which activity measures were most strongly associated with systolic blood pressure. Sequential linear regression was used to determine if these activity measures were associated with systolic blood pressure after accounting for walking capacity (6-Minute Walk Test). Results Average bout cadence (i.e., the average steps/minute across all bouts of walking) and the number of long (≥ 30 min) sedentary bouts were most strongly associated with systolic blood pressure. After accounting for covariates (ΔR2 = 0.089, p < 0.001) and walking capacity (ΔR2 = 0.002, p = 0.48), these activity measures were significantly associated with systolic blood pressure (ΔR2 = 0.027, p = 0.02). Higher systolic blood pressure was associated with older age (β = 0.219, p < 0.001), male gender (β = − 0.121, p = 0.046), black race (β = 0.165, p = 0.008), and a slower average bout cadence (β = − 0.159, p = 0.022). Conclusions Measures of activity intensity and sedentary behavior may be superior to commonly used measures, such as steps/day, when the outcome of interest is cardiovascular risk. The relationship between walking activity and cardiovascular risk cannot be inferred through laboratory-based assessments of walking capacity.
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Affiliation(s)
- Allison Miller
- Department of Biomechanics and Movement Science Program, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA
| | - Zachary Collier
- Department of Education and Human Development, University of Delaware, Newark, DE, USA
| | - Darcy S Reisman
- Department of Biomechanics and Movement Science Program, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA. .,Department of Physical Therapy, University of Delaware, Newark, DE, USA.
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7
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Hornby TG, Plawecki A, Lotter JK, Scofield ME, Lucas E, Henderson CE. Gains in Daily Stepping Activity in People With Chronic Stroke After High-Intensity Gait Training in Variable Contexts. Phys Ther 2022; 102:pzac073. [PMID: 35670001 PMCID: PMC9396452 DOI: 10.1093/ptj/pzac073] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 11/03/2021] [Accepted: 01/25/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Many physical therapist interventions provided to individuals with chronic stroke can lead to gains in gait speed or endurance (eg, 6-Minute Walk Test [6MWT]), although changes in objective measures of participation are not often observed. The goal of this study was to determine the influence of different walking interventions on daily stepping (steps per day) and the contributions of demographic, training, and clinical measures to these changes. METHODS In this secondary analysis of a randomized clinical trial, steps per day at baseline and changes in steps per day following 1 of 3 locomotor interventions were evaluated in individuals who were ambulatory and >6 months after stroke. Data were collected on 58 individuals who received ≤30 sessions of high-intensity training (HIT) in variable contexts (eg, tasks and environments; n = 19), HIT focused on forward walking (n = 19), or low-intensity variable training (n = 20). Primary outcomes were steps per day at baseline, at post-training, and at a 3-month follow-up, and secondary outcomes were gait speed, 6MWT, balance, and balance confidence. Correlation and regression analyses identified demographic and clinical variables associated with steps per day. RESULTS Gains in steps per day were observed across all groups combined, with no between-group differences; post hoc within-group analyses revealed significant gains only following HIT in variable contexts. Both HIT groups showed gains in endurance (6MWT), with increases in balance confidence only following HIT in variable contexts. Changes in steps per day were associated primarily with gains in 6MWT, with additional associations with baseline 6MWT, lower-extremity Fugl-Meyer scores, and changes in balance confidence. CONCLUSION HIT in variable contexts elicited gains in daily stepping, with changes primarily associated with gains in gait endurance. IMPACT Providing HIT in variable contexts appears to improve measures of participation (eg, daily stepping) that may be associated with clinical measures of function. Gains in multiple measures of mobility and participation with HIT in variable contexts may improve the efficiency and value of physical therapy services.
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Affiliation(s)
- T George Hornby
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Rehabilitation Hospital of Indiana, Indianapolis, Indiana, USA
| | - Abbey Plawecki
- Rehabilitation Hospital of Indiana, Indianapolis, Indiana, USA
| | | | | | - Emily Lucas
- Rehabilitation Hospital of Indiana, Indianapolis, Indiana, USA
| | - Christopher E Henderson
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Rehabilitation Hospital of Indiana, Indianapolis, Indiana, USA
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Manning OJ, Rancourt S, Tomasone JR, Finlayson M, DePaul V. Water-based therapeutic exercise in stroke: a scoping review. Disabil Rehabil 2022; 45:1549-1562. [PMID: 35450495 DOI: 10.1080/09638288.2022.2063415] [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: 11/03/2022]
Abstract
PURPOSE To (1) describe the state of the literature on water-based therapeutic exercise (WBTE) for people living with stroke, (2) describe the content and structure of interventions, (3) summarize the effects of interventions described in the literature, and (4) identify gaps in the literature limiting application and implementation. MATERIALS AND METHODS Scoping review methodology described by Arksey and O'Malley (2005) and Levac et al. (2010). Electronic databases were searched for articles with eligibility criteria including: (1) adult stroke survivors (18 years or older) of any type (ischemic/hemorrhagic) or stage (acute/chronic) in any setting, and (2) the study intervention involved WBTE to address a post-stroke deficit. RESULTS 40 articles were included in this review. Five trials had a treatment control, 20 had an active comparison. Calculated intervention effect sizes demonstrated a strong effect of WBTE on balance and gait related outcomes in 80% of controlled and comparison trials. CONCLUSIONS This scoping review highlights common parameters of WBTE interventions and provides an inventory of the differences in the treatment approaches utilized in this population. Opportunities for future work include the development of a standardized treatment protocol, qualitative or mixed methodology research, and greater inclusion of more individuals with more severe stroke-related impairments. IMPLICATIONS FOR REHABILITATIONWater-based therapeutic exercise is an approach that may allow stroke survivors to carry out challenging activities in a safe and accessible environment.Water-based interventions for stroke survivors appear to have a beneficial impact on walking and balance.Given that an aquatic environment offers an opportunity for individuals with more significant physical impairments to carry out early practice of walking and balance related tasks, clinicians should explore the feasibility and effectiveness for this subset of stroke survivors.
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Affiliation(s)
- O J Manning
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - S Rancourt
- Providence Care Hospital, Kingston, Canada
| | - J R Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, Canada
| | - M Finlayson
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - V DePaul
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
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Komiya M, Maeda N, Narahara T, Suzuki Y, Fukui K, Tsutsumi S, Yoshimi M, Ishibashi N, Shirakawa T, Urabe Y. Effect of 6-Week Balance Exercise by Real-Time Postural Feedback System on Walking Ability for Patients with Chronic Stroke: A Pilot Single-Blind Randomized Controlled Trial. Brain Sci 2021; 11:1493. [PMID: 34827492 PMCID: PMC8615752 DOI: 10.3390/brainsci11111493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/04/2021] [Accepted: 11/10/2021] [Indexed: 12/01/2022] Open
Abstract
Stroke causes balance dysfunction, leading to decreased physical activity and increased falls. Thus, effective balance exercises are needed to improve balance dysfunction. This single-blind, single-center randomized controlled trial evaluated the long-term and continuous effects of balance exercise using a real-time postural feedback system to improve balancing ability safely. Thirty participants were randomized into intervention (n = 15) and control (n = 15) groups; 11 in each group completed the final evaluation. The effect of the intervention was evaluated by muscle strength of knee extension, physical performance (short physical performance battery, the center of pressure trajectory length per second, and Timed Up and Go test [TUG]), and self-reported questionnaires (modified Gait Efficacy Scale [mGES] and the Fall Efficacy Scale) at pre (0 week), post (6-week), and at follow-up (10-week) visits. The TUG and mGES showed a significant interactive (group * time) effect (p = 0.007 and p = 0.038, respectively). The intervention group showed significant decreasing time to perform TUG from pre- to post-intervention (p = 0.015) and pre-intervention to follow-up (p = 0.016); mGES showed a significant change from pre-intervention to follow-up (p = 0.036). Thus, balance exercise using a real-time postural feedback system can confer a positive effect on the walking ability in patients with chronic stroke and increase their self-confidence in gait performance.
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Affiliation(s)
- Makoto Komiya
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (N.M.); (K.F.); (S.T.); (M.Y.); (Y.U.)
| | - Noriaki Maeda
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (N.M.); (K.F.); (S.T.); (M.Y.); (Y.U.)
| | - Taku Narahara
- Department of Rehabilitation, Matterhorn Rehabilitation Hospital, Hiroshima 737-0046, Japan; (T.N.); (Y.S.); (N.I.)
| | - Yuta Suzuki
- Department of Rehabilitation, Matterhorn Rehabilitation Hospital, Hiroshima 737-0046, Japan; (T.N.); (Y.S.); (N.I.)
| | - Kazuki Fukui
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (N.M.); (K.F.); (S.T.); (M.Y.); (Y.U.)
| | - Shogo Tsutsumi
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (N.M.); (K.F.); (S.T.); (M.Y.); (Y.U.)
| | - Mistuhiro Yoshimi
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (N.M.); (K.F.); (S.T.); (M.Y.); (Y.U.)
| | - Naoki Ishibashi
- Department of Rehabilitation, Matterhorn Rehabilitation Hospital, Hiroshima 737-0046, Japan; (T.N.); (Y.S.); (N.I.)
| | - Taizan Shirakawa
- Department of Orthopedics, Matterhorn Rehabilitation Hospital, Hiroshima 737-0046, Japan;
| | - Yukio Urabe
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (N.M.); (K.F.); (S.T.); (M.Y.); (Y.U.)
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10
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Waddell KJ, Patel MS, Clark K, Harrington TO, Greysen SR. Leveraging insights from behavioral economics to improve mobility for adults with stroke: Design and rationale of the BE Mobile clinical trial. Contemp Clin Trials 2021; 107:106483. [PMID: 34129953 DOI: 10.1016/j.cct.2021.106483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/06/2021] [Accepted: 06/10/2021] [Indexed: 11/29/2022]
Abstract
Physical inactivity post-stroke can negatively impact long-term health outcomes and contribute to cardiovascular deconditioning, muscle loss, and increased risk for recurrent stroke. The limited number of interventions designed to improve daily physical activity post-stroke have lacked precision in step goals, are resource intensive, and difficult to scale. The purpose of the Leveraging Insights from Behavioral Economics to Improve Mobility for Adults with Stroke (BE Mobile) trial is to examine the preliminary effectiveness of a novel gamification with social incentives intervention for improving physical activity post-stroke. This trial includes adults who have experienced an ischemic or hemorrhagic stroke ≥3 months prior to the time of recruitment who are randomized to a control or gamification arm. All participants receive a Fitbit Inspire 2 wearable device to quantify daily steps and complete a 2-week baseline run-in period followed by an 8-week intervention period. All participants select a daily step goal and the gamification arm is enrolled in a game with loss-framed points and levels to help participants achieve their daily step goal. Participants in the gamification arm also select a support partner who receives weekly updates on their progress in the game. The primary outcome is change in daily steps from baseline during the intervention period. The secondary outcome is difference in the proportion of days participants achieved their daily step goal. Results from this trial will inform future, larger studies that leverage insights from behavioral economics to help improve daily physical activity post-stroke. Trial registration: NCT #04607811.
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Affiliation(s)
- Kimberly J Waddell
- Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia, PA, USA; Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.
| | - Mitesh S Patel
- Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; The Wharton School, University of Pennsylvania, Philadelphia, PA, USA; The LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA; Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Kayla Clark
- Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia, PA, USA
| | - Tory O Harrington
- Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia, PA, USA
| | - S Ryan Greysen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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11
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Beyond Physical Capacity: Factors Associated With Real-world Walking Activity After Stroke. Arch Phys Med Rehabil 2021; 102:1880-1887.e1. [PMID: 33894218 DOI: 10.1016/j.apmr.2021.03.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/10/2020] [Accepted: 03/22/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To identify homogeneous subsets of survivors of chronic stroke who share similar characteristics across several domains and test if these groups differ in real-world walking activity. We hypothesized that variables representing the domains of walking ability, psychosocial, environment, and cognition would be important contributors in differentiating real-world walking activity in survivors of chronic stroke. DESIGN Cross-sectional, secondary data analysis. SETTING University/laboratory. PARTICIPANTS A total of 283 individuals with chronic (≥6mo) stroke (N=238). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Thirteen variables representing 5 domains were included: (1) walking ability: 6-minute walk test (6MWT), self-selected speed (SSS) of gait; (2) psychosocial: Patient Health Questionnaire-9, Activities-specific Balance Confidence (ABC) scale; (3) physical health: low-density lipoprotein cholesterol, body mass index, Charlson Comorbidity Index (CCI); (4) cognition: Montreal Cognitive Assessment (MoCA); and (5) environment: living situation and marital status, work status, Area Deprivation Index (ADI), Walk Score. Mixture modeling was used to identify latent classes of survivors of stroke. After identifying the latent classes, walking activity, measured as steps per day (SPD), was included as a distal outcome to understand if classes were meaningfully different in their real-world walking RESULTS: A model with 3 latent classes was selected. The 6MWT, SSS, ABC scale, and Walk Score were significantly different among all 3 classes. Differences were also seen for the MoCA, ADI, and CCI between 2 of the 3 classes. Importantly, the distal outcome of SPD was significantly different in all classes, indicating that real-world walking activity differs among the groups identified by the mixture model. CONCLUSIONS Survivors of stroke with lower walking ability, lower self-efficacy, lower cognitive abilities, and greater area deprivation had lower SPD. These results demonstrate that the physical and social environment (including socioeconomic factors) and cognitive function should also be considered when developing interventions to improve real-world walking activity after stroke.
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12
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Miller A, Wright T, Wright H, Thompson E, Pohlig RT, Reisman DS. Readiness to Change is Related to Real-World Walking and Depressive Symptoms in Chronic Stroke. J Neurol Phys Ther 2021; 45:28-35. [PMID: 33315834 PMCID: PMC7739270 DOI: 10.1097/npt.0000000000000345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE The transtheoretical model is a health behavior model used to understand an individual's readiness to change their behavior. This study aims to apply the transtheoretical model in understanding a person with stroke's readiness to change their activity level, as it relates to physical capacity, physical health, depressive symptoms, self-efficacy, and daily stepping activity. METHODS This was a cross-sectional analysis of baseline data from a clinical trial. Participants' readiness to change their activity levels was measured via self-report and daily stepping activity was measured using a step activity monitor. Robust regression (M-estimation with robust standard errors) was used to test the relationship between readiness to change and measures of physical capacity (6-minute walk test, self-selected walking speed), physical health (body mass index, age-adjusted Charlson Comorbidity Index), depressive symptoms (Patient Health Questionnaire-9), self-efficacy (Activities-Specific Balance Confidence Scale), and daily stepping (steps per day). RESULTS A total of 274 individuals were included in the analysis. Adjusted for age, readiness to change was positively related to daily stepping (β = 0.29, P < 0.001) and negatively related to depressive symptoms (β = -0.13, P = 0.01). Readiness to change was not significantly associated with measures of physical capacity, physical health, or self-efficacy. DISCUSSION These results suggest that individuals with stroke in the later stages of change may demonstrate greater daily stepping activity and lower depressive symptoms compared with those in earlier stages. CONCLUSIONS Understanding the relationship between readiness to change, daily stepping, and depressive symptoms will help clinicians implement appropriate stage-specific intervention strategies and facilitate greater improvement in activity levels.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A333).
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Affiliation(s)
- Allison Miller
- Department of Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware 19713
| | - Tamara Wright
- Department of Physical Therapy, University of Delaware, Newark, Delaware 19713
| | - Henry Wright
- Department of Physical Therapy, University of Delaware, Newark, Delaware 19713
| | - Elizabeth Thompson
- Department of Physical Therapy, University of Delaware, Newark, Delaware 19713
| | - Ryan T. Pohlig
- Department of Biostatistics Core Facility, University of Delaware, Newark, Delaware 19716
| | - Darcy S. Reisman
- Department of Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware 19713
- Department of Physical Therapy, University of Delaware, Newark, Delaware 19713
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13
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Andreasen SC, Wright TR, Crenshaw JR, Reisman DS, Knarr BA. Relationships of Linear and Non-linear Measurements of Post-stroke Walking Activity and Their Relationship to Weather. Front Sports Act Living 2020; 2:551542. [PMID: 33345115 PMCID: PMC7739597 DOI: 10.3389/fspor.2020.551542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/22/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Stroke survivors are more sedentary than the general public. Previous research on stroke activity focuses on linear quantities. Non-linear measures, such as Jensen-Shannon Divergence and Lempel-Ziv Complexity, may help explain when and how stroke survivors move so that interventions to increase activity may be designed more effectively. Objectives: Our objective was to understand what factors affect a stroke survivor's physical activity, including weather, by characterizing activity by step counts, structure, and complexity. Methods: A custom MATLAB code was used to analyze clinical trial (NCT02835313, https://clinicaltrials.gov/ct2/show/NCT02835313) data presented as minute by minute step counts. Six days of data were analyzed for 142 participants to determine the regularity of activity structure across days and complexity patterns of varied cadences. The effect of steps on structure and complexity, the season's effect on steps, structure, and complexity, and the presence of precipitation's effect on steps and complexity were all analyzed. Results: Step counts and regularity were linearly related (p < 0.001). Steps and complexity were quadratically related (r2 = 0.70 for mean values, 0.64 for daily values). Season affected complexity between spring and winter (p = 0. 019). Season had no effect on steps or structure. Precipitation had no effect on steps or complexity. Conclusions: Stroke survivors with high step counts are active at similar times each day and have higher activity complexities as measured through patterns of movement at different intensity levels. Non-linear measures, such as Jensen-Shannon Divergence and Lempel-Ziv Complexity, are valuable in describing a person's activity. Weather affects our activity parameters in terms of complexity between spring and winter.
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Affiliation(s)
- Sydney C Andreasen
- Department of Biomechanics, Biomechanics Research Building, University of Nebraska at Omaha, Omaha, NE, United States
| | - Tamara R Wright
- Clinical Research Laboratory, Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - Jeremy R Crenshaw
- Falls and Mobility Laboratory, Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Darcy S Reisman
- Neuromotor Behavior Lab, Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - Brian A Knarr
- Department of Biomechanics, Biomechanics Research Building, University of Nebraska at Omaha, Omaha, NE, United States
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14
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Handlery R, Fulk G, Pellegrini C, Stewart JC, Monroe C, Fritz S. Stepping After Stroke: Walking Characteristics in People With Chronic Stroke Differ on the Basis of Walking Speed, Walking Endurance, and Daily Steps. Phys Ther 2020; 100:807-817. [PMID: 31995194 DOI: 10.1093/ptj/pzaa020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/01/2019] [Accepted: 10/06/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND What contributes to free-living walking after stroke is poorly understood. Studying the characteristics of walking may provide further details that guide interventions. OBJECTIVE The objectives of this study were to examine how the walking characteristics of bouts per day, median steps per bout, maximum steps per bout, and time spent walking differ in individuals with various walking speeds, walking endurance, and daily steps and to identify cutoffs for differentiating ambulators who were active versus inactive. DESIGN This study involved a cross-sectional analysis of data from the Locomotor Experience Applied Post-Stroke trial. METHODS Participants were categorized by walking speed, walking endurance (via the 6-minute walk test), and daily steps (via 2 consecutive days of objective activity monitoring). Differences in walking characteristics were assessed. Linear regression determined which characteristics predicted daily step counts. Receiver operating characteristic curves and areas under the curve were used to determine which variable was most accurate in classifying individuals who were active (≥5500 daily steps). RESULTS This study included 252 participants with chronic stroke. Regardless of categorization by walking speed, walking endurance, or daily steps, household ambulators had significantly fewer bouts per day, steps per bout, and maximum steps per bout and spent less time walking compared with community ambulators. The areas under the curve for maximum steps per bout and bouts per day were 0.91 (95% confidence interval = 0.88 to 0.95) and 0.83 (95% confidence interval = 0.78 to 0.88), respectively, with cutoffs of 648 steps and 53 bouts being used to differentiate active and inactive ambulation. LIMITATIONS Activity monitoring occurred for only 2 days. CONCLUSIONS Walking characteristics differed based on walking speed, walking endurance, and daily steps. Differences in daily steps between household and community ambulators were largely due to shorter and fewer walking bouts. Assessing and targeting walking bouts may prove useful for increasing stepping after stroke.
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Affiliation(s)
- Reed Handlery
- Department of Exercise Science, University of South Carolina, 1300 Wheat St, Columbia, SC 29208 (USA)
| | - George Fulk
- Department of Physical Therapy Education, SUNY Upstate Medical University, Syracuse, New York
| | | | | | - Courtney Monroe
- Department of Health Promotion, Education, and Behavior, University of South Carolina
| | - Stacy Fritz
- Department of Exercise Science, University of South Carolina
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15
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Modifiable Physical Factors Associated With Physical Functioning for Patients Receiving Dialysis: A Systematic Review. J Phys Act Health 2020; 17:475-489. [DOI: 10.1123/jpah.2019-0338] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/10/2019] [Accepted: 12/29/2019] [Indexed: 11/18/2022]
Abstract
Background: Patients receiving dialysis have reduced physical function, which is associated with unfavorable clinical outcomes and decreased quality of life. The authors aimed to identify and explore modifiable physical factors associated with physical function for patients receiving dialysis. Methods: Searches were performed in MEDLINE, Embase, Ovid Emcare, and The Cochrane Library in October 2018. Etiological studies involving dialysis populations that report association or predictive statistics between a modifiable physical factor and physical function were eligible for inclusion. Predictor variables were (1) modifiable via exercise and (2) considered an impairment in the International Classification of Functioning, Disability and Health. Results: Of 5384 titles screened, 23 studies were included. Thirteen studies focused on physical activity levels and muscle strength and the relationship with physical function while 2 studies investigated sedentary behavior. Twenty-one studies focused on hemodialysis populations. Studies related to physical activity levels displayed a moderately strong relationship with physical function, whereas muscle strength displayed a predominantly weak to moderate relationship. Conclusions: Physical activity levels, sedentary behavior levels, and muscle strength are related to physical function status for patients receiving dialysis. There is a need for robust longitudinal data to confirm the results of this investigation and for more focus on populations receiving peritoneal dialysis.
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16
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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: 1.6] [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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17
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Lim C. Multi-Sensorimotor Training Improves Proprioception and Balance in Subacute Stroke Patients: A Randomized Controlled Pilot Trial. Front Neurol 2019; 10:157. [PMID: 30881333 PMCID: PMC6407432 DOI: 10.3389/fneur.2019.00157] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/07/2019] [Indexed: 12/14/2022] Open
Abstract
Introduction: The objective was to determine whether advanced rehabilitation therapy combined with conventional rehabilitation therapy consisting of sensorimotor exercises would be superior to usual treadmill training for proprioception variation and balance ability in subacute stroke patients. Methods: Thirty subjects (post-stroke time period: 3.96 ± 1.19 months) were randomly assigned to either a multi-sensorimotor training group (n = 19) or a treadmill training group (n = 18). Both groups first performed conventional physical therapy for 30 min, after which the multi-sensorimotor training group performed multi-sensorimotor training for 30 min, and the treadmill training group performed treadmill gait training for 30 min. Both groups performed the therapeutic interventions 5 days per week for 8 weeks. The primary outcome (proprioception variation) was evaluated using an acryl panel and electrogoniometer. The secondary outcome (balance ability) was measured using the Biodex Balance system before intervention and after 8 weeks. Results: The multi-sensorimotor training and treadmill training groups showed significant improvement in proprioception variation and balance (overall, A-P and M-L) (all P < 0.05). In particular, the multi-sensorimotor training group showed more significant differences in proprioception variation (P = 0.002) and anterior-posterior (A-P) balance ability (P = 0.033) than the treadmill training group. Conclusions: The multi-sensorimotor training program performed on multiple types of sensory input had a beneficial effect on proprioception sense in the paretic lower limb and A-P balance. A large-scale randomized controlled study is needed to prove the effect of this training. Clinical Trial Registration:https://cris.nih.go.kr/cris/, identifier KCT0003097.
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Affiliation(s)
- Chaegil Lim
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon, South Korea
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18
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Xie G, Rao T, Lin L, Lin Z, Xiao T, Yang M, Xu Y, Fan J, Lin S, Wu J, Feng X, Li L, Tao J, Chen L. Effects of Tai Chi Yunshou exercise on community-based stroke patients: a cluster randomized controlled trial. Eur Rev Aging Phys Act 2018; 15:17. [PMID: 30564291 PMCID: PMC6292054 DOI: 10.1186/s11556-018-0206-x] [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: 04/13/2018] [Accepted: 11/28/2018] [Indexed: 02/03/2023] Open
Abstract
Backgroud Tai Chi Chuan was used for stroke survivors with balance impairments. However, even a short-form of Tai Chi Chuan includes forms that make the exercise challenging for the stroke survivors. Tai Chi Yunshou (wave hands in the cloud) is the “mother” form and the fundamental form of all Tai Chi Chuan styles, which is considered more suitable and feasible for stroke survivors with balance impairments. So this study was designed to evaluate the effects of Tai Chi Yunshou exercise on community-based stroke patients with balance dysfunctions. Methods A total of 250 participants from 10 community health centers (5 per arm) were selected and randomly allocated into Tai Chi Yunshou exercise group (TC group) or a balance rehabilitation training group (control group) in an equal ratio. Participants in the TC group were received Tai Chi Yunshou exercise training five times per week for 12 weeks and those in control group were received balance rehabilitation training five times per week for 12 weeks. Outcome assessments including Berg Balance Scale (BBS), Time up to go test (TUGT), Modified Barthel Index (MBI) were measured at baseline, 4 weeks, 8 weeks, 12 weeks and followed-up 6 weeks (18 weeks), 12 weeks (24 weeks). Intention-to-treat analysis was performed. Analysis of variance of repeated measures was used to assess between-group differences. Results A total of 244 participants, 120 in the TC group and 124 in the rehabilitation group, were included in final analysis. There was no siginificant difference in Tai Chi Yunshou and balance rehabilitation training on the improvement of balance ability and mobility (P = 0.531 and P = 0.839, respectively) after adjustment for baseline. However, there was significant difference between two groups on improvement of motor funtion (P = 0.022), fear of falling (P < 0.001) and depression (P = 0.035) for the post stroke patients. No adverse events were reported during the study. Conclusion Tai Chi Yunshou and balance rehabilitation training led to improved balance ability and functional mobility, and both are suitable community-based programs that may benefit for stroke recovery and community reintegration. Our data demonstrated that a 12-week Tai Chi Yunshou intervention was more effective in motor function, fear of falling and depression than balance rehabilitation training. Future studies examining the effectiveness of Tai Chi Yunahou as a balance ability improvement strategy for community-dwelling survivors of stroke are recommended. Trial registration Chinese Clinical Trail Registry: ChiCRT-TRC-13003641. Registration date: 22 August, 2013.
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Affiliation(s)
- Guanli Xie
- 1College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China.,Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fuzhou, People's Republic of China
| | - Ting Rao
- 2Affiliated Rehabilitation Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Lili Lin
- 1College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China
| | - Zhengkun Lin
- 1College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China
| | - Tianshen Xiao
- 1College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China.,Rehabilitation medical technology Joint National Local Engineering Research Center, Fuzhou, China
| | - Ming'ge Yang
- 1College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China.,Rehabilitation medical technology Joint National Local Engineering Research Center, Fuzhou, China
| | - Ying Xu
- 1College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China.,Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fuzhou, People's Republic of China
| | - Jinmei Fan
- 1College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China
| | - Shufang Lin
- 2Affiliated Rehabilitation Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jinsong Wu
- 1College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China.,Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, China
| | - Xiaodong Feng
- 6The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Li Li
- 7The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jing Tao
- 1College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China.,Rehabilitation medical technology Joint National Local Engineering Research Center, Fuzhou, China.,Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, China
| | - Lidian Chen
- 1College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China.,Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fuzhou, People's Republic of China.,Rehabilitation medical technology Joint National Local Engineering Research Center, Fuzhou, China
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19
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Gouveia ÉR, Gouveia BR, Ihle A, Kliegel M, Marques A, Freitas DL. Balance and mobility relationships in older adults: A representative population-based cross-sectional study in Madeira, Portugal. Arch Gerontol Geriatr 2018; 80:65-69. [PMID: 30388458 DOI: 10.1016/j.archger.2018.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/19/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Balance and mobility impairments are important modifiable risk factors associated with falls in older people. PURPOSE To investigate how different functional fitness components relate to balance and mobility, after controlling for age, sex, body mass index (BMI), and different physical activity (PA) domains. METHODS This representative cross-sectional study included 802 individuals, 401 males and 401 females (69.8 ± 5.6 years) from Madeira, Portugal. The Fullerton Advance Balance (FAB) scale was used to assess balance. Mobility in terms of gait velocity, cadence, stride length, and gait stability ratio (GSR) were assessed using the 50-foot Walk test. PA was assessed through a face-to-face interview using the Baecke questionnaire, and functional fitness was assessed with Senior Fitness tests (strength, flexibility, and aerobic endurance). RESULTS Balance and mobility were negatively associated with age and BMI, and positively related to PA and functional fitness. Moreover, male presented better performance in balance and mobility. Hierarchical multiple regression analyses showed that functional fitness explained the highest amount of variance in balance and all mobility parameters (over and above age, sex, BMI, and PA). Specifically, entering functional fitness components significantly increased explained variance in FAB (+19%), gait velocity (+25%), cadence (+15%), stride length (+9%), and GSR (+ 31%). In these models, aerobic endurance consistently had the strongest contribution. CONCLUSION Strength, flexibility, and especially aerobic endurance, over and above non-modifiable variables like age and sex, are crucial for maintaining or improving balance and mobility and, thereby, prevent falls in older people.
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Affiliation(s)
- Élvio R Gouveia
- Department of Physical Education and Sport, University of Madeira, Funchal, Portugal; Madeira Interactive Technologies Institute, Funchal, Portugal; Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland.
| | - Bruna R Gouveia
- Madeira Interactive Technologies Institute, Funchal, Portugal; Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland; Health Administration Institute, Secretary of Health of the Autonomous Region of Madeira, Funchal, Portugal; Saint Joseph of Cluny Higher School of Nursing, Funchal, Portugal
| | - Andreas Ihle
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland; Department of Psychology, University of Geneva, Geneva, Switzerland
| | - Matthias Kliegel
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland; Department of Psychology, University of Geneva, Geneva, Switzerland
| | - Adilson Marques
- Centro Interdisciplinar de Estudo da Performance Humana, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal; Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Duarte L Freitas
- Department of Physical Education and Sport, University of Madeira, Funchal, Portugal; Department of Mathematical Sciences, University of Essex, Colchester, UK; CIFI(2)D, Faculty of Sport, University of Porto, Porto, Portugal
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20
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Wright H, Wright T, Pohlig RT, Kasner SE, Raser-Schramm J, Reisman D. Protocol for promoting recovery optimization of walking activity in stroke (PROWALKS): a randomized controlled trial. BMC Neurol 2018; 18:39. [PMID: 29649992 PMCID: PMC5898044 DOI: 10.1186/s12883-018-1044-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/04/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Stroke survivors are more physically inactive than even the most sedentary older adults, and low activity is associated with increased risk of recurrent stroke, medical complications, and mortality. We hypothesize that the combination of a fast walking intervention that improves walking capacity, with a step activity monitoring program that facilitates translation of gains from the clinic to the "real-world", would generate greater improvements in real world walking activity than with either intervention alone. METHODS Using a single-blind randomized controlled experimental design, 225 chronic (> 6 months) stroke survivors complete 12 weeks of fast walking training, a step activity monitoring program or a fast walking training + step activity monitoring program. Main eligibility criteria include: chronic ischemic or hemorrhagic stroke (> 6 months post), no evidence of cerebellar stroke, baseline walking speed between 0.3 m/s and 1.0 m/s, and baseline average steps / day < 8000. The primary (steps per day), secondary (self-selected and fastest walking speed, walking endurance, oxygen consumption) and exploratory (vascular events, blood lipids, glucose, blood pressure) outcomes are assessed prior to initiating treatment, after the last treatment and at a 6 and 12-month follow-up. Moderation of the changes in outcomes by baseline characteristics are evaluated to determine for whom the interventions are effective. DISCUSSION Following completion of this study, we will not only understand the efficacy of the interventions and the individuals for which they are effective, we will have the necessary information to design a study investigating the secondary prevention benefits of improved physical activity post-stroke. This study is, therefore, an important step in the development of both rehabilitative and secondary prevention guidelines for persons with stroke. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02835313 . First Posted: July 18, 2016.
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Affiliation(s)
- Henry Wright
- Department of Physical Therapy, University of Delaware, Newark, DE 19713 USA
| | - Tamara Wright
- Department of Physical Therapy, University of Delaware, Newark, DE 19713 USA
| | - Ryan T. Pohlig
- Biostatistics Core Facility, University of Delaware, Newark, DE 19713 USA
| | - Scott E. Kasner
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104 USA
| | | | - Darcy Reisman
- Department of Physical Therapy, University of Delaware, Newark, DE 19713 USA
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The beneficial role of early exercise training following stroke and possible mechanisms. Life Sci 2018; 198:32-37. [DOI: 10.1016/j.lfs.2018.02.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 02/04/2018] [Accepted: 02/12/2018] [Indexed: 12/21/2022]
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Fini NA, Bernhardt J, Holland AE. What is the relationship between physical activity and cardiovascular risk factors in stroke survivors post completion of rehabilitation? Protocol for a longitudinal study. BMJ Open 2017; 7:e019193. [PMID: 29146661 PMCID: PMC5695331 DOI: 10.1136/bmjopen-2017-019193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Physical activity (PA) can modify cardiovascular and other health risks in people with stroke, but we know little about long-term PA in this group. This study aims to describe PA levels and investigate relationships between PA, cardiovascular risk factors, mobility and participant characteristics (eg, age, mood and fatigue) in the 2 years following rehabilitation discharge after first stroke. METHODS AND ANALYSIS This is a longitudinal observational study with follow-up at 6, 12 and 24 months after rehabilitation discharge. Inclusion criteria are broad; excluding only those with previous stroke, palliative diagnosis, living more than 2 hours from the centre or admitted less than 5 days.The primary outcome of interest is duration of moderate to vigorous PA (min/day) measured by the Sensewear MF Armband (SWAB). Secondary outcomes include other PA measures measured with the SWAB; cardiovascular risk factors (eg, systolic blood pressure, fasting lipid profile and smoking status), mobility (10 m walk test), the Hospital Anxiety and Depression Scale and the Fatigue Severity Scale. All outcomes, except blood tests, are gathered at each time point.The target sample size is 77. We will explore associations between PA levels, cardiovascular risk factors, mobility and participant characteristics at baseline compared with 6, 12 and 24 months using random-effects regression modelling.The long-term PA of stroke survivors is largely unknown. We hope to identify factors that influence PA and cardiovascular risk in this population, which may help health professionals target the stroke survivors most at risk and implement appropriate treatment, preventative strategies and education. ETHICS AND DISSEMINATION Approval was granted from Alfred Hospital and La Trobe University Research Ethics Committees. The study results will be disseminated in a number of ways including journal publication and international conference presentations. TRIAL REGISTRATION NUMBER ACTRN12613000196741.
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Affiliation(s)
- Natalie A Fini
- Physiotherapy Department, Caulfield Hospital, Alfred Health, Melbourne, Australia
- Physiotherapy Department, School of Allied Health, La Trobe University, Melbourne, Australia
- Physiotherapy Department, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Julie Bernhardt
- Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Australia
| | - Anne E Holland
- Physiotherapy Department, School of Allied Health, La Trobe University, Melbourne, Australia
- Physiotherapy Department, Alfred Health, Melbourne, Australia
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Kim KH, Lee KB, Bae YH, Fong SS, Lee SM. Effects of progressive backward body weight suppoted treadmill training on gait ability in chronic stroke patients: A randomized controlled trial. Technol Health Care 2017; 25:867-876. [DOI: 10.3233/thc-160720] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kyung Hun Kim
- Department of Physical Therapy, Sahmyook University, Seoul, Korea
| | - Kyoung Bo Lee
- Department of Physical Therapy, ST Vincent’s Hospital, Suwon, Korea
| | - Young-Hyeon Bae
- Rehabilitation Clinical Research Center, Korea Worker’s Compensation & Welfare Service Daegu Hospital, Daegu, Korea
| | - Shirley S.M. Fong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Suk Min Lee
- Department of Physical Therapy, Sahmyook University, Seoul, Korea
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Dunn A, Marsden DL, Barker D, Van Vliet P, Spratt NJ, Callister R. Cardiorespiratory fitness and walking endurance improvements after 12 months of an individualised home and community-based exercise programme for people after stroke. Brain Inj 2017; 31:1617-1624. [PMID: 28872360 DOI: 10.1080/02699052.2017.1355983] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the immediate and longer-term effects of an individually tailored, home- and community-based exercise programme with ongoing remote support in people with stroke on cardiorespiratory fitness (CRF), ambulation and health-related quality of life (HRQoL). METHODS Twenty people 5.3 ± 3.5 months post stroke completed the 12-week HowFITSS? exercise programme aimed at increasing CRF and daily physical activity. Support was provided by phone and email, which decreased in frequency over time. Participants were assessed at baseline, then at 3, 6 and 12 months after initiation of the intervention. CRF (VO2peak) was evaluated using a portable metabolic system during the 6-minute walk test (6MWT), the Shuttle Walk Test (SWT) and the cycle graded exercise test (cGXT). Walking speed, balance, body composition, fatigue, depression and HRQoL were also measured. RESULTS CRF improved significantly from pre-intervention to 12-month follow-up on the 6MWT (Effect Size, ES = 0.87; p = 0.002) and cGXT (ES = 0.60; p < 0.001), with more modest improvements on the SWT (ES = 0.52; p = 0.251). From baseline to 12 months, significant within-participant improvements were found for self-selected walking speed, balance and HRQoL. Performances on the remaining tests were maintained over the post-intervention period. CONCLUSION There may be health benefits of providing people with stroke an exercise intervention with long-term support that encourages increased regular physical activity.
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Affiliation(s)
- Ashlee Dunn
- a Priority Research Centre for Physical Activity and Nutrition, University of Newcastle , Callaghan , New South Wales , Australia.,d Hunter Medical Research Institute , New Lambton Heights , New South Wales , Australia
| | - Dianne L Marsden
- b Priority Research Centre for Stroke and Brain Injury, University of Newcastle , Callaghan , New South Wales , Australia.,d Hunter Medical Research Institute , New Lambton Heights , New South Wales , Australia.,e Hunter Stroke Service, Hunter New England Local Health District, New Lambton Heights , New Lambton Heights , New South Wales , Australia
| | - Daniel Barker
- c School of Medicine and Population Health , University of Newcastle , Callaghan , New South Wales , Australia
| | - Paulette Van Vliet
- b Priority Research Centre for Stroke and Brain Injury, University of Newcastle , Callaghan , New South Wales , Australia.,d Hunter Medical Research Institute , New Lambton Heights , New South Wales , Australia
| | - Neil J Spratt
- b Priority Research Centre for Stroke and Brain Injury, University of Newcastle , Callaghan , New South Wales , Australia.,d Hunter Medical Research Institute , New Lambton Heights , New South Wales , Australia.,e Hunter Stroke Service, Hunter New England Local Health District, New Lambton Heights , New Lambton Heights , New South Wales , Australia
| | - Robin Callister
- a Priority Research Centre for Physical Activity and Nutrition, University of Newcastle , Callaghan , New South Wales , Australia.,d Hunter Medical Research Institute , New Lambton Heights , New South Wales , Australia
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Kim JC, Lee HM. The Effect of Action Observation Training on Balance and Sit to Walk in Chronic Stroke: A Crossover Randomized Controlled Trial. J Mot Behav 2017; 50:373-380. [DOI: 10.1080/00222895.2017.1363697] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jin-Cheol Kim
- Department of Physical Therapy, College of Health Science, Honam University, Gwangju, Korea
| | - Hyun-Min Lee
- Department of Physical Therapy, College of Health Science, Honam University, Gwangju, Korea
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Bénéfices de l’activité physique en endurance chez les seniors âgés de 70 ans ou plus : une revue systématique. Presse Med 2017; 46:794-807. [DOI: 10.1016/j.lpm.2017.05.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 05/07/2017] [Accepted: 05/23/2017] [Indexed: 01/13/2023] Open
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Fini NA, Holland AE, Keating J, Simek J, Bernhardt J. How Physically Active Are People Following Stroke? Systematic Review and Quantitative Synthesis. Phys Ther 2017; 97:707-717. [PMID: 28444348 DOI: 10.1093/ptj/pzx038] [Citation(s) in RCA: 182] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 04/05/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Mobility limitations are common following stroke and frequently lead to poor participation in physical activity (PA). PURPOSE The purpose of this study was to describe PA across the various stages following stroke (acute, subacute, and chronic). DATA SOURCES Searches were conducted in 5 databases. STUDY SELECTION Eligible studies included participants with stroke whose PA was quantitatively measured for at least 4 hours in a single session. Two reviewers independently reviewed titles and abstracts. DATA EXTRACTION One reviewer extracted data and assessed quality using the Downs and Black checklist. Weighted means were calculated for PA outcomes. DATA SYNTHESIS Searches yielded 103 eligible papers including 5306 participants aged 21 to 96 years. Devices (eg, activity monitors) were used in 73 papers, and behavioral mapping (observational monitoring) in 30. Devices show that people with stroke took on average 5535 steps per day (n = 406, 10 studies) in the subacute phase and 4078 steps (n = 1280, 32 studies) in the chronic phase. Average daily walking duration (% measured time) was higher in the chronic phase (9.0%, n = 100) than subacute (1.8%, n = 172), and sedentary time was >78% regardless of time post stroke. Acute data were lacking for these variables. Matched healthy individuals took an average of 8338 steps per day (n = 129). Behavioral mapping showed time in bed was higher in the acute than subacute phase (mean 45.1% versus 23.8%), with similar time spent sitting (mean 37.6% versus 32.6%). LIMITATIONS Limitations of this review include not pooling data reported as medians. CONCLUSIONS Physical activity levels do not meet guidelines following stroke. Time spent inactive and sedentary is high at all times. Increasing PA and developing standardized activity targets may be important across all stages of stroke recovery.
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Affiliation(s)
- Natalie A Fini
- Physiotherapy Department, Caulfield Hospital, Alfred Health, 260 Kooyong Rd, Caulfield, Victoria, 3162 Australia; Department of Physiotherapy, La Trobe University, Bundoora, Victoria, Australia; and Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Anne E Holland
- Department of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia, and Alfred Health, Melbourne, Victoria, Australia
| | - Jenny Keating
- Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia
| | - Jacinta Simek
- Physiotherapy Department, Eastern Health, Melbourne, Victoria, Australia
| | - Julie Bernhardt
- Department of Physiotherapy, La Trobe University, and Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne
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Martins JC, Aguiar LT, Nadeau S, Scianni AA, Teixeira-Salmela LF, Faria CDCDM. Efficacy of Task-Specific Training on Physical Activity Levels of People With Stroke: Protocol for a Randomized Controlled Trial. Phys Ther 2017; 97:640-648. [PMID: 28371936 DOI: 10.1093/physth/pzx032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 03/15/2017] [Indexed: 11/14/2022]
Abstract
BACKGROUND The majority of people after stroke demonstrate mobility limitations, which may reduce their physical activity levels. Task-specific training has been shown to be an effective intervention to improve mobility in individuals with stroke, however, little is known about the impact of this intervention on levels of physical activity. OBJECTIVES The main objective is to investigate the efficacy of task-specific training, focused on both upper and lower limbs, in improving physical activity levels and mobility in individuals with stroke. The secondary objective is to investigate the effects of the training on muscle strength, exercise capacity, and quality of life. DESIGN This is a randomized controlled trial. SETTING The setting is public health centers. PARTICIPANTS Community-dwelling people with chronic stroke. INTERVENTIONS Participants will be randomized to either an experimental or control group, who will receive group interventions 3 times per week over 12 weeks. The experimental group will undertake task-specific training, while the control group will undertake global stretching, memory exercises, and health education sessions. MEASUREMENTS Primary outcomes include measures of physical activity levels and mobility, whereas secondary outcomes are muscle strength, exercise capacity, and quality of life. The outcomes will be measured at baseline, postintervention, and at the 4- and 12-week follow-ups. CONCLUSIONS The findings of this trial have the potential to provide important insights regarding the effects of task-specific training, focused on both upper and lower limbs, in preventing secondary poststroke complications and improving the participants' general health through changes in physical activity levels.
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Affiliation(s)
- Júlia Caetano Martins
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Larissa Tavares Aguiar
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Sylvie Nadeau
- Centre de Recherche Interdisciplinaire en Réadaptation, Institut de Réadaptation Gingras-Lindsay de Montréal, Université de Montreal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Aline Alvim Scianni
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
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Marsden DL, Dunn A, Callister R, McElduff P, Levi CR, Spratt NJ. Interval circuit training for cardiorespiratory fitness is feasible for people after stroke. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2017. [DOI: 10.12968/ijtr.2017.24.5.190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aims: To determine if community-dwelling stroke survivors can achieve exercise intensities sufficient to improve cardiorespiratory fitness during a single session of circuit training using an interval training approach. Methods: Thirteen independently ambulant participants within 1 year of stroke were included in this observational study (females=54%; median age=65.6 years; interquartile range=23.9). Exercise intensities were assessed throughout an individually tailored circuit of up to seven 5-minute workstations from a selection of nine functional (e.g. walking, stairs, balance) and three ergometer (upright cycle, rower, treadmill) workstations. The interval durations ranged from 5–60 seconds. Oxygen consumption (VO2) was recorded continuously using a portable metabolic system. The average VO2 during each 30-second epoch was determined. VO2≥10.5 mL/kg/min was categorised as ≥moderate intensity. Findings: Participants exercised at VO2≥10.5 mL/kg/min for the majority of the time on the workstations [functional: 369/472 epochs (78%), ergometer: 170/204 epochs (83%)]. Most (69%) participants exercised for ≥30 minutes. No serious adverse events occurred. Conclusions: Applying interval training principles to a circuit of functional and ergometer workstations enabled ambulant participants to exercise at an intensity and for a duration that can improve cardiorespiratory fitness. The training approach appears feasible, safe and a promising way to incorporate both cardiorespiratory fitness and functional training into post-stroke management.
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Affiliation(s)
- Dianne L Marsden
- Manager, Professional Education and Development, Hunter Stroke Service, Hunter New England Local Health District; post-doctoral researcher, University of Newcastle, New South Wales, Australia
| | - Ashlee Dunn
- Research assistant/casual academic, University of Newcastle, New South Wales, Australia
| | - Robin Callister
- Professor of Human Physiology, University of Newcastle, New South Wales, Australia
| | - Patrick McElduff
- Professor of Biostatistics, University of Newcastle, New South Wales, Australia
| | - Christopher R Levi
- Director of Clinical Research and Translation, Hunter New England Local Health District, New South Wales, Australia
| | - Neil J Spratt
- Professor, University of Newcastle; senior staff specialist neurologist, Department of Neurology, John Hunter Hospital, New South Wales, Australia
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Ferreira LAB, Galli M, Lazzari RD, Dumont AJL, Cimolin V, Oliveira CS. Stabilometric analysis of the effect of postural insoles on static balance in patients with hemiparesis: A randomized, controlled, clinical trial. J Bodyw Mov Ther 2017; 21:290-296. [DOI: 10.1016/j.jbmt.2016.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 06/04/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
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Jackson S, Mercer C, Singer BJ. An exploration of factors influencing physical activity levels amongst a cohort of people living in the community after stroke in the south of England. Disabil Rehabil 2016; 40:414-424. [PMID: 28029070 DOI: 10.1080/09638288.2016.1258437] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To explore factors influencing physical activity (PA) reported by people living in rural/semi-rural communities in the south of England post-stroke, and to understand relationships between personal, interpersonal and environmental barriers and self-reported levels of PA. METHOD A survey was mailed to patients of NHS Trusts who were identified as potential participants. Self-reported PA levels, type, and frequency of reported barriers were tabulated. Spearman's rank correlation coefficient was used to explore associations between self-reported PA level and: age, gender, level of physical function, fear of falling, beliefs regarding PA, available supports, and socioeconomic status. RESULTS Seventy-six of 322 questionnaires distributed were returned (24%). Only 55.2% of respondents reported undertaking PA of sufficient intensity to meet current guidelines. Personal barriers included fear of falling, stroke-related disability, pain, and fatigue. Interpersonal and environmental barriers included lack of social support, transport, and inclement weather. Significant relationships existed between self-reported PA and fear of falling, functional mobility, and beliefs relating to PA. CONCLUSIONS Almost half of the survey cohort reported PA levels insufficient to meet current guidelines. Similar to barriers reported in previous studies in USA and other parts of the UK, numerous interlinking and overlapping personal, interpersonal, and environmental barriers to undertaking PA were identified. Implications for Rehabilitation This study found that although more than 60% of the survey population were able to ambulate >200 m, only 55.2% reported undertaking sufficient PA to meet current guidelines, putting them at increased risk of further stroke and other co-morbidities. Participants reported a number of interlinking and overlapping personal, interpersonal, and environmental barriers to undertaking PA, which may explain this discrepancy between mobility status and self reported activity levels. Rehabilitation professionals and primary care providers are well positioned to address the barriers identified in this survey, such as providing interventions to reduce fear of falling, pain, and fatigue, providing support and education about safely increasing physical activity and addressing unhelpful beliefs about PA. Behaviour change strategies, such as increasing self-efficacy, and partnering with the person with stroke to problem solve strategies to address the barriers identified by this, and related research, are likely to be more successful in increasing PA than providing information alone.
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Affiliation(s)
- Sharon Jackson
- a School of Surgery, FMDHS , The Centre for Musculoskeletal Studies, The University of Western Australia , Perth , Australia.,b Portsmouth Hospitals NHS Foundation Trust , Portsmouth , UK
| | | | - Barbara Jennifer Singer
- a School of Surgery, FMDHS , The Centre for Musculoskeletal Studies, The University of Western Australia , Perth , Australia
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Effects of Gait Training With Body Weight Support on a Treadmill Versus Overground in Individuals With Stroke. Arch Phys Med Rehabil 2016; 98:738-745. [PMID: 28034719 DOI: 10.1016/j.apmr.2016.11.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/16/2016] [Accepted: 11/21/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the effects of gait training with body weight support (BWS) on a treadmill versus overground in individuals with chronic stroke. DESIGN Randomized controlled trial. SETTING University research laboratory. PARTICIPANTS Individuals (N=28) with chronic stroke (>6mo from the stroke event). INTERVENTIONS Participants were randomly assigned to receive gait training with BWS on a treadmill (n=14) or overground (n=14) 3 times a week for 6 weeks. MAIN OUTCOME MEASURES Gait speed measured using the 10-meter walk test, endurance measured using the 6-minute walk test, functional independence measured using the motor domain of the FIM, lower limb recovery measured using the lower extremity domain of the Fugl-Meyer assessment, step length, step length symmetry ratio, and single-limb support duration. Measurements were obtained at baseline, immediately after the training session, and 6 weeks after the training session. RESULTS At 1 week after the last training session, both groups improved in all outcome measures except paretic step length and step length symmetry ratio, which were improved only in the overground group (P=.01 and P=.01, respectively). At 6 weeks after the last training session, all improvements remained and the treadmill group also improved paretic step length (P<.001) but not step length symmetry ratio (P>.05). CONCLUSIONS Individuals with chronic stroke equally improve gait speed and other gait parameters after 18 sessions of BWS gait training on either a treadmill or overground. Only the overground group improved step length symmetry ratio, suggesting a role of integrating overground walking into BWS interventions poststroke.
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Lendraitienė E, Tamošauskaitė A, Petruševičienė D, Savickas R. Balance evaluation techniques and physical therapy in post-stroke patients: A literature review. Neurol Neurochir Pol 2016; 51:92-100. [PMID: 27884459 DOI: 10.1016/j.pjnns.2016.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/04/2016] [Accepted: 11/09/2016] [Indexed: 11/19/2022]
Abstract
A stroke (cerebrovascular accident - CVA) is a significant social-economic issue. Approximately 15-30% of all patients develop life-long disability, 20% require over 3 months of specialized care in healthcare institutions, and the majority of the patients never recover the ability to maintain a proper vertical position. Such CVA sequelae as balance disturbances not only negatively affect patients' daily physical activity, but also result in social isolation. A number of standardized clinical scales, tests, and instrumental examination techniques have been proposed for evaluating not only post-CVA balance function, but also any changes in this function following various interventions. Even though scientific literature lists numerous methods and instruments for the improvement of balance after a CVA, not all of them are equally effective, and there have been rather controversial evaluations of some techniques. Nevertheless, the application of the majority of the techniques as complementary or alternative measures to traditional physical therapy (PT) frequently yields better results.
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Affiliation(s)
- Eglė Lendraitienė
- Department of Rehabilitation, Medical Academy of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Agnė Tamošauskaitė
- Department of Rehabilitation, Medical Academy of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Daiva Petruševičienė
- Department of Rehabilitation, Medical Academy of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Raimondas Savickas
- Department of Rehabilitation, Medical Academy of Lithuanian University of Health Sciences, Kaunas, Lithuania.
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Yu WH, Chen KL, Huang SL, Lu WS, Lee SC, Hsieh CL. Intrarater and Interrater Reliability of the Hierarchical Balance Short Forms in Patients With Stroke. Arch Phys Med Rehabil 2016; 97:2137-2145.e2. [PMID: 27465751 DOI: 10.1016/j.apmr.2016.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the intrarater and interrater reliability of a quick balance measure, the Hierarchical Balance Short Forms (HBSF), in outpatients with stroke receiving rehabilitation. DESIGN A repeated-assessments design (1wk apart) was used to examine the intrarater and interrater reliability of the HBSF. The HBSF was administered by a single rater in the intrarater reliability study and by 2 raters in the interrater reliability study. The raters had sufficient working experience in stroke rehabilitation. SETTING Seven teaching hospitals. PARTICIPANTS Two independent groups of outpatients (N=106; each group, n=53) with stroke in chronic stages and in stable medical condition were recruited. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE HBSF. RESULTS For the intrarater reliability study, the values of the intraclass correlation coefficient (ICC), minimal detectable change (MDC), and percentage of minimal detectable change (MDC%) were .95, 1.02, and 16.3%, respectively, for the HBSF. The 95% limits of agreement (LOA) of the HBSF ranged from -.69 to 1.19. For the interrater reliability study, the values of the ICC, MDC, and MDC% were .91, 1.22, and 18.3%, respectively, for the HBSF. The 95% LOA of the HBSF ranged from -1.01 to 1.35. CONCLUSIONS Our results suggest that the HBSF has satisfactory intrarater and interrater reliability for assessing balance function in outpatients with stroke. The MDC values of the HBSF are useful for both researchers and clinicians to determine whether the change in balance function of an individual patient is real when administered by an individual rater or by different raters.
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Affiliation(s)
- Wan-Hui Yu
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuan-Lin Chen
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Sheau-Ling Huang
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Shian Lu
- School of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan; Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shu-Chun Lee
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Occupational Therapy, Taipei City Hospital Songde Branch, Taipei, Taiwan
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
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Marsden DL, Dunn A, Callister R, McElduff P, Levi CR, Spratt NJ. A Home- and Community-Based Physical Activity Program Can Improve the Cardiorespiratory Fitness and Walking Capacity of Stroke Survivors. J Stroke Cerebrovasc Dis 2016; 25:2386-98. [PMID: 27378733 DOI: 10.1016/j.jstrokecerebrovasdis.2016.06.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/23/2016] [Accepted: 06/03/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The cardiorespiratory fitness of stroke survivors is low. Center-based exercise programs that include an aerobic component have been shown to improve poststroke cardiorespiratory fitness. This pilot study aims to determine the feasibility, safety, and preliminary efficacy of an individually tailored home- and community-based exercise program to improve cardiorespiratory fitness and walking capacity in stroke survivors. METHODS Independently ambulant, community-dwelling stroke survivors were recruited. The control (n = 10) and intervention (n = 10) groups both received usual care. In addition the intervention group undertook a 12-week, individually tailored, home- and community-based exercise program, including once-weekly telephone or e-mail support. Assessments were conducted at baseline and at 12 weeks. Feasibility was determined by retention and program participation, and safety by adverse events. Efficacy measures included change in cardiorespiratory fitness (peak oxygen consumption [VO2peak]) and distance walked during the Six-Minute Walk Test (6MWT). Analysis of covariance was used for data analysis. RESULTS All participants completed the study with no adverse events. All intervention participants reported undertaking their prescribed program. VO2peak improved more in the intervention group (1.17 ± .29 L/min to 1.35 ± .33 L/min) than the control group (1.24 ± .23 L/min to 1.24 ± .33 L/min, between-group difference = .18 L/min, 95% confidence interval [CI]: .01-.36). Distance walked improved more in the intervention group (427 ± 123 m to 494 ± 67m) compared to the control group (456 ± 101m to 470 ± 106m, between-group difference = 45 m, 95% CI: .3-90). CONCLUSIONS Our individually tailored approach with once-weekly telephone or e-mail support was feasible and effective in selected stroke survivors. The 16% greater improvement in VO2peak during the 6MWT achieved in the intervention versus control group is comparable to improvements attained in supervised, center-based programs.
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Affiliation(s)
- Dianne Lesley Marsden
- School of Medicine and Public Health and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, New South Wales, Australia; Hunter Stroke Service, Hunter New England Local Health District, New Lambton Heights, New South Wales, Australia; Brain and Mental Health Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.
| | - Ashlee Dunn
- School of Biomedical Sciences and Pharmacy and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, New South Wales, Australia; Cardiovascular Research, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Robin Callister
- School of Biomedical Sciences and Pharmacy and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, New South Wales, Australia; Cardiovascular Research, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Patrick McElduff
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Christopher Royce Levi
- Brain and Mental Health Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia; Clinical Research & Translation and Neurology Department at John Hunter Hospital, Hunter New England Local Health District, New Lambton Heights, New South Wales, Australia; Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, New South Wales, Australia
| | - Neil James Spratt
- Brain and Mental Health Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia; School of Biomedical Sciences and Pharmacy and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, New South Wales, Australia; Neurology Department at John Hunter Hospital, Hunter New England Local Health District, New Lambton Heights, New South Wales, Australia
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Danks KA, Pohlig R, Reisman DS. Combining Fast-Walking Training and a Step Activity Monitoring Program to Improve Daily Walking Activity After Stroke: A Preliminary Study. Arch Phys Med Rehabil 2016; 97:S185-93. [PMID: 27240430 DOI: 10.1016/j.apmr.2016.01.039] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 01/13/2016] [Accepted: 01/15/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To determine preliminary efficacy and to identify baseline characteristics predicting who would benefit most from fast walking training plus a step activity monitoring program (FAST+SAM) compared with fast walking training (FAST) alone in persons with chronic stroke. DESIGN Randomized controlled trial with blinded assessors. SETTING Outpatient clinical research laboratory. PARTICIPANTS Individuals (N=37) >6 months poststroke. INTERVENTIONS Subjects were assigned to either FAST, which was walking training at their fastest possible speed on the treadmill (30min) and overground 3 times per week for 12 weeks, or FAST+SAM. The step activity monitoring program consisted of daily step monitoring with an activity monitor, goal setting, and identification of barriers to activity and strategies to overcome barriers. MAIN OUTCOME MEASURES Daily step activity metrics (steps/day [SPD], time walking per day), walking speed, and 6-minute walk test (6MWT) distance. RESULTS There was a significant effect of time for both groups, with all outcomes improving from pre- to posttraining (all P values <.05). The FAST+SAM was superior to FAST for 6MWT (P=.018), with a larger increase in the FAST+SAM group. The interventions had differential effectiveness based on baseline step activity. Sequential moderated regression models demonstrated that for subjects with baseline levels of step activity and 6MWT distances that were below the mean, the FAST+SAM intervention was more effective than FAST (1715±1584 vs 254±933 SPD; P<.05 for overall model and ΔR(2) for SPD and 6MWT). CONCLUSIONS The addition of a step activity monitoring program to a fast walking training intervention may be most effective in persons with chronic stroke who have initial low levels of walking endurance and activity. Regardless of baseline performance, the FAST+SAM intervention was more effective for improving walking endurance.
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Affiliation(s)
- Kelly A Danks
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Ryan Pohlig
- Biostatistics Core Facility, University of Delaware, Newark, DE
| | - Darcy S Reisman
- Department of Physical Therapy, University of Delaware, Newark, DE; Biomechanics and Movement Science Program, University of Delaware, Newark, DE.
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Block VAJ, Pitsch E, Tahir P, Cree BAC, Allen DD, Gelfand JM. Remote Physical Activity Monitoring in Neurological Disease: A Systematic Review. PLoS One 2016; 11:e0154335. [PMID: 27124611 PMCID: PMC4849800 DOI: 10.1371/journal.pone.0154335] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/11/2016] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To perform a systematic review of studies using remote physical activity monitoring in neurological diseases, highlighting advances and determining gaps. METHODS Studies were systematically identified in PubMed/MEDLINE, CINAHL and SCOPUS from January 2004 to December 2014 that monitored physical activity for ≥24 hours in adults with neurological diseases. Studies that measured only involuntary motor activity (tremor, seizures), energy expenditure or sleep were excluded. Feasibility, findings, and protocols were examined. RESULTS 137 studies met inclusion criteria in multiple sclerosis (MS) (61 studies); stroke (41); Parkinson's Disease (PD) (20); dementia (11); traumatic brain injury (2) and ataxia (1). Physical activity levels measured by remote monitoring are consistently low in people with MS, stroke and dementia, and patterns of physical activity are altered in PD. In MS, decreased ambulatory activity assessed via remote monitoring is associated with greater disability and lower quality of life. In stroke, remote measures of upper limb function and ambulation are associated with functional recovery following rehabilitation and goal-directed interventions. In PD, remote monitoring may help to predict falls. In dementia, remote physical activity measures correlate with disease severity and can detect wandering. CONCLUSIONS These studies show that remote physical activity monitoring is feasible in neurological diseases, including in people with moderate to severe neurological disability. Remote monitoring can be a psychometrically sound and responsive way to assess physical activity in neurological disease. Further research is needed to ensure these tools provide meaningful information in the context of specific neurological disorders and patterns of neurological disability.
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Affiliation(s)
- Valerie A. J. Block
- Graduate Program in Physical Therapy, University of California San Francisco/ San Francisco State University, San Francisco, California, United States of America
| | - Erica Pitsch
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, California, United States of America
| | - Peggy Tahir
- University of California San Francisco Library, San Francisco, California, United States of America
| | - Bruce A. C. Cree
- Multiple Sclerosis and Neuroinflammation Center, Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
| | - Diane D. Allen
- Graduate Program in Physical Therapy, University of California San Francisco/ San Francisco State University, San Francisco, California, United States of America
| | - Jeffrey M. Gelfand
- Multiple Sclerosis and Neuroinflammation Center, Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
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Effects of treadmill inclination on hemiparetic gait: controlled and randomized clinical trial. Am J Phys Med Rehabil 2015; 94:718-27. [PMID: 25357148 DOI: 10.1097/phm.0000000000000240] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the effects of inclined treadmill training on the kinematic characteristics of gait in subjects with hemiparesis. DESIGN A blind, randomized, controlled study was conducted with 28 subjects divided into two groups: the control group, submitted to partial body weight-support treadmill gait training with no inclination, and the experimental group, which underwent partial body weight-support treadmill training at 10% of inclination. All volunteers were assessed for functional independence, motor function, balance, and gait before and after the 12 training sessions. RESULTS Both groups showed posttraining alterations in balance (P < 0.001), motor function (P < 0.001), and functional independence (P = 0.002). Intergroup differences in spatiotemporal differences were observed, where only the experimental group showed posttraining alterations in velocity (P = 0.02) and paretic step length (P = 0.03). Angular variables showed no significant differences in either group. CONCLUSIONS In subjects with hemiparesis, the addition of inclination is a stimulus capable of enhancing the effects of partial body weight-support treadmill gait training.
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Profil des patients post-AVC volontaires à un programme d’éducation thérapeutique à l’activité physique : étude descriptive. Sci Sports 2015. [DOI: 10.1016/j.scispo.2015.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Gäverth J, Parker R, MacKay-Lyons M. Exercise Stress Testing After Stroke or Transient Ischemic Attack: A Scoping Review. Arch Phys Med Rehabil 2015; 96:1349-1359.e12. [DOI: 10.1016/j.apmr.2015.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 02/02/2015] [Accepted: 03/15/2015] [Indexed: 10/23/2022]
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Bambirra C, Rodrigues MCDB, Faria CDCDM, Paula FRD. Clinical evaluation of balance in hemiparetic adults: a systematic review. FISIOTERAPIA EM MOVIMENTO 2015. [DOI: 10.1590/0103-5150.028.001.ar03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Hemiparesis is a common post-stroke impairment often associated with balance deficits. Standardized instruments for balance assessment may be useful in identifying individuals at risk of falling and evaluating intervention outcomes. Objectives To identify instruments with adequate psychometric properties and clinical application to assess balance in hemiparetic cases within the scope of physiotherapy and to verify tools most frequently used in studies that evaluated the effects of therapeutic interventions in order to improve the balance of hemiparetic patients. Methods A search was conducted in the Medline, Lilacs, PEDro, and Web of Science databases by two independent researchers, who selected and analyzed studies that evaluated the reliability and validity of balance assessment instruments and intervention results. Results and discussion The Berg Balance Scale was the most frequently used instrument in the intervention studies. Nine single-task tests (timed up and go, functional reach test, step test, four-square step test, side step test, supported standing balance, standing arm raise, static tandem standing, and weight shifting) and six multiple-task tests (Berg balance scale, Brunel balance assessment, Fugl-Meyer Assessment/balance section, mini balance evaluation systems test, and postural assessment scale for stroke patients) demonstrated adequate psychometric properties and clinical applications to assess balance in hemiparetic individuals. Conclusions The Berg Balance Scale had the most widely studied psychometric properties and was the most frequently used scale in the intervention studies. Further studies are required to validate and adapt other instruments for the Brazilian population.
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Cleveland S, Driver S, Swank C, Macklin S. Classifying physical activity research following stroke using the behavioral epidemiologic framework. Top Stroke Rehabil 2015; 22:289-98. [PMID: 26258454 DOI: 10.1179/1074935714z.0000000043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Stroke is a significant public health issue in the USA and a need emerges to better understand how to reduce an individual's co-morbidity risk. Physical activity is one approach to improving the health of individuals and comprehensive literature supports increased activity as a means to reduce risk of morbidity and mortality. One approach to examining whether research in a field is addressing a public health issue is through application of the behavioral epidemiological framework. OBJECTIVE To classify physical activity research for individuals following stroke into distinct phases so that efforts can be made to systematically address gaps and disseminate evidence-based practice. METHODS Specific key words were identified and then searched through EBSCO host, PubMed, and Google Scholar. Physical activity and stroke literature from 2000-2014 was categorized into one of five discrete phases. Research in Phase 1 identified associations between activity and health; Phase 2 established valid measures of activity; Phase 3 examined determinants of behavior; Phase 4 evaluated activity interventions; and Phase 5 disseminated evidence-based practice. RESULTS A comprehensive review of literature identified 202 articles with 70% categorized in Phase 1 (n = 141), 11% in Phase 2 (n = 23), 10% in Phase 3 (n = 20), 8% in Phase 4 (n = 15), and 1% in Phase 5 (n = 3). CONCLUSION Findings suggest that physical activity research for individuals following stroke is in the early stages of development with less than 10% of research evaluating or disseminating interventions.
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Protocol variations and six-minute walk test performance in stroke survivors: a systematic review with meta-analysis. Stroke Res Treat 2015; 2015:484813. [PMID: 25685596 PMCID: PMC4320847 DOI: 10.1155/2015/484813] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/18/2014] [Accepted: 12/18/2014] [Indexed: 11/17/2022] Open
Abstract
Objective. To investigate the use of the six-minute walk test (6MWT) for stroke survivors, including adherence to 6MWT protocol guidelines and distances achieved. Methods. A systematic search was conducted from inception to March 2014. Included studies reported a baseline (intervention studies) or first instance (observational studies) measure for the 6MWT performed by stroke survivors regardless of time after stroke. Results. Of 127 studies (participants n = 6,012) that met the inclusion criteria, 64 were also suitable for meta-analysis. Only 25 studies made reference to the American Thoracic Society (ATS) standards for the 6MWT, and 28 reported using the protocol standard 30 m walkway. Thirty-nine studies modified the protocol walkway, while 60 studies did not specify the walkway used. On average, stroke survivors walked 284 ± 107 m during the 6MWT, which is substantially less than healthy age-matched individuals. The meta-analysis identified that changes to the ATS protocol walkway are associated with reductions in walking distances achieved. Conclusion. The 6MWT is now widely used in stroke studies. The distances achieved by stroke patients indicate substantially compromised walking ability. Variations to the standard 30 m walkway for the 6MWT are common and caution should be used when comparing the values achieved from studies using different walkway lengths.
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George Hornby T, Straube DS, Kinnaird CR, Holleran CL, Echauz AJ, Rodriguez KS, Wagner EJ, Narducci EA. Importance of Specificity, Amount, and Intensity of Locomotor Training to Improve Ambulatory Function in Patients Poststroke. Top Stroke Rehabil 2015; 18:293-307. [DOI: 10.1310/tsr1804-293] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Fini NA, Holland AE, Keating J, Simek J, Bernhardt J. How is physical activity monitored in people following stroke? Disabil Rehabil 2014; 37:1717-31. [DOI: 10.3109/09638288.2014.978508] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Abstract
BACKGROUND During the physical rehabilitation of individuals poststroke, therapists are challenged to provide sufficient amounts of task-specific practice in order to maximize outcomes of multiple functional skills within limited visits. Basic and applied studies have suggested that training of one motor task may affect performance of biomechanically separate tasks that utilize overlapping neural circuits. However, few studies have explicitly investigated the impact of training one functional task on separate, nonpracticed tasks. OBJECTIVE The purpose of this preliminary study was to investigate the potential gains in specific nonlocomotor assessments in individuals poststroke following only stepping training of variable, challenging tasks at high aerobic intensities. METHODS Individuals with locomotor deficits following subacute and chronic stroke (n=22) completed a locomotor training paradigm using a repeated-measures design. Practice of multiple stepping tasks was provided in variable environments or contexts at high aerobic intensities for ≥40 sessions over 10 weeks. The primary outcome was timed Five-Times Sit-to-Stand Test (5XSTS) performance, with secondary measures of sit-to-stand kinematics and kinetics, clinical assessment of balance, and isometric lower limb strength. RESULTS Participants improved their timed 5XSTS performance following stepping training, with changes in selected biomechanical measures. Statistical and clinically meaningful improvements in balance were observed, with more modest changes in paretic leg strength. CONCLUSIONS The present data suggest that significant gains in selected nonlocomotor tasks can be achieved with high-intensity, variable stepping training. Improvements in nonpracticed tasks may minimize the need to practice multiple tasks within and across treatment sessions.
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Yoo J, Jeong J, Lee W. The effect of trunk stabilization exercise using an unstable surface on the abdominal muscle structure and balance of stroke patients. J Phys Ther Sci 2014; 26:857-9. [PMID: 25013283 PMCID: PMC4085208 DOI: 10.1589/jpts.26.857] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 01/07/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigated the effect of unstable surface trunk stabilization
exercise on the abdominal muscle structure and balance of stroke patients. [Subjects] The
subjects were divided into two groups: an unstable surface trunk stabilization exercise
group (n=13), and a stable surface trunk stabilization exercise group (n=11). [Methods]
Both groups performed trunk stabilization exercise for 30 minutes, 3 days per week for 6
weeks. Abdominal muscle thickness and the Berg Balance Scale (BBS) were measured at the
baseline and after 6 weeks. [Results] There was a significant improvement in the internal
oblique muscle thickness, transversus abdominis thickness and balance ability of the
unstable surface trunk stabilization exercise group. [Conclusion] The unstable surface
trunk stabilization exercise improved the internal oblique and transversus abdominis
muscles and balance ability. These results suggest that unstable surface trunk exercise is
useful in the rehabilitation stroke patients.
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Affiliation(s)
- Junsang Yoo
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - Juri Jeong
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - Wanhee Lee
- Department of Physical Therapy, Sahmyook University, Republic of Korea
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Túbero GS, Gobbi S, Teixeira CVL, Pereira JR, Shigematsu R, Canonici AP. Effects of square stepping exercise in patients with sequel of cerebrovascular accident. FISIOTERAPIA EM MOVIMENTO 2014. [DOI: 10.1590/0103-5150.027.002.ao08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Cerebral stroke is the interruption of blood flow to the brain and can be classified into hemorrhagic and ischemic. It may result in serious body balance and cognition complications. Kinesiotherapy is a privileged means of rehabilitation.Objective Verify the effects of Square Stepping Exercise (SSE) on cognitive functions, depressive symptoms and the body balance of cerebral stroke sequel patients.Methods Thirteen brain stroke sequel patients were divided into two groups: SSE (SSEG n = 8) and conventional physiotherapy group (PG, n = 5). The SSEG participated only of the SSE training protocol, while the PG participated of its physical therapy routine group, both for 4 months. They were evaluated using the Mini Mental State Examination (MMSE), the Brief Cognitive Screening Battery (BBRC), the Geriatric Depression Scale (GDS),Berg Balance Scale(BBS) and Timed Up and Go(TUG).Results The U Mann Whitney test showed no significant differences between groups. In intragroup analysis, the Wilcoxon test showed significant improvement in global cognitive status for PG (p < 0.042), and for SSEG there were positive results for verbal fluency (p < 0.04) and in TUG for number of steps (p < 0.04) and the time (p < 0.02).Conclusion The SSE seems to benefit dynamic balance, influencing gait agility, cognition related to verbal fluency and may have contributed to maintain other cognitive functions.
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Affiliation(s)
| | - Sebastião Gobbi
- Universidade Estadual Paulista “Júlio Mesquita Filho”, Brazil
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Kunkel D, Fitton C, Burnett M, Ashburn A. Physical inactivity post-stroke: a 3-year longitudinal study. Disabil Rehabil 2014; 37:304-10. [DOI: 10.3109/09638288.2014.918190] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Dorit Kunkel
- Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Carolyn Fitton
- Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Malcolm Burnett
- Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Ann Ashburn
- Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Southampton, UK
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Morris JH, Oliver T, Kroll T, Joice S, Williams B. From physical and functional to continuity with pre-stroke self and participation in valued activities: A qualitative exploration of stroke survivors’, carers’ and physiotherapists’ perceptions of physical activity after stroke. Disabil Rehabil 2014; 37:64-77. [DOI: 10.3109/09638288.2014.907828] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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