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Sehle A, Salzmann C, Liepert J. Effects of flexor reflex stimulation on gait aspects in stroke patients: randomized clinical trial. J Neuroeng Rehabil 2024; 21:83. [PMID: 38802939 PMCID: PMC11131186 DOI: 10.1186/s12984-024-01377-y] [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: 03/06/2023] [Accepted: 05/10/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Gait deficits are very common after stroke and therefore an important aspect in poststroke rehabilitation. A currently little used method in gait rehabilitation after stroke is the activation of the flexor reflex (FR) by electrical stimulation of the sole of foot while walking. The aim of this study was to investigate the effect of FR stimulation on gait performance and gait parameters in participants with stroke within a single session of flexor reflex stimulation using Incedo™. METHODS Twenty-five participants with subacute (n = 14) and chronic (n = 11) stroke were enrolled in the study. Motor functions were tested with a 10-m walk test (10mWT), a 2-min walk test (2minWT), and a gait analysis. These tests were performed with and without Incedo™ within a single session in randomized order. RESULTS In the 10mWT, a significant difference was found between walking with Incedo™ (15.0 ± 8.5 s) versus without Incedo™ (17.0 ± 11.4 s, p = 0.01). Similarly, the 2minWT showed a significant improvement with Incedo™ use (90.0 ± 36.4 m) compared to without Incedo™ (86.3 ± 36.8 m, p = 0.03). These results indicate that while the improvements are statistically significant, they are modest and should be considered in the context of their clinical relevance. The gait parameters remained unchanged except for the step length. A subgroup analysis indicated that participants with subacute and chronic stroke responded similarly to the stimulation. There was a correlation between the degree of response to electrostimulation while walking and degree of improvement in 2minWT (r = 0.50, p = 0.01). CONCLUSIONS This study is the first to examine FR activation effects in chronic stroke patients and suggests that stimulation effects are independent of the time since stroke. A larger controlled clinical trial is warranted that addresses issues as the necessary number of therapeutical sessions and for how long stimulation-induced improvements outlast the treatment period. TRIAL REGISTRATION The trial was retrospectively registered in German Clinical Trials Register. CLINICAL TRIAL REGISTRATION NUMBER DRKS00021457. Date of registration: 29 June 2020.
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Affiliation(s)
- Aida Sehle
- Kliniken Schmieder, Allensbach, Germany
- Lurija Institute, Allensbach, Germany
| | - Christian Salzmann
- Kliniken Schmieder, Allensbach, Germany
- Lurija Institute, Allensbach, Germany
| | - Joachim Liepert
- Kliniken Schmieder, Allensbach, Germany.
- Lurija Institute, Allensbach, Germany.
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Abdollahi M, Kuber PM, Rashedi E. Dual Tasking Affects the Outcomes of Instrumented Timed up and Go, Sit-to-Stand, Balance, and 10-Meter Walk Tests in Stroke Survivors. SENSORS (BASEL, SWITZERLAND) 2024; 24:2996. [PMID: 38793850 PMCID: PMC11125653 DOI: 10.3390/s24102996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/29/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024]
Abstract
Stroke can impair mobility, with deficits more pronounced while simultaneously performing multiple activities. In this study, common clinical tests were instrumented with wearable motion sensors to study motor-cognitive interference effects in stroke survivors (SS). A total of 21 SS and 20 healthy controls performed the Timed Up and Go (TUG), Sit-to-Stand (STS), balance, and 10-Meter Walk (10MWT) tests under single and dual-task (counting backward) conditions. Calculated measures included total time and gait measures for TUG, STS, and 10MWT. Balance tests for both open and closed eyes conditions were assessed using sway, measured using the linear acceleration of the thorax, pelvis, and thighs. SS exhibited poorer performance with slower TUG (16.15 s vs. 13.34 s, single-task p < 0.001), greater sway in the eyes open balance test (0.1 m/s2 vs. 0.08 m/s2, p = 0.035), and slower 10MWT (12.94 s vs. 10.98 s p = 0.01) compared to the controls. Dual tasking increased the TUG time (~14%, p < 0.001), balance thorax sway (~64%, p < 0.001), and 10MWT time (~17%, p < 0.001) in the SS group. Interaction effects were minimal, suggesting similar dual-task costs. The findings demonstrate exaggerated mobility deficits in SS during dual-task clinical testing. Dual-task assessments may be more effective in revealing impairments. Integrating cognitive challenges into evaluation can optimize the identification of fall risks and personalize interventions targeting identified cognitive-motor limitations post stroke.
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Affiliation(s)
| | | | - Ehsan Rashedi
- Industrial and Systems Engineering Department, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.)
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Sánchez-Sánchez ML, Ruescas-Nicolau MA, Arnal-Gómez A, Iosa M, Pérez-Alenda S, Cortés-Amador S. Validity of an android device for assessing mobility in people with chronic stroke and hemiparesis: a cross-sectional study. J Neuroeng Rehabil 2024; 21:54. [PMID: 38616288 PMCID: PMC11017601 DOI: 10.1186/s12984-024-01346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 03/22/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Incorporating instrument measurements into clinical assessments can improve the accuracy of results when assessing mobility related to activities of daily living. This can assist clinicians in making evidence-based decisions. In this context, kinematic measures are considered essential for the assessment of sensorimotor recovery after stroke. The aim of this study was to assess the validity of using an Android device to evaluate kinematic data during the performance of a standardized mobility test in people with chronic stroke and hemiparesis. METHODS This is a cross-sectional study including 36 individuals with chronic stroke and hemiparesis and 33 age-matched healthy subjects. A simple smartphone attached to the lumbar spine with an elastic band was used to measure participants' kinematics during a standardized mobility test by using the inertial sensor embedded in it. This test includes postural control, walking, turning and sitting down, and standing up. Differences between stroke and non-stroke participants in the kinematic parameters obtained after data sensor processing were studied, as well as in the total execution and reaction times. Also, the relationship between the kinematic parameters and the community ambulation ability, degree of disability and functional mobility of individuals with stroke was studied. RESULTS Compared to controls, participants with chronic stroke showed a larger medial-lateral displacement (p = 0.022) in bipedal stance, a higher medial-lateral range (p < 0.001) and a lower cranio-caudal range (p = 0.024) when walking, and lower turn-to-sit power (p = 0.001), turn-to-sit jerk (p = 0.026) and sit-to-stand jerk (p = 0.001) when assessing turn-to-sit-to-stand. Medial-lateral range and total execution time significantly correlated with all the clinical tests (p < 0.005), and resulted significantly different between independent and limited community ambulation patients (p = 0.042 and p = 0.006, respectively) as well as stroke participants with significant disability or slight/moderate disability (p = 0.024 and p = 0.041, respectively). CONCLUSION This study reports a valid, single, quick and easy-to-use test for assessing kinematic parameters in chronic stroke survivors by using a standardized mobility test with a smartphone. This measurement could provide valid clinical information on reaction time and kinematic parameters of postural control and gait, which can help in planning better intervention approaches.
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Affiliation(s)
- M Luz Sánchez-Sánchez
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain
| | - Maria-Arantzazu Ruescas-Nicolau
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain.
| | - Anna Arnal-Gómez
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain
| | - Marco Iosa
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy
- Smart Lab, Santa Lucia Foundation IRCCS, Via Ardeatina 306, 00179, Rome, Italy
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain
| | - Sara Cortés-Amador
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain
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Zhao Y, Liao X, Gu H, Jiang Y, Jiang Y, Wang Y, Zhang Y. Gait speed at the acute phase predicted health-related quality of life at 3 and 12 months after stroke: a prospective cohort study. J Rehabil Med 2024; 56:jrm24102. [PMID: 38616713 PMCID: PMC11031874 DOI: 10.2340/jrm.v56.24102] [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: 10/21/2023] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
OBJECTIVE To investigate the association between acute-phase gait speed and health-related quality of life (HRQoL) at 3 and 12 months post-stroke. DESIGN Prospective cohort study. SUBJECTS/PATIENTS 1,475 patients with first-ever ischaemic stroke. METHODS The patients were divided into 3 groups according to tertiles of gait speed, namely ≤0.8, 0.8-1.1, ≥1.1 m/s. Gait speed was assessed by the 10-m walking test within 2 weeks of hospitalization for acute stroke and before the rehabilitation programme. HRQoL measurements include the 3-level EuroQol five dimensions (EQ-5D-3L) index and EuroQoL visual analogue scale (EQ-VAS) scores. Linear and logistic regression analyses were used to identify associations between gait speed and HRQoL. RESULTS Adjusted for all covariates, the highest gait speed tertile group were associated with higher EQ-5D-3L index (B = 0.0303 and B = 0.0228, respectively, p < 0.001), and higher EQ-VAS (B = 3.3038 and B = 3.8877, respectively, p < 0.001), and lower odds of having problems with mobility (OR = 2.55 [95% CI: 0.141-0.458] and 0.485 [0.289-0.812], respectively, p < 0.01), self-care (OR = 0.328 [95% CI: 0.167-0.646] and 0.412 [0.217-0.784], respectively, p < 0.01), and usual activities (OR = 0.353 [95% CI: 0.211-0.590] and 0.325 [0.198-0.536], respectively, p < 0.0001) at 3 and 12 months, and pain/discomfort at 12 months (OR = 0.558 [95% CI:0.335-0.930], p < 0.05). CONCLUSION Acute-phase gait speed was predictive of post-stroke HRQoL at 3 and 12 months, especially when associated with domain-specific EQ-5D-3L.
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Affiliation(s)
- Yishuang Zhao
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoling Liao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hongqiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yong Jiang
- 2Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yingyu Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yumei Zhang
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Sieghartsleitner S, Sebastián-Romagosa M, Cho W, Grünwald J, Ortner R, Scharinger J, Kamada K, Guger C. Upper extremity training followed by lower extremity training with a brain-computer interface rehabilitation system. Front Neurosci 2024; 18:1346607. [PMID: 38500488 PMCID: PMC10944934 DOI: 10.3389/fnins.2024.1346607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/08/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction Brain-computer interfaces (BCIs) based on functional electrical stimulation have been used for upper extremity motor rehabilitation after stroke. However, little is known about their efficacy for multiple BCI treatments. In this study, 19 stroke patients participated in 25 upper extremity followed by 25 lower extremity BCI training sessions. Methods Patients' functional state was assessed using two sets of clinical scales for the two BCI treatments. The Upper Extremity Fugl-Meyer Assessment (FMA-UE) and the 10-Meter Walk Test (10MWT) were the primary outcome measures for the upper and lower extremity BCI treatments, respectively. Results Patients' motor function as assessed by the FMA-UE improved by an average of 4.2 points (p < 0.001) following upper extremity BCI treatment. In addition, improvements in activities of daily living and clinically relevant improvements in hand and finger spasticity were observed. Patients showed further improvements after the lower extremity BCI treatment, with walking speed as measured by the 10MWT increasing by 0.15 m/s (p = 0.001), reflecting a substantial meaningful change. Furthermore, a clinically relevant improvement in ankle spasticity and balance and mobility were observed. Discussion The results of the current study provide evidence that both upper and lower extremity BCI treatments, as well as their combination, are effective in facilitating functional improvements after stroke. In addition, and most importantly improvements did not stop after the first 25 upper extremity BCI sessions.
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Affiliation(s)
- Sebastian Sieghartsleitner
- g.tec Medical Engineering GmbH, Schiedlberg, Austria
- Institute of Computational Perception, Johannes Kepler University, Linz, Austria
| | | | - Woosang Cho
- g.tec Medical Engineering GmbH, Schiedlberg, Austria
| | - Johannes Grünwald
- g.tec Medical Engineering GmbH, Schiedlberg, Austria
- Institute of Computational Perception, Johannes Kepler University, Linz, Austria
| | - Rupert Ortner
- g.tec Medical Engineering Spain S.L., Barcelona, Spain
| | - Josef Scharinger
- Institute of Computational Perception, Johannes Kepler University, Linz, Austria
| | | | - Christoph Guger
- g.tec Medical Engineering GmbH, Schiedlberg, Austria
- g.tec Medical Engineering Spain S.L., Barcelona, Spain
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Zhang B, Wong KP, Kang R, Fu S, Qin J, Xiao Q. Efficacy of Robot-Assisted and Virtual Reality Interventions on Balance, Gait, and Daily Function in Patients With Stroke: A Systematic Review and Network Meta-analysis. Arch Phys Med Rehabil 2023; 104:1711-1719. [PMID: 37119954 DOI: 10.1016/j.apmr.2023.04.005] [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: 11/03/2022] [Revised: 03/17/2023] [Accepted: 04/04/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE This study aimed to evaluate the comparative effectiveness and ranking of robot-assisted training, virtual reality, and robot-assisted rehabilitation combined with virtual reality in improving balance, gait, and daily function in patients with stroke. DATA SOURCES PubMed, EMBASE, the Cochrane Library, Physiotherapy Evidence Database, CINAHL, Web of Science, and ProQuest Dissertations and Theses abstracting and indexing databases were comprehensively searched to include randomized controlled trials published through August 31, 2022. STUDY SELECTION Randomized controlled trials comparing robot-assisted training, virtual reality, robot-assisted rehabilitation combined with virtual reality, and conventional therapy to assess the effects on balance, gait, and daily function of patients with stroke. DATA EXTRACTION The risk of bias was assessed using the Cochrane Risk of Bias tool and the methodological quality of the studies was assessed using the Physiotherapy Evidence Database scale. A network meta-analysis of random effects models was performed for direct and indirect effects. Data were analyzed using Stata SE 17.0 and R 4.2.1. DATA SYNTHESIS A total of 52 randomized controlled trials involving 1,559 participants were included in this study. Based on the ranking probabilities, robot-assisted rehabilitation combined with virtual reality was most effective in improving balance (surface under the cumulative ranking curve [SUCRA]=82.0%; mean difference [MD]=4.10; 95% confidence interval [CI], 0.43 to 7.67). Virtual reality was most effective in improving velocity (SUCRA=97.8%; MD=-0.15; 95% CI, -0.24 to -0.06) and daily function (SUCRA=92.1%; MD=-7.85; 95% CI, -15.18 to -1.07). CONCLUSIONS Compared to robot-assisted training and conventional therapy, robot-assisted training combined virtual reality was most likely the best intervention for balance, and virtual reality might be the most helpful in improving daily function for patients after stroke. Further studies are needed to clarify the specific efficacy of robot-assisted training combined with virtual reality and virtual reality on gait.
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Affiliation(s)
- Bohan Zhang
- Centre for Smart Health, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Ka Po Wong
- Centre for Smart Health, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong; Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Ruifu Kang
- School of Nursing, Capital Medical University, Beijing, China
| | - Shuojin Fu
- School of Nursing, Capital Medical University, Beijing, China
| | - Jing Qin
- Centre for Smart Health, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
| | - Qian Xiao
- School of Nursing, Capital Medical University, Beijing, China.
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Hosoi Y, Kamimoto T, Sakai K, Yamada M, Kawakami M. Estimation of minimal detectable change in the 10-meter walking test for patients with stroke: a study stratified by gait speed. Front Neurol 2023; 14:1219505. [PMID: 37538254 PMCID: PMC10395330 DOI: 10.3389/fneur.2023.1219505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/05/2023] [Indexed: 08/05/2023] Open
Abstract
Objective This study aimed to classify and calculate the minimal detectable changes (MDC) in gait time and gait speed in a 10-meter walking test (10MWT) in patients with stroke classified according to their gait speed. Methods The participants were 84 patients with stroke. Their gait times were measured twice each at their comfortable gait speed (CGS) and maximum gait speed (MGS) on a 10-meter straight track, and gait speed was calculated using gait time. Participants were assigned to three speed groups based on their CGS: low-speed (<0.4 m/s; n = 19); moderate-speed (0.4-0.8 m/s; n = 29); and high-speed (>0.8 m/s; n = 36). For each group, first and second retest reliability and MDC of CGS and MGS were calculated using gait time and gait speed in the 10MWT. Results MDCs in the 10MWT at CGS were: low-speed group, gait time 5.25 s, gait speed 0.05 m/s; moderate-speed group, gait time 2.83 s, gait speed 0.11 m/s; and high-speed group, gait time 1.58 s, gait speed 0.21 m/s. MDCs in the 10MWT at MGS were: low-speed group, gait time 7.26 s, gait speed 0.04 m/s; moderate-speed group, gait time 2.48 s, gait speed 0.12 m/s; and high-speed group, gait time 1.28 s, gait speed 0.19 m/s. Conclusion Since the MDC of gait speed and gait time differ depending on the participant's gait speed, it is necessary to interpret the results according to the participant's gait speed when judging the effectiveness of therapeutic interventions.
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Affiliation(s)
- Yuichiro Hosoi
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takayuki Kamimoto
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Katsuya Sakai
- Department of Physical Therapy, Faculty of Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Masanari Yamada
- Department of Rehabilitation, Ukai Rehabilitation Hospital, Aichi, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
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Evensen J, Soberg HL, Sveen U, Hestad KA, Moore JL, Bronken BA. Measurement Properties of the Patient-Specific Functional Scale in Rehabilitation for Patients With Stroke: A Prospective Observational Study. Phys Ther 2023; 103:pzad014. [PMID: 37140476 PMCID: PMC10158643 DOI: 10.1093/ptj/pzad014] [Citation(s) in RCA: 2] [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: 03/24/2022] [Revised: 08/22/2022] [Accepted: 12/05/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVE This study investigated the validity, reliability, responsiveness, and interpretability of the Patient-Specific Functional Scale (PSFS) in subacute stroke rehabilitation to determine its suitability to measure patient-identified rehabilitation goals. METHODS A prospective observational study was designed according to the checklist from Consensus-Based Standards for Selecting Health Measurement Instruments. Seventy-one patients diagnosed with stroke were recruited in the subacute phase from a rehabilitation unit in Norway. The International Classification of Functioning, Disability and Health was used to assess the content validity. Assessment of construct validity was based on hypotheses for correlation of the PSFS and comparator measurements. We assessed reliability by calculating the Intraclass Correlation Coefficient (ICC) (3.1) and the standard error of measurement. The assessment of responsiveness was based on hypotheses for the correlation of change scores between the PSFS and the comparator measurements. A receiver operating characteristic analysis was conducted to assess responsiveness. The smallest detectable change and minimal important change were calculated. RESULTS Eighty percent of the PSFS items were classified as activities and participation in the International Classification of Functioning, Disability and Health, indicating satisfactory content validity. The reliability was satisfactory with an ICC of 0.81 (95% CI = 0.69-0.89). The standard error of measurement was 0.70 point, and the smallest detectable change was 1.94 points. Five of 7 hypotheses were confirmed for construct validity, and 5 of 6 were confirmed for responsiveness, indicating moderate construct validity and high responsiveness. Assessing responsiveness with a criterion approach resulted in an area under the curve of 0.74. A ceiling effect was identified for 25% of the participants 3 months after discharge. The minimal important change was estimated to be 1.58 points. CONCLUSION This study demonstrates satisfactory measurement properties for the PSFS in individuals undergoing inpatient stroke rehabilitation. IMPACT This study supports the use of the PSFS to document and monitor patient-identified rehabilitation goals in patients receiving subacute stroke rehabilitation when applied using a shared decision approach.
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Affiliation(s)
- Janne Evensen
- Department of Physical Medicine and Rehabilitation, Innlandet Hospital Trust, Gjøvik, Norway
| | - Helene Lundgaard Soberg
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Unni Sveen
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Knut A Hestad
- Department of Mental Health and Rehabilitation, Faculty of Health- and Social Sciences, The Inland Norway University of Applied Sciences, Elverum, Norway
- Department of Research, Innlandet Hospital Trust, Brumunddal, Norway
| | - Jennifer L Moore
- Regional Center of Knowledge Translation in Rehabilitation, Sunnaas Rehabilitation Hospital, Oslo/Nesodden, Norway
| | - Berit Arnesveen Bronken
- Department of Mental Health and Rehabilitation, Faculty of Health- and Social Sciences, The Inland Norway University of Applied Sciences, Elverum, Norway
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Tasseel-Ponche S, Roussel M, Toba MN, Sader T, Barbier V, Delafontaine A, Meynier J, Picard C, Constans JM, Schnitzler A, Godefroy O, Yelnik AP. Dual-task versus single-task gait rehabilitation after stroke: the protocol of the cognitive-motor synergy multicenter, randomized, controlled superiority trial (SYNCOMOT). Trials 2023; 24:172. [PMID: 36890548 PMCID: PMC9994785 DOI: 10.1186/s13063-023-07138-x] [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: 07/07/2022] [Accepted: 02/07/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Gait disorders and cognitive impairments are prime causes of disability and institutionalization after stroke. We hypothesized that relative to single-task gait rehabilitation (ST GR), cognitive-motor dual-task (DT) GR initiated at the subacute stage would be associated with greater improvements in ST and DT gait, balance, and cognitive performance, personal autonomy, disability, and quality of life in the short, medium and long terms after stroke. METHODS This multicenter (n=12), two-arm, parallel-group, randomized (1:1), controlled clinical study is a superiority trial. With p<0.05, a power of 80%, and an expected loss to follow-up rate of 10%, the inclusion of 300 patients will be required to evidence a 0.1-m.s-1 gain in gait speed. Trial will include adult patients (18-90 years) in the subacute phase (0 to 6 months after a hemispheric stroke) and who are able to walk for 10 m (with or without a technical aid). Registered physiotherapists will deliver a standardized GR program (30 min three times a week, for 4 weeks). The GR program will comprise various DTs (phasic, executive function, praxis, memory, and spatial cognition tasks during gait) in the DT (experimental) group and gait exercises only in the ST (control) group. The primary outcome measure is gait speed 6 months after inclusion. The secondary outcomes are post-stroke impairments (National Institutes of Health Stroke Scale and the motor part of the Fugl-Meyer Assessment of the lower extremity), gait speed (10-m walking test), mobility and dynamic balance (timed up-and-go test), ST and DT cognitive function (the French adaptation of the harmonization standards neuropsychological battery, and eight cognitive-motor DTs), personal autonomy (functional independence measure), restrictions in participation (structured interview and the modified Rankin score), and health-related quality of life (on a visual analog scale). These variables will be assessed immediately after the end of the protocol (probing the short-term effect), 1 month thereafter (the medium-term effect), and 5 months thereafter (the long-term effect). DISCUSSION The main study limitation is the open design. The trial will focus on a new GR program applicable at various stages after stroke and during neurological disease. TRIAL REGISTRATION NCT03009773 . Registered on January 4, 2017.
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Affiliation(s)
- Sophie Tasseel-Ponche
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France. .,Laboratory of Functional Neurosciences, UR UPJV 4559, Jules Verne University of Picardie, Amiens, France.
| | - Martine Roussel
- Laboratory of Functional Neurosciences, UR UPJV 4559, Jules Verne University of Picardie, Amiens, France.,Department of Neurology, Amiens University Hospital, Amiens, France
| | - Monica N Toba
- Laboratory of Functional Neurosciences, UR UPJV 4559, Jules Verne University of Picardie, Amiens, France
| | - Thibaud Sader
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Vincent Barbier
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Arnaud Delafontaine
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Jonathan Meynier
- Clinical Research and Innovation Directorate, Amiens University Hospital, Amiens, France
| | - Carl Picard
- Clinical Research and Innovation Directorate, Amiens University Hospital, Amiens, France
| | | | - Alexis Schnitzler
- PRM Department, Hôpital Lariboisière-F.Widal AP-HP, Paris, France.,INSERM U1153 - CRESS EpiAgeing, Paris University, Hôtel-Dieu, Paris, France
| | - Olivier Godefroy
- Laboratory of Functional Neurosciences, UR UPJV 4559, Jules Verne University of Picardie, Amiens, France.,Department of Neurology, Amiens University Hospital, Amiens, France
| | - Alain Pierre Yelnik
- PRM Department, Hôpital Lariboisière-F.Widal AP-HP, Paris, France.,UMR 9010, Paris University, Centre Borelli, Paris, France
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Cabanas-Valdés R, García-Rueda L, Salgueiro C, Pérez-Bellmunt A, Rodríguez-Sanz J, López-de-Celis C. Assessment of the 4-meter walk test test-retest reliability and concurrent validity and its correlation with the five sit-to-stand test in chronic ambulatory stroke survivors. Gait Posture 2023; 101:8-13. [PMID: 36696822 DOI: 10.1016/j.gaitpost.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/02/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND The 4-meter walk test (4-MWT) is a widely used measure to assess gait speed in the elderly but has not been validated for stroke survivors to date. OBJECTIVES To assess the test-retest reliability and concurrent validity of the 4-MWT compared to the 10-meter walk test (10-MWT) as a measure of gait speed in chronic post-stroke. SECONDARY OUTCOME MEASURE to assess the correlation of both gait measures with the 5 times sit-to-stand test (5TSTS). METHODS A cross-sectional observational study was conducted. Reliability was assessed by intraclass correlation coefficient (ICC2,1), standard error of measurement (SEM) and minimal detectable change (MDC-95%). Bland & Altman analysis was used to quantify agreement between the 4-MWT and the 10-MWT. Two consecutive walking trials of the 4-MWT and 10-MWT followed by 5TSTS were performed all on the same day. A single researcher made all measurements. RESULTS Thirty-six chronic ambulatory post-stroke (average age 58.56 ± 11.28 years) were analyzed at their self-selected walking speed with a dynamic start. The 4-MWT showed excellent concurrent validity and test-retest reliability: ICC2.1 = 0.991 (95% CI: 0.983, 0.996); SEM= 0.032 and MDC- 95% = 0.090 m/second) with a strong positive correlation with the 10-MWT (r = 0.957, p < 0.001). The Bland & Altman analysis showed a concordance of -0.05 m/second bias (p = 0.039) (95% limits of agreement: 0.20 to -0.29 m/second). The paired t-test showed no statistically significant difference in the mean of both walking tests (p < 0.091). However, there was only moderate correlation between the two gait assessments and the 5TSTS. CONCLUSIONS This study indicates excellent test-retest reliability concurrent validity and strong correlation between 4-MWT and 10-MWT with a dynamic start at comfortable speed. The 4-MWT could be used as a measure of gait speed in both outpatients and home settings in chronic ambulatory stroke survivors.
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Affiliation(s)
- Rosa Cabanas-Valdés
- Universitat Internacional de Catalunya, Physiotherapy Department, Faculty of Medicine and Health Sciences, Sant Cugat del Vallés, Barcelona, Spain.
| | - Laura García-Rueda
- Universitat Internacional de Catalunya, PhD Program, Sant Cugat del Vallés, Barcelona, Spain.
| | - Carina Salgueiro
- Universitat Internacional de Catalunya, Physiotherapy Department, Faculty of Medicine and Health Sciences, Sant Cugat del Vallés, Barcelona, Spain; Clínica de Neurorehabilitación, Sant Cugat del Vallés, Barcelona, Spain.
| | - Albert Pérez-Bellmunt
- Universitat Internacional de Catalunya, Campus Sant Cugat, Basic Sciences Department, Actium Functional Anatomy Research Group, Sant Cugat del Vallés, Barcelona, Spain.
| | - Jacobo Rodríguez-Sanz
- Universitat Internacional de Catalunya, Campus Sant Cugat, Basic Sciences Department, Actium Functional Anatomy Research Group, Sant Cugat del Vallés, Barcelona, Spain.
| | - Carlos López-de-Celis
- Universitat Internacional de Catalunya, Campus Sant Cugat, Basic Sciences Department, Actium Functional Anatomy Research Group, Sant Cugat del Vallés, Barcelona, Spain; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
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11
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Dos Santos RB, Fiedler A, Badwal A, Legasto-Mulvale JM, Sibley KM, Olaleye OA, Diermayr G, Salbach NM. Standardized tools for assessing balance and mobility in stroke clinical practice guidelines worldwide: A scoping review. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1084085. [PMID: 36896249 PMCID: PMC9989207 DOI: 10.3389/fresc.2023.1084085] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/16/2023] [Indexed: 02/25/2023]
Abstract
Background Use of standardized tools to assess balance and mobility limitations is a recommended practice in stroke rehabilitation. The extent to which clinical practice guidelines (CPGs) for stroke rehabilitation recommend specific tools and provide resources to support their implementation is unknown. Purpose To identify and describe standardized, performance-based tools for assessing balance and/or mobility and describe postural control components challenged, the approach used to select tools, and resources provided for clinical implementation, in CPGs for stroke. Methods A scoping review was conducted. We included CPGs with recommendations on the delivery of stroke rehabilitation to address balance and mobility limitations. We searched seven electronic databases and grey literature. Pairs of reviewers reviewed abstracts and full texts in duplicate. We abstracted data about CPGs, standardized assessment tools, the approach for tool selection, and resources. Experts identified postural control components challenged by each tool. Results Of the 19 CPGs included in the review, 7 (37%) and 12 (63%) were from middle- and high-income countries, respectively. Ten CPGs (53%) recommended or suggested 27 unique tools. Across 10 CPGs, the most commonly cited tools were the Berg Balance Scale (BBS) (90%), 6-Minute Walk Test (6MWT) (80%), Timed Up and Go Test (80%) and 10-Meter Walk Test (70%). The tool most frequently cited in middle- and high-income countries was the BBS (3/3 CPGs), and 6MWT (7/7 CPGs), respectively. Across 27 tools, the three components of postural control most frequently challenged were underlying motor systems (100%), anticipatory postural control (96%), and dynamic stability (85%). Five CPGs provided information in varying detail on how tools were selected; only 1 CPG provided a level of recommendation. Seven CPGs provided resources to support clinical implementation; one CPG from a middle-income country included a resource available in a CPG from a high-income country. Conclusion CPGs for stroke rehabilitation do not consistently provide recommendations for standardized tools to assess balance and mobility or resources to facilitate clinical application. Reporting of processes for tool selection and recommendation is inadequate. Review findings can be used to inform global efforts to develop and translate recommendations and resources for using standardized tools to assess balance and mobility post-stroke. Systematic Review Registration https://osf.io/, identifier: 10.17605/OSF.IO/6RBDV.
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Affiliation(s)
- Renato B Dos Santos
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de Sao Paulo - UNICID, Sao Paulo, Brazil.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Annabelle Fiedler
- School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
| | - Anchal Badwal
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Jean Michelle Legasto-Mulvale
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Kathryn M Sibley
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Olubukola A Olaleye
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Gudrun Diermayr
- School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
| | - Nancy M Salbach
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,The KITE Research Institute, University Health Network, Toronto, ON, Canada
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12
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De Luca V, Femminella GD, Patalano R, Formosa V, Lorusso G, Rivetta C, Di Lullo F, Mercurio L, Rea T, Salvatore E, Korkmaz Yaylagul N, Apostolo J, Silva RC, Dantas C, van Staalduinen WH, Liotta G, Iaccarino G, Triassi M, Illario M. Assessment Tools of Biopsychosocial Frailty Dimensions in Community-Dwelling Older Adults: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16050. [PMID: 36498125 PMCID: PMC9739796 DOI: 10.3390/ijerph192316050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Frailty is a complex interplay between several factors, including physiological changes in ageing, multimorbidities, malnutrition, living environment, genetics, and lifestyle. Early screening for frailty risk factors in community-dwelling older people allows for preventive interventions on the clinical and social determinants of frailty, which allows adverse events to be avoided. By conducting a narrative review of the literature employing the International Narrative Systematic Assessment tool, the authors aimed to develop an updated framework for the main measurement tools to assess frailty risks in older adults, paying attention to use in the community and primary care settings. This search focused on the biopsychosocial domains of frailty that are covered in the SUNFRAIL tool. The study selected 178 reviews (polypharmacy: 20; nutrition: 13; physical activity: 74; medical visits: 0; falls: 39; cognitive decline: 12; loneliness: 15; social support: 5; economic constraints: 0) published between January 2010 and December 2021. Within the selected reviews, 123 assessment tools were identified (polypharmacy: 15; nutrition: 15; physical activity: 25; medical visits: 0; falls: 26; cognitive decline: 18; loneliness: 9; social support: 15; economic constraints: 0). The narrative review allowed us to evaluate assessment tools of frailty domains to be adopted for multidimensional health promotion and prevention interventions in community and primary care.
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Affiliation(s)
- Vincenzo De Luca
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Grazia Daniela Femminella
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Roberta Patalano
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Valeria Formosa
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Grazia Lorusso
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Cristiano Rivetta
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Federica Di Lullo
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Lorenzo Mercurio
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Teresa Rea
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Elena Salvatore
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | | | - Joao Apostolo
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
| | - Rosa Carla Silva
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
| | | | | | - Giuseppe Liotta
- Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Guido Iaccarino
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Maria Triassi
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Maddalena Illario
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
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13
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Salbach NM, MacKay-Lyons M, Howe JA, McDonald A, Solomon P, Bayley MT, McEwen S, Nelson M, Bulmer B, Lovasi GS. Assessment of Walking Speed and Distance Post-Stroke Increases After Providing a Theory-Based Toolkit. J Neurol Phys Ther 2022; 46:251-259. [PMID: 35671402 PMCID: PMC9462135 DOI: 10.1097/npt.0000000000000406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE While underutilized, poststroke administration of the 10-m walk test (10mWT) and 6-minute walk test (6MWT) can improve care and is considered best practice. We aimed to evaluate provision of a toolkit designed to increase use of these tests by physical therapists (PTs). METHODS In a before-and-after study, 54 PTs and professional leaders in 9 hospitals were provided a toolkit and access to a clinical expert over a 5-month period. The toolkit comprised a guide, smartphone app, and video, and described how to set up walkways, implement learning sessions, administer walk tests, and interpret and apply test results clinically. The proportion of hospital visits for which each walk test score was documented at least once (based on abstracted health records of ambulatory patients) were compared over 8-month periods pre- and post-intervention using generalized mixed models. RESULTS Data from 347 and 375 pre- and postintervention hospital visits, respectively, were analyzed. Compared with preintervention, the odds of implementing the 10mWT were 12 times greater (odds ratio [OR] = 12.4, 95% confidence interval [CI] 5.8, 26.3), and of implementing the 6MWT were approximately 4 times greater (OR = 3.9, 95% CI 2.3, 6.7), post-intervention, after adjusting for hospital setting, ambulation ability, presence of aphasia and cognitive impairment, and provider-level clustering. Unadjusted change in the percentage of visits for which the 10mWT/6MWT was documented at least once was smallest in acute care settings (2.0/3.8%), and largest in inpatient and outpatient rehabilitation settings (28.0/19.9% and 29.4/23.4%, respectively). DISCUSSION AND CONCLUSIONS Providing a comprehensive toolkit to hospitals with professional leaders likely contributed to increasing 10mWT and 6MWT administration during inpatient and outpatient stroke rehabilitation.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A390 ).
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Affiliation(s)
- Nancy M. Salbach
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Marilyn MacKay-Lyons
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Jo-Anne Howe
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Alison McDonald
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Patricia Solomon
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Mark T. Bayley
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Sara McEwen
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Michelle Nelson
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Beverly Bulmer
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Gina S. Lovasi
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
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14
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Tasseel-Ponche S, Delafontaine A, Godefroy O, Yelnik AP, Doutrellot PL, Duchossoy C, Hyra M, Sader T, Diouf M. Walking speed at the acute and subacute stroke stage: A descriptive meta-analysis. Front Neurol 2022; 13:989622. [PMID: 36226075 PMCID: PMC9549366 DOI: 10.3389/fneur.2022.989622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/05/2022] [Indexed: 11/30/2022] Open
Abstract
Gait disorders are one of the leading patient complaints at the sub-acute stroke stage (SSS) and a main determinant of disability. Walking speed (WS) is a major vital and functional index, and the Ten-Meter Walk Test is considered the gold standard after stroke. Based on a systematic review of the literature, studies published between January 2000 and November 2021 were selected when WS was reported (ten-meter walk test for short distance and/or 6-min walking distance for long distance) within 6 months following a first ischemic and/or hemorrhagic stroke (SSS) in adults prior to receiving specific walking rehabilitation. Following PRISMA guidelines, a meta-analysis was conducted on two kinds of WS: the principal criterion focused on short-distance WS (ten-meter walking test) and the secondary criteria focused on long-distance WS (6-min test) and meta-regressions to study the association of WS with balance, cognitive disorders and autonomy. Nine studies comprising a total of 939 data on post-stroke patients were selected. The weighted average age was 61 years [95% IC [55-67] and males represented 62% ± 2.7 of patients [57-67]. Average short-distance WS was 0.36 ± 0.06 m.s−1 [95% CI (0.23–0.49)]. Average long-distance WS was 0.46 ± 0.1 m.s−1 [95% CI (0.26–0.66)]. The funnel plot revealed asymmetry of publication bias and high heterogeneity of the nine studies (I2 index 98.7% and Q-test p < 0.0001). Meta-regressions of secondary endpoints could not be performed due to a lack of study data. At the SSS, WS would be lower than data in general population published in literature, but above all, lower than the WS required for safe daily autonomy and community ambulation after stroke. WS must be a priority objective of stroke rehabilitation to increase walking function but also for survival, autonomy, social participation and health-related quality of life.
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Affiliation(s)
- Sophie Tasseel-Ponche
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
- Laboratory of Functional Neurosciences (EA 4559), Amiens University Hospital, Amiens, France
- *Correspondence: Sophie Tasseel-Ponche
| | - Arnaud Delafontaine
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
- CIAMS, Paris-Saclay University, Orsay, France
- CIAMS, Orléans University, Orléans, France
| | - Olivier Godefroy
- Laboratory of Functional Neurosciences (EA 4559), Amiens University Hospital, Amiens, France
- Department of Neurology, Amiens University Hospital, Amiens, France
| | - Alain P. Yelnik
- Physical Medicine and Rehabilitation Department, Hôpital Lariboisière-F. Widal AP-HP, Paris, France
- INSERM U1153 - CRESS EpiAgeing, Paris University, Hôtel-Dieu, Paris, France
| | - Pierre-Louis Doutrellot
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Charline Duchossoy
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Marie Hyra
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Thibaud Sader
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Momar Diouf
- Department of Biostatistics, Amiens University Hospital, Amiens, France
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15
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Sivertsen M, Arntzen EC, Alstadhaug KB, Normann B. Effect of innovative vs. usual care physical therapy in subacute rehabilitation after stroke. A multicenter randomized controlled trial. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:987601. [PMID: 36407967 PMCID: PMC9673903 DOI: 10.3389/fresc.2022.987601] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/30/2022] [Indexed: 12/04/2022]
Abstract
Background Research on stroke rehabilitation often addresses common difficulties such as gait, balance or physical activity separately, a fragmentation contrasting the complexity in clinical practice. Interventions aiming for recovery are needed. The purpose of this study was to investigate effects of a comprehensive low-cost physical therapy intervention, I-CoreDIST, vs. usual care on postural control, balance, physical activity, gait and health related quality of life during the first 12 weeks post-stroke. Methods This prospective, assessor-masked randomized controlled trial included 60 participants from two stroke units in Norway. Participants, who were randomized to I-CoreDIST (n = 29) or usual care physical therapy (n = 31), received 5 sessions/week when in-patients or 3 sessions/week as out-patients. Primary outcomes were the Trunk Impairment Scale-modified Norwegian version (TISmodNV) and activity monitoring (ActiGraphsWgt3X-BT). Secondary outcomes were the Postural Assessment Scale for Stroke, MiniBesTEST, 10-meter walk test, 2-minute walk test, force-platform measurements and EQ5D-3L. Stroke specific quality of life scale was administered at 12 weeks. Linear regression and non-parametric tests were used for statistical analysis. Results Five participants were excluded and seven lost to follow-up, leaving 48 participants in the intention-to-treat analysis. There were no significant between-group effects for primary outcomes: TIS-modNV (p = 0,857); daily average minutes of sedative (p = 0.662), light (p = 0.544) or moderate activity (p = 0.239) and steps (p = 0.288), or secondary outcomes at 12 weeks except for significant improvements on EQ5D-3L in the usual care group. Within-group changes were significant for all outcomes in both groups except for activity levels that were low, EQ5D-3L favoring the usual care group, and force-platform data favoring the intervention group. Conclusions Physical therapy treatment with I-CoreDIST improved postural control, balance, physical activity and gait during the first 12 weeks after a stroke but is not superior to usual care.
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Affiliation(s)
- Marianne Sivertsen
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsoe, Norway
- Department of Medicine, Nordland Hospital Trust, Bodoe, Norway
- Correspondence: Marianne Sivertsen
| | - Ellen Christin Arntzen
- Department of Medicine, Nordland Hospital Trust, Bodoe, Norway
- Faculty of Nursing and Health Sciences, Nord University, Bodoe, Norway
| | - Karl Bjørnar Alstadhaug
- Department of Medicine, Nordland Hospital Trust, Bodoe, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsoe, Norway
| | - Britt Normann
- Department of Medicine, Nordland Hospital Trust, Bodoe, Norway
- Faculty of Nursing and Health Sciences, Nord University, Bodoe, Norway
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Aravind G, Bashir K, Cameron JI, Howe JA, Jaglal SB, Bayley MT, Teasell RW, Moineddin R, Zee J, Wodchis WP, Tee A, Hunter S, Salbach NM. Community-based exercise programs incorporating healthcare-community partnerships to improve function post-stroke: feasibility of a 2-group randomized controlled trial. Pilot Feasibility Stud 2022; 8:88. [PMID: 35459194 PMCID: PMC9028093 DOI: 10.1186/s40814-022-01037-9] [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: 06/06/2021] [Accepted: 03/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Despite the potential for community-based exercise programs supported through healthcare-community partnerships (CBEP-HCPs) to improve function post-stroke, insufficient trial evidence limits widespread program implementation and funding. We evaluated the feasibility and acceptability of a CBEP-HCP compared to a waitlist control group to improve everyday function among people post-stroke. Methods We conducted a 3-site, pilot randomized trial with blinded follow-up evaluations at 3, 6, and 10 months. Community-dwelling adults able to walk 10 m were stratified by site and gait speed and randomized (1:1) to a CBEP-HCP or waitlist control group. The CBEP-HCP involved a 1-h, group exercise class, with repetitive and progressive practice of functional balance and mobility tasks, twice a week for 12 weeks. We offered the exercise program to the waitlist group at 10 months. We interviewed 13 participants and 9 caregivers post-intervention and triangulated quantitative and qualitative results. Study outcomes included feasibility of recruitment, interventions, retention, and data collection, and potential effect on everyday function. Results Thirty-three people with stroke were randomized to the intervention (n = 16) or waitlist group (n = 17). We recruited 1–2 participants/month at each site. Participants preferred being recruited by a familiar healthcare professional. Participants described a 10- or 12-month wait in the control group as too long. The exercise program was implemented per protocol across sites. Five participants (31%) in the intervention group attended fewer than 50% of classes for health reasons. In the intervention and waitlist group, retention was 88% and 82%, respectively, and attendance at 10-month evaluations was 63% and 71%, respectively. Participants described inclement weather, availability of transportation, and long commutes as barriers to attending exercise classes and evaluations. Among participants in the CBEP-HCP who attended ≥ 50% of classes, quantitative and qualitative results suggested an immediate effect of the intervention on balance, balance self-efficacy, lower limb strength, everyday function, and overall health. Conclusion The CBEP-HCP appears feasible and potentially beneficial. Findings will inform protocol revisions to optimize recruitment, and program and evaluation attendance in a future trial. Trial registration ClinicalTrials.gov, NCT03122626. Registered April 21, 2017 — retrospectively registered.
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Affiliation(s)
- Gayatri Aravind
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Kainat Bashir
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Jill I Cameron
- Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Jo-Anne Howe
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.,Toronto Rehabilitation Institute, University Health Network, University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Susan B Jaglal
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.,The KITE Research Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Mark T Bayley
- Toronto Rehabilitation Institute, University Health Network, University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.,The KITE Research Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.,Department of Medicine, University of Toronto, C. David Naylor Building, 6 Queen's Park Crescent West, Third Floor, London, ON, M5S 3H2, Canada
| | - Robert W Teasell
- Schulich School of Medicine and Dentistry, Western University, St Joseph's Health Care London - Parkwood Institute, 550 Wellington Rd, London, ON, N6C 0A7, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, 160‑500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Joanne Zee
- Toronto General Hospital, University Health Network, 585 University Avenue, Toronto, ON, M5G 2N2, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Alda Tee
- Central East Stroke Network, Royal Victoria Regional Health Centre, 201 Georgian Drive, Barrie, ON, L4M6M2, Canada
| | - Susan Hunter
- School of Physical Therapy, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Nancy M Salbach
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada. .,The KITE Research Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
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