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Krauss MJ, Holden BM, Somerville E, Blenden G, Bollinger RM, Barker AR, McBride TD, Hollingsworth H, Yan Y, Stark SL. Community Participation Transition After Stroke (COMPASS) Randomized Controlled Trial: Effect on Adverse Health Events. Arch Phys Med Rehabil 2024:S0003-9993(24)01004-9. [PMID: 38772517 DOI: 10.1016/j.apmr.2024.05.015] [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: 11/03/2023] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVE To compare adverse health events in intervention versus control group participants in the Community Participation Transition After Stroke trial to reduce barriers to independent living for community-dwelling stroke survivors. DESIGN Randomized controlled trial. SETTING Inpatient rehabilitation (IR) to home and community transition. PARTICIPANTS Stroke survivors aged ≥50 years being discharged from IR who had been independent in activities of daily living prestroke (N=183). INTERVENTIONS Participants randomized to intervention group (n=85) received home modifications and self-management training from an occupational therapist over 4 visits in the home. Participants randomized to control group (n=98) received the same number of visits consisting of stroke education. MAIN OUTCOME MEASURES Death, skilled nursing facility (SNF) admission, 30-day rehospitalization, and fall rates after discharge from IR. RESULTS Time-to-event analysis revealed that the intervention reduced SNF admission (cumulative survival, 87.8%; 95% confidence interval [CI], 78.6%-96.6%) and death (cumulative survival, 100%) compared with the control group (SNF cumulative survival, 78.9%; 95% CI, 70.4%-87.4%; P=.039; death cumulative survival, 87.3%; 95% CI, 79.9%-94.7%; P=.001). Thirty-day rehospitalization also appeared to be lower among intervention participants (cumulative survival, 95.1%; 95% CI, 90.5%-99.8%) than among control participants (cumulative survival, 86.3%; 95% CI, 79.4%-93.2%; P=.050) but was not statistically significant. Fall rates did not significantly differ between the intervention group (5.6 falls per 1000 participant-days; 95% CI, 4.7-6.5) and the control group (7.2 falls per 1000 participant-days; 95% CI, 6.2-8.3; incidence rate ratio, 0.78; 95% CI, 0.46-1.33; P=.361). CONCLUSIONS A home-based occupational therapist-led intervention that helps stroke survivors transition to home by reducing barriers in the home and improving self-management could decrease the risk of mortality and SNF admission after discharge from rehabilitation.
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Affiliation(s)
- Melissa J Krauss
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, MO
| | - Brianna M Holden
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, MO
| | - Emily Somerville
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, MO
| | - Gabrielle Blenden
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, MO
| | - Rebecca M Bollinger
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, MO
| | - Abigail R Barker
- Center for Advancing Health Services, Economics, and Policy Research, Institute for Public Health at Washington University in St Louis, St Louis, MO
| | - Timothy D McBride
- Center for Advancing Health Services, Economics, and Policy Research, Institute for Public Health at Washington University in St Louis, St Louis, MO
| | - Holly Hollingsworth
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, MO
| | - Yan Yan
- Department of Surgery, Washington University School of Medicine in St Louis, St Louis, MO
| | - Susan L Stark
- Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, MO.
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Srinivasan S, Kumavor P, Morgan K. A Training Program Using Modified Joystick-Operated Ride-on Toys to Complement Conventional Upper Extremity Rehabilitation in Children with Cerebral Palsy: Results from a Pilot Study. Bioengineering (Basel) 2024; 11:304. [PMID: 38671726 PMCID: PMC11048159 DOI: 10.3390/bioengineering11040304] [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: 02/02/2024] [Revised: 02/22/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
The pilot study assessed the utility of a training program using modified, commercially available dual-joystick-operated ride-on toys to promote unimanual and bimanual upper extremity (UE) function in children with cerebral palsy (CP). The ride-on-toy training was integrated within a 3-week, intensive, task-oriented training camp for children with CP. Eleven children with hemiplegia between 4 and 10 years received the ride-on-toy training program 20-30 min/day, 5 days/week for 3 weeks. Unimanual motor function was assessed using the Quality of Upper Extremity Skills Test (QUEST) before and after the camp. During ride-on-toy training sessions, children wore activity monitors on both wrists to assess the duration and intensity of bimanual UE activity. Video data from early and late sessions were coded for bimanual UE use, independent navigation, and movement bouts. Children improved their total and subscale QUEST scores from pretest to post-test while increasing moderate activity in their affected UE from early to late sessions, demonstrating more equal use of both UEs across sessions. There were no significant changes in the rates of movement bouts from early to late sessions. We can conclude that joystick-operated ride-on toys function as child-friendly, intrinsically rewarding tools that can complement conventional therapy and promote bimanual motor functions in children with CP.
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Affiliation(s)
- Sudha Srinivasan
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT 06268, USA
- The Institute for the Brain and Cognitive Sciences (IBACS), University of Connecticut, Storrs, CT 06268, USA
| | - Patrick Kumavor
- Biomedical Engineering Department, University of Connecticut, Storrs, CT 06268, USA; (P.K.); (K.M.)
| | - Kristin Morgan
- Biomedical Engineering Department, University of Connecticut, Storrs, CT 06268, USA; (P.K.); (K.M.)
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Rapolthy-Beck A, Fleming J, Turpin M, Sosnowski K, Dullaway S, White H. Efficacy of Early Enhanced Occupational Therapy in an Intensive Care Unit (EFFORT-ICU): A Single-Site Feasibility Trial. Am J Occup Ther 2023; 77:7706205110. [PMID: 38015492 DOI: 10.5014/ajot.2023.050230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
IMPORTANCE This research trial contributes to the evidence for occupational therapy service delivery in intensive care settings. OBJECTIVE To explore the feasibility of a trial to evaluate the impact of early enhanced occupational therapy on mechanically ventilated patients in intensive care. DESIGN Single-site assessor-blinded randomized controlled feasibility trial. SETTING Level 5 8-bed adult medical-surgical intensive care unit (ICU) at Logan Hospital, Brisbane, Australia. PARTICIPANTS Participants were 30 mechanically ventilated patients randomly allocated to two groups. OUTCOMES AND MEASURES We compared standard care with enhanced occupational therapy with outcomes measured at discharge from the ICU, hospital discharge, and 90 days post randomization. The primary outcome measure was the FIM®. Secondary outcomes included the Modified Barthel Index (MBI); Montreal Cognitive Assessment; grip strength, measured using a dynamometer; Hospital Anxiety and Depression Scale; and the 36-Item Short-Form Health Survey (Version 2). The intervention group received daily occupational therapy, including cognitive stimulation, upper limb retraining, and activities of daily living. Data were analyzed using independent groups t tests and effect sizes. RESULTS Measures and procedures were feasible. A significant difference was found between groups on FIM Motor score at 90 days with a large effect size (p = .05, d = 0.76), and MBI scores for the intervention group approached significance (p = .051) with a large effect size (d = 0.75) at 90 days. Further moderate to large effect sizes were obtained for the intervention group for cognitive status, functional ability, and quality of life. CONCLUSIONS AND RELEVANCE This trial demonstrated that occupational therapy is feasible and beneficial in the ICU. Criteria to progress to a full-scale randomized controlled trial were met. This study contributes to embedding ongoing consistency of practice and scope of service delivery for occupational therapy in this field. What This Article Adds: Occupational therapists should be considered core team members in the critical care-ICU, with funding to support ongoing service provision and optimization of patient outcomes based on effective and feasible service delivery.
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Affiliation(s)
- Andrea Rapolthy-Beck
- Andrea Rapolthy-Beck, MSc Neurorehabilitation, BScOccTher, BSc(Med)ExSc, is Senior Occupational Therapist, Occupational Therapy Department, Surgical Treatment and Rehabilitation Service, Herston Health Precinct, Queensland, Australia; Senior Occupational Therapist, Occupational Therapy Department, Logan Hospital, Meadowbrook, Queensland, Australia; and PhD Candidate, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia;
| | - Jennifer Fleming
- Jennifer Fleming, PhD, BOccThy (Hons), FOTARA, is Professor and Head, Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Merrill Turpin
- Merrill Turpin, PhD, BOccThy, GradDipCounsel, is Senior Lecturer, Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Kellie Sosnowski
- Kellie Sosnowski, MNursing(Hons), BNursing, GradCertHlthMgt, GradDipCriticalCare, is Nurse Unit Manager, Intensive Care Unit, Logan Hospital, Meadowbrook, Queensland, Australia
| | - Simone Dullaway
- Simone Dullaway, BAppSc (Occ Ther), is Senior Occupational Therapist, Chronic Disease Team, Metro South Health and Hospital Service, Queensland, Australia
| | - Hayden White
- Hayden White, PhD, MBBCH, FCP (SA), MMED (Wits), FCICM, FRACP, is Deputy Director, Intensive Care Unit, Logan Hospital, Meadowbrook, Queensland, Australia
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van Vliet P, Carey LM, Turton A, Kwakkel G, Palazzi K, Oldmeadow C, Searles A, Lavis H, Middleton S, Galloway M, Dimech-Betancourt B, O'Keefe S, Tavener M. Task-specific training versus usual care to improve upper limb function after stroke: the "Task-AT Home" randomised controlled trial protocol. Front Neurol 2023; 14:1140017. [PMID: 37456648 PMCID: PMC10345498 DOI: 10.3389/fneur.2023.1140017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 05/04/2023] [Indexed: 07/18/2023] Open
Abstract
Background Sixty percent of people have non-functional arms 6 months after stroke. More effective treatments are needed. Cochrane Reviews show low-quality evidence that task-specific training improves upper limb function. Our feasibility trial showed 56 h of task-specific training over 6 weeks resulted in an increase of a median 6 points on the Action Research Arm test (ARAT), demonstrating the need for more definitive evidence from a larger randomised controlled trial. Task-AT Home is a two-arm, assessor-blinded, multicentre randomised, controlled study, conducted in the home setting. Aim The objective is to determine whether task-specific training is a more effective treatment than usual care, for improving upper limb function, amount of upper limb use, and health related quality of life at 6 weeks and 6 months after intervention commencement. Our primary hypothesis is that upper limb function will achieve a ≥ 5 point improvement on the ARAT in the task-specific training group compared to the usual care group, after 6 weeks of intervention. Methods Participants living at home, with remaining upper limb deficit, are recruited at 3 months after stroke from sites in NSW and Victoria, Australia. Following baseline assessment, participants are randomised to 6 weeks of either task-specific or usual care intervention, stratified for upper limb function based on the ARAT score. The task-specific group receive 14 h of therapist-led task-specific training plus 42 h of guided self-practice. The primary outcome measure is the ARAT at 6 weeks. Secondary measures include the Motor Activity Log (MAL) at 6 weeks and the ARAT, MAL and EQ5D-5 L at 6 months. Assessments occur at baseline, after 6 weeks of intervention, and at 6 months after intervention commencement. Analysis will be intention to treat using a generalised linear mixed model to report estimated mean differences in scores between the two groups at each timepoint with 95% confidence interval and value of p. Discussion If the task-specific home-based training programme is more effective than usual care in improving arm function, implementation of the programme into clinical practice would potentially lead to improvements in upper limb function and quality of life for people with stroke. Clinical Trial Registration ANZCTR.org.au/ACTRN12617001631392p.aspx.
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Affiliation(s)
- Paulette van Vliet
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Leeanne Mary Carey
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
- Brain Research Institute, Florey Institute of Neuroscience and Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Ailie Turton
- School of Health and Social Wellbeing, Faculty of Health and Applied Sciences, University of the West of England, Bristol, England, United Kingdom
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Movement Science and Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Kerrin Palazzi
- Clinical Research Design, Information Technology and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Christopher Oldmeadow
- Clinical Research Design, Information Technology and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, The University of Newcastle, New Lambton, NSW, Australia
| | - Heidi Lavis
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent’s Network Sydney and Australian Catholic University, Sydney, NSW, Australia
| | - Margaret Galloway
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Bleydy Dimech-Betancourt
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
| | - Sophie O'Keefe
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
| | - Meredith Tavener
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
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Lee LJ, Choi SY, Lee HS, Han SW. Efficacy analysis of virtual reality-based training for activities of daily living and functional task training in stroke patients: A single-subject study. Medicine (Baltimore) 2023; 102:e33573. [PMID: 37083778 PMCID: PMC10118341 DOI: 10.1097/md.0000000000033573] [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: 11/27/2022] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Abstract
INTRODUCTION Virtual reality (VR)-based training for functions such as cognition, upper extremities, balancing, and activities of daily living (ADL) has been used on stroke patients, and its efficacy has been reported. However, no comparison has been made between the efficacy of VR-based training for daily activities that exactly reproduces ADL and functional training. Therefore, this study sought to analyze the difference in independency enhancement of VR-based training for daily activities compared to cognitive and motor functional training. PATIENT CONCERNS AND DIAGNOSIS This study was conducted on 4 patients who have been diagnosed with stroke and are currently receiving rehabilitation therapy in G hospital located in the city of Gwangju, using A-B-A'-B' design from single-subject experimental designs. INTERVENTIONS Intervention was performed in 2 ways: application of VR-based training for daily activities after the application of cognitive and motor function training; and application of cognitive and motor function training after the application of VR-based training for daily activities. The Assessment of Motor and Process Skills, Computer Cognitive Screening Assessment System, Box and Block Test, and Grip and Pinch Strength Test were used to measure the changes in the performance of daily activities, cognitive function, and upper extremities function. OUTCOMES The results confirmed that the performance of daily activities, cognitive function, and upper extremities function was improved after the application of VR-based intervention. In addition, the efficacy of independency enhancement was maximized by the early approach of training for daily activities at the time of VR-based intervention in stroke patients. CONCLUSIONS VR-based intervention of training for daily activities and functional training can be considered to benefit the improvement of the performance of daily activities, cognitive function, and upper extremities function in stroke patients. In addition, although functional training was also effective in enhancing independency and functional improvement in stroke patients, an early approach to training for ADL based on tasks with objectives was deemed to be more effective.
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Affiliation(s)
- Lan-Ju Lee
- Department of Occupational Therapy, Gwangju Heemang Hospital, Haseo-ro, Buk-gu, Gwangju, Korea
| | - Seong-Youl Choi
- Department of Occupational Therapy, Kangwon National University, Dogye-eup, Samcheok-si, Gangwon-do, Korea
| | - Hye-Sun Lee
- Department of Occupational Therapy, Kwangju Women’s University, Yeodae-gil, Gwangsan-gu, Gwangju, Korea
| | - Sang-Woo Han
- Department of Occupational Therapy, Kwangju Women’s University, Yeodae-gil, Gwangsan-gu, Gwangju, Korea
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Christie LJ, Fearn N, McCluskey A, Lovarini M, Rendell R, Pearce A. Cost-Effectiveness of Constraint-Induced Movement Therapy Implementation in Neurorehabilitation: The ACTIveARM Project. PHARMACOECONOMICS - OPEN 2022; 6:437-450. [PMID: 35316523 PMCID: PMC9043065 DOI: 10.1007/s41669-022-00323-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Constraint-induced movement therapy (CIMT) is a recommended intervention for improving arm recovery following stroke and traumatic brain injury; however, delivery in practice remains rare. PURPOSE The aim of this study was to investigate the costs and cost effectiveness of CIMT delivery, and the use of a CIMT implementation package designed to improve CIMT uptake and delivery by therapists in Sydney, Australia. METHODS This economic evaluation was conducted with a subset of CIMT programmes (n = 20) delivered by neurological rehabilitation teams at five varied hospitals within a mixed methods implementation study (ACTIveARM). The costs of delivering the CIMT implementation package and publicly funded CIMT were calculated using a bottom-up approach. A cost-effectiveness analysis was conducted, using decision analytic modelling. We compared the uptake and outcomes of people who received CIMT from health services that had received a CIMT implementation package, with those receiving standard upper limb therapy. An Australian health care system perspective was used in the model, over a 3-week time horizon (the average timeframe of a CIMT programme). All costs were calculated in Australian dollars (AUD). Inputs were derived from the ACTIveARM study and relevant literature. The Action Research Arm Test was used to measure arm outcomes. Sensitivity analyses assessed the impact of improving CIMT uptake, scale-up of the implementation package and resource adjustment, including a 'best-case' scenario analysis. RESULTS The total cost of delivering the implementation package to nine teams across five hospitals was $110,336.43 AUD over 18 months. The mean cost of delivering an individual CIMT programme was $1233.38 AUD per participant, and $936.03 AUD per participant for group-based programmes. The incremental cost-effectiveness ratio (ICER) of individual CIMT programmes was $8052 AUD per additional person achieving meaningful improvement in arm function, and $6045 AUD for group-based CIMT. The ICER was most sensitive to reductions in staffing costs. In the 'best-case' scenario, the ICER for both individual and group-based CIMT was $245 AUD per additional person gaining a meaningful change in function. CONCLUSION Therapists improved CIMT uptake and delivery with the support of an implementation package, however cost effectiveness was unclear. CLINICAL TRIAL REGISTRATION https://anzctr.org.au/Trial ID: ACTRN12617001147370.
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Affiliation(s)
- Lauren J Christie
- Brain Injury Rehabilitation Unit, Liverpool Hospital, Sydney, NSW, Australia.
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- Allied Health Research Unit, St Vincent's Health Network, Sydney, NSW, Australia.
- Nursing Research Institute, St Vincent's Health Network, Sydney, NSW, Australia.
| | - Nicola Fearn
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Allied Health Research Unit, St Vincent's Health Network, Sydney, NSW, Australia
| | - Annie McCluskey
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- The StrokeEd Collaboration, Sydney, NSW, Australia
| | - Meryl Lovarini
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Reem Rendell
- Brain Injury Rehabilitation Unit, Liverpool Hospital, Sydney, NSW, Australia
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Alison Pearce
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Aries AM, Pomeroy VM, Sim J, Read S, Hunter SM. Sensory Stimulation of the Foot and Ankle Early Post-stroke: A Pilot and Feasibility Study. Front Neurol 2021; 12:675106. [PMID: 34290663 PMCID: PMC8287025 DOI: 10.3389/fneur.2021.675106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/17/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Somatosensory stimulation of the lower extremity could improve motor recovery and walking post-stroke. This pilot study investigated the feasibility of a subsequent randomized controlled trial (RCT) to determine whether task-specific gait training is more effective following either (a) intensive hands-on somatosensory stimulation or (b) wearing textured insoles. Objectives: Determine recruitment and attrition rates, adherence to intervention, acceptability and viability of interventions and outcome measures, and estimate variance of outcome data to inform sample size for a subsequent RCT. Methods: Design: randomized, single-blinded, mixed-methods pilot study. Setting: In-patient rehabilitation ward and community. Participants: n = 34, 18+years, 42-112 days following anterior or posterior circulation stroke, able to follow simple commands, able to walk independently pre-stroke, and providing informed consent. Intervention: Twenty 30-min sessions of task-specific gait training (TSGT) (delivered over 6 weeks) in addition to either: (a) 30-60 min mobilization and tactile stimulation (MTS); or (b) unlimited textured insole (TI) wearing. Outcomes: Ankle range of movement (electrogoniometer), touch-pressure sensory thresholds (Semmes Weinstein Monofilaments), motor impairment (Lower Extremity Motricity Index), walking ability and speed (Functional Ambulation Category, 5-m walk test, pressure insoles) and function (modified Rivermead Mobility Index), measured before randomization, post-intervention, and 1-month thereafter (follow-up). Adherence to allocated intervention and actual dose delivered (fidelity) were documented in case report forms and daily diaries. Focus groups further explored acceptability of interventions and study experience. Analysis: Recruitment, attrition, and dose adherence rates were calculated as percentages of possible totals. Thematic analysis of daily diaries and focus group data was undertaken. Standard deviations of outcome measures were calculated and used to inform a sample size calculation. Results: Recruitment, attrition, and adherence rates were 48.57, 5.88, and 96.88%, respectively. Focus groups, daily-diaries and case report forms indicated acceptability of interventions and outcome measures to participants. The 5-m walk was selected as primary outcome measure for a future trial [mean (SD) at end of intervention: 16.86 (11.24) MTS group and 21.56 (13.57) TI group]; sample size calculation indicated 60 participants are required per group. Conclusion: Recruitment, attrition and adherence rates and acceptability of interventions and outcomes justify a subsequent powered RCT of MTS+TSGT compared with TI+TSGT.
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Affiliation(s)
- Alison M. Aries
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
| | - Valerie M. Pomeroy
- Acquired Brain Injury Recovery Alliance (ABIRA), School of Health Sciences, University of East Anglia, Norwich, United Kingdom
- National Institute for Health Research (NIHR) Brain Injury MedTech Co-operative, Cambridge, United Kingdom
| | - Julius Sim
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
| | - Susan Read
- School of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
| | - Susan M. Hunter
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
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Rapolthy-Beck A, Fleming J, Turpin M, Sosnowski K, Dullaway S, White H. A comparison of standard occupational therapy versus early enhanced occupation-based therapy in a medical/surgical intensive care unit: study protocol for a single site feasibility trial (EFFORT-ICU). Pilot Feasibility Stud 2021; 7:51. [PMID: 33602337 PMCID: PMC7889705 DOI: 10.1186/s40814-021-00795-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 02/08/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Admissions to intensive care units (ICUs) are increasing due to an ageing population, and rising incidence of cardiac and respiratory disease. With advances in medical care, more patients are surviving an initial stay in critical care; however, they can experience ongoing health and cognitive limitations that may influence return to baseline function up to a year post-admission. Recent research has focused on the introduction of early rehabilitation within the ICU to reduce long-term physical and cognitive complications. The aim of this study is to explore the feasibility and impact of providing early enhanced occupation-based therapy, including cognitive stimulation and activities of daily living, to patients in intensive care. METHODS This study involves a single site randomised-controlled feasibility trial comparing standard occupational therapy care to an early enhanced occupation-based therapy. Thirty mechanically ventilated ICU patients will be recruited and randomly allocated to the intervention or control group. The primary outcome measure is the Functional Independence Measure (FIM), and secondary measures include the Modified Barthel Index (MBI), Montreal Cognitive Assessment (MoCA), grip strength, Hospital Anxiety and Depression Scale (HADS) and Short-Form 36 Health survey (SF-36). Measures will be collected by a blind assessor at discharge from intensive care, hospital discharge and a 90-day follow-up. Daily outcome measures including the Glasgow Coma Scale (GCS), Richmond Agitation and Sedation Scale (RASS) and Confusion Assessment Measure for intensive care units (CAM-ICU) will be taken prior to treatment. Participants in the intervention group will receive daily a maximum of up to 60-min sessions with an occupational therapist involving cognitive and functional activities such as self-care and grooming. At the follow-up, intervention group participants will be interviewed to gain user perspectives of the intervention. Feasibility data including recruitment and retention rates will be summarised descriptively. Parametric tests will compare outcomes between groups. Interview data will be thematically analysed. DISCUSSION This trial will provide information about the feasibility of investigating how occupational therapy interventions in ICU influence longer term outcomes. It seeks to inform the design of a phase III multicentre trial of occupational therapy in critical care general medical intensive care units. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618000374268 ; prospectively registered on 13 March 2018/ https://www.anzctr.org.au Trial funding: Metro South Health Research Support Scheme Postgraduate Scholarship.
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Affiliation(s)
- Andrea Rapolthy-Beck
- Logan Hospital, Brisbane, Queensland, Australia.
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia.
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Merrill Turpin
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
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Effect of Adding Motor Imagery to Task Specific Training on Facilitation of Sit to Stand in Hemiparetic Patients. ARCHIVES OF NEUROSCIENCE 2020. [DOI: 10.5812/ans.102053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Motor imagery training is a cognitive process in which an internal representation of a movement is activated in working memory. The movement is mentally rehearsed, without any physical activity. Task-specific training emphasizes the repetitive practice of skilled movement to enhance functional abilities in hemiparesis. Objectives: To investigate whether task specific training preceded by motor imagery or task specific training alone was more effective for facilitating sit to stand in patients with stroke. Methods: Thirty male patients with stroke were selected from the Cairo University Outpatient Clinic; the median age of participants was 54.5 ± 3.51 years and they were divided equally into two groups. Patients in study group A (n = 15) received motor imagery training for 15 minutes followed by task specific training for 45 minutes, as well as a selected physical therapy program 3 times per week for 6 weeks. The control group B (n = 15) received task specific training for 45 minutes, as well as a selected physical therapy program 3 times per week for 6 weeks. The Fugl-Meyer section of the lower extremity (FMA-LE), Timed up and go test (TUG), and Biodex Balance system were assessed before and after treatment. Results: The results were highly significant for all variables including FMA-LE, TUG and Biodex Balance system in favor of the study group, post treatment. (P = 0.0004, P = 0.0001 and P = 0.0001, respectively). Conclusions: Motor imagery training results in greater improvement in sit to stand ability when used in conjunction with task specific training, rather than task specific training alone.
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Effects of Virtual Reality-Based Rehabilitation on Burned Hands: A Prospective, Randomized, Single-Blind Study. J Clin Med 2020; 9:jcm9030731. [PMID: 32182742 PMCID: PMC7141182 DOI: 10.3390/jcm9030731] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 12/22/2022] Open
Abstract
Hands are the most frequent burn injury sites. Appropriate rehabilitation is essential to ensure good functional recovery. Virtual reality (VR)-based rehabilitation has proven to be beneficial for the functional recovery of the upper extremities. We investigated and compared VR-based rehabilitation with conventional rehabilitation (CON) in patients with burned hands. Fifty-seven patients were randomized into a VR or CON group. Each intervention was applied to the affected hand for four weeks, and clinical and functional variables were evaluated. Hand function was evaluated before intervention and four weeks after intervention using the Jebsen-Taylor hand function test (JTT), Grasp and Pinch Power Test, Purdue Pegboard test (PPT), and Michigan Hand Outcomes Questionnaire (MHQ). The JTT scores for picking up small objects and the MHQ scores for hand function, functional ADL, work, pain, aesthetics, and patient satisfaction were significantly higher in the VR group than in the CON group (p < 0.05). The results suggested that VR-based rehabilitation is likely to be as effective as conventional rehabilitation for recovering function in a burned hand. VR-based rehabilitation may be considered as a treatment option for patients with burned hands.
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Somerville E, Minor B, Keglovits M, Yan Y, Stark S. Effect of a Novel Transition Program on Disability After Stroke: A Trial Protocol. JAMA Netw Open 2019; 2:e1912356. [PMID: 31577356 PMCID: PMC6777394 DOI: 10.1001/jamanetworkopen.2019.12356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IMPORTANCE A gap in care for stroke survivors exists at the point of transition from inpatient rehabilitation to home, when survivors encounter new environmental barriers because of the cognitive and sensorimotor sequelae of stroke. Resolving these barriers and improving independence in the community have the potential to significantly improve stroke survivors' long-term morbidity. OBJECTIVE To investigate the efficacy and safety of a novel enhanced rehabilitation transition program to reduce environmental barriers and improve daily activity performance and community participation among stroke survivors. DESIGN, SETTING, AND PARTICIPANTS This is a phase 2b, single-blind, parallel-group, randomized clinical trial. Participants will be randomized using a 1:1 allocation ratio, stratified by Functional Independence Measure and age, to either attentional control or the intervention. Community Participation Transition After Stroke (COMPASS) is a complex intervention that uses 2 complementary evidence-based interventions: home modifications and strategy training delivered in the home. Community participation after stroke, measured by the Reintegration to Normal Living Index, is the primary outcome. Secondary outcomes include quality of life after stroke, measured by the Stroke Impact Scale, and daily activity performance and magnitude of environmental barriers in the home, both measured by the In-Home Occupational Performance Evaluation. An intention-to-treat analysis will be used. A total of 180 participants, who are 50 years or older, were independent in activities of daily living prior to stroke, and are undergoing inpatient rehabilitation following stroke with a plan to be discharged home, will be included in the study. DISCUSSION Stroke is a leading cause of serious long-term disability in the United States. The COMPASS study is ongoing. To date, 99 participants have been recruited and 77 randomized, with 37 in the treatment group and 40 in the control group. Resumption of previous activities immediately after discharge can improve immediate and long-term community participation. Results from this study will fill a critical gap in stroke rehabilitation evidence by providing important information about the long-term community participation and daily activity performance among stroke survivors as well as environmental barriers in their homes. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03485820.
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Affiliation(s)
- Emily Somerville
- School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Brittany Minor
- School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Marian Keglovits
- School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Yan Yan
- School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Susan Stark
- School of Medicine, Washington University in St Louis, St Louis, Missouri
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Wolf TJ, Doherty M, Boone A, Rios J, Polatajko H, Baum C, McEwen S. Cognitive oriented strategy training augmented rehabilitation (COSTAR) for ischemic stroke: a pilot exploratory randomized controlled study. Disabil Rehabil 2019; 43:201-210. [PMID: 31155969 DOI: 10.1080/09638288.2019.1620877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To investigate the effect of adding cognitive strategy training to task-specific training (TST), called Cognitive Oriented Strategy Training Augmented Rehabilitation (COSTAR), compared with TST on activity and participation for chronic stroke survivors in an outpatient occupational therapy settingMaterials and methods: We conducted an exploratory, single-blind, randomized controlled trial. Participants were randomized to TST or COSTAR protocol. Our primary outcomes measured activity and participation after stroke: the Stroke Impact Scale (SIS), Canadian Occupational Performance Measure (COPM), and Performance Quality Rating Scale (PQRS).Results: Forty-four participants were randomized. The COSTAR group had an attrition rate of 50% and an average of 9.8 of 12 sessions were completed; the TST group had an attrition rate of 25% and an average of 10.7 sessions were completed. Generally both groups improved on the majority of primary and secondary outcomes. There is little evidence to support a beneficial effect of COSTAR over TST for improvement of primary measures of activity performance or secondary measures.Conclusion: Negligible findings may be attributed to an inadvertent treatment group equivalency. Further, the research design did not allow for adequate measurement of the effect of each intervention on participants' ability to generalize learned skills.Implications for rehabilitationStroke rehabilitation is largely based upon the principles of task-specific training, which is associated with improvements in upper extremity motor performance; however, TST requires a heavy dosage and lacks generalization to untrained activities.Cognitive strategy use has been associated with improved generalization of treatment to untrained activities and novel contexts however, it is often not used in TST protocols.The results of this preliminary study found no clear advantage between task-specific training and strategy-adapted task-specific training on trained and untrained activities when both interventions targeted activity performance.Task-specific training, if focused at the activity performance level rather than the impairment reduction level, may have a stronger effect on improving in individual's ability to participate in everyday life activities even without the use of cognitive-strategies.Incorporating cognitive strategy-use into TST would likely produce the greatest effect on generalization and transfer of the treatment effects to other activities and contexts rather than solely on activity performance of trained activities.
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Affiliation(s)
- Timothy J Wolf
- Department of Occupational Therapy, University of Missouri, Columbia, MO, USA
| | - Meghan Doherty
- Department of Occupational Science and Occupational Therapy, Saint Louis University, St. Louis, MO, USA
| | - Anna Boone
- Department of Occupational Therapy, University of Missouri, Columbia, MO, USA
| | - Jorge Rios
- Sunnybrook Research Institute, St. John's Rehab Program, Toronto, Canada
| | - Helene Polatajko
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Carolyn Baum
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Sara McEwen
- Sunnybrook Research Institute, St. John's Rehab Program, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
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Bonnyaud C, Gallien P, Decavel P, Marque P, Aymard C, Pellas F, Isner ME, Boyer FC, Muller F, Daviet JC, Dehail P, Perrouin-Verbe B, Bayle N, Coudeyre E, Perennou D, Laffont I, Ropers J, Domingo-Saidji NY, Bensmail D, Roche N. Effects of a 6-month self-rehabilitation programme in addition to botulinum toxin injections and conventional physiotherapy on limitations of patients with spastic hemiparesis following stroke (ADJU-TOX): protocol study for a randomised controlled, investigator blinded study. BMJ Open 2018; 8:e020915. [PMID: 30166290 PMCID: PMC6119443 DOI: 10.1136/bmjopen-2017-020915] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Home-based self-rehabilitation programmes combined with botulinum toxin injections (BTIs) appear to be a relevant approach to increase the recommended intensive rehabilitation of patients with spasticity following a stroke. The literature highlights a lack of evidence of beneficial effects of this adjuvant therapy to reduce limitations of patients with stroke. The aim of this study is to assess the effects of a 6-month self-rehabilitation programme in adjunction to BTI, in comparison with BTI alone, to reduce limitations of patients with spasticity following a stroke. METHODS AND ANALYSIS 220 chronic patients will participate to this multicentre, prospective, randomised, controlled, assessor blinded study. All patients will benefit from two successive BTI (3 months apart), and patients randomised in the self-rehabilitation group will perform in adjunction 6 months of self-rehabilitation at home. All patients continue their conventional physiotherapy. The main outcome is the primary treatment goal (PTG), which will be determined jointly by the patient and the medical doctor using Goal Attainment Scaling. Impairments and functions, quality of life, mood and fatigue will be assessed. Botulinum toxin will be injected into the relevant muscles according to the PTG. Patients in the self-rehab group will be taught the self-rehabilitation programme involving respectively 10 min of stretching, 10 min of strengthening and 10 min of task-oriented exercises, corresponding to their PTG. Compliance to the self-rehabilitation programme will be monitored. ETHICS AND DISSEMINATION Patients will sign written informed consent. Ethical approval was obtained from ethics committee. The results will be disseminated in a peer-reviewed journal and presented at international congresses. The results will also be disseminated to patients. TRIAL REGISTRATION NUMBER NCT02944929.
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Affiliation(s)
- Celine Bonnyaud
- Service de Physiologie et d’exploration Fonctionnelle, Hôpital Raymond Poincaré APHP, Garches, Université Versailles Saint Quentin en Yvelines, Garches, France
| | - Philippe Gallien
- Service de Médecine Physique et de Réadaptation, Pole Saint-Helier, Rennes, Bretagne, France
| | - Pierre Decavel
- Service de Médecine Physique et de Réadaptation, Hôpital Jean-Minjoz, Besançon, France
| | - Philippe Marque
- Service de Médecine Physique et de Réadaptation, Hôpital Rangueil, Toulouse, France
| | - Claire Aymard
- Service de Médecine Physique et de Réadaptation, Fondation Hospitaliere Sainte-Marie, Paris, France
| | - Frédéric Pellas
- Service Rééducation Post Réanimation, Unité Cérébro-Lésés, Hopital Carémeau, Nimes, France
| | - Marie-Eve Isner
- Service de Médecine Physique et de Réadaptation, Institut Réadaptation Clémenceau, Strasbourg, France
| | | | - François Muller
- Service de Médecine Physique et de Réadaptation, Clinique Les Embruns, Bidart, France
| | | | - Patrick Dehail
- Service de Médecine Physique et de Réadaptation, Hôpital Pellegrin, Bordeaux, France
| | | | - Nicolas Bayle
- Service de Médecine Physique et de Réadaptation, Albert Chenevier, Hôpital Henri Mondor, Créteil, France
| | - Emmanuel Coudeyre
- Service de Médecine Physique et de Réadaptation, Hôpital Nord, Clermont-Ferrand, France
| | - Dominic Perennou
- Service de Médecine Physique et de Réadaptation, Neurologie, Centre Hospitalier Universitaire, Grenoble, France
| | - Isabelle Laffont
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, France
| | - Jacques Ropers
- Unité de Recherche Clinique, Paris Île-de-France Ouest (URCPO), Hôpital Raymond Poincaré, APHP, Garches, France
| | | | - Djamel Bensmail
- Service de Physiologie et d’exploration Fonctionnelle, Hôpital Raymond Poincaré APHP, Garches, Université Versailles Saint Quentin en Yvelines, Garches, France
| | - Nicolas Roche
- Service de Physiologie et d’exploration Fonctionnelle, Hôpital Raymond Poincaré APHP, Garches, Université Versailles Saint Quentin en Yvelines, Garches, France
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Lin SH, Dionne TP. Interventions to Improve Movement and Functional Outcomes in Adult Stroke Rehabilitation: Review and Evidence Summary. J Particip Med 2018; 10:e3. [PMID: 33052128 PMCID: PMC7434068 DOI: 10.2196/jopm.8929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/02/2017] [Indexed: 12/30/2022] Open
Abstract
Background Patients who have had a stroke may not be familiar with the terminology nor have the resources to efficiently search for evidence-based rehabilitation therapies to restore movement and functional outcomes. Recognizing that a thorough systematic review on this topic is beyond the scope of this article, we conducted a rapid review evidence summary to determine the level of evidence for common rehabilitation interventions to improve movement/motor and functional outcomes in adults who have had a stroke. Objective The objective of this study was to find evidence for common rehabilitation interventions to improve movement/motor and functional outcomes in adults who have had a stroke. Methods Medline Complete, PubMed, CINAHL Complete, Cochrane Database, Rehabilitation and Sports Medicine Source, Dissertation Abstracts International, and National Guideline Clearinghouse, from 1996 to April of 2016, were searched. From 348 articles, 173 met the following inclusion criteria: (1) published systematic reviews or meta-analyses, (2) outcomes target functional movement or motor skills of the upper and lower limbs, (3) non-pharmacological interventions that are commonly delivered to post-stroke population (acute and chronic), (4) human studies, and (5) English. Evidence tables were created to analyze the findings of systematic reviews and meta-analyses by category of interventions and outcomes. Results This rapid review found that the following interventions possess credible evidence to improve functional movement of persons with stroke: cardiorespiratory training, therapeutic exercise (ie, strengthening), task-oriented training (task-specific training), constraint-induced movement therapy (CIMT), mental practice, and mirror therapy. Neuromuscular electrical stimulation (NMES) (ie, functional electrical stimulation) shows promise as an intervention for stroke survivors. Conclusions Most commonly delivered therapeutic interventions to improve motor recovery after a stroke possess moderate quality evidence and are effective. Future research recommendations, such as optimal timing and dosage, would help rehabilitation professionals tailor interventions to achieve the best outcomes for stroke survivors.
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Affiliation(s)
- Susan Hamady Lin
- Institute of Health Professions, Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA, United States
| | - Timothy P Dionne
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, United States
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Stark S, Keglovits M, Somerville E, Hu YL, Conte J, Yan Y. Feasibility of a Novel Intervention to Improve Participation after Stroke. Br J Occup Ther 2017; 81:116-124. [PMID: 29861533 DOI: 10.1177/0308022617736704] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Stroke is a leading cause of serious, long-term disability in the US. With shorter inpatient hospital stays, more time in rehabilitation is devoted to medical stabilization and less on skills to regain independence in daily activities. The transition home may be an opportunity for intervention focused on regaining independence. We propose an enhanced rehabilitation transition program called: Community Participation Transition after Stroke (COMPASS). Method A prospective, randomized, single-blinded, parallel-group pilot study was completed to demonstrate feasibility with N=15 participants. Findings Fidelity to the protocol was achieved: the COMPASS group received 81% of the planned minutes and 83% of the intervention visits. There was no difference between groups for healthcare utilization or falls. Adherence was 85% at 3-months and 71% at 9-months for the home modification intervention. At 6-months, the COMPASS group's reintegration to normal living scores improved by 17.39 points for the COMPASS group, and 1.30 for the control group. Environmental barriers decreased in both groups. Conclusion This pilot study demonstrated that it is feasible to implement a community participation intervention during the period of transitioning home from inpatient rehabilitation for stroke survivors. Additional studies are necessary to determine the efficacy of the intervention.
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Affiliation(s)
- Susan Stark
- Assistant Professor of Occupational Therapy, Neurology and Social Work, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Marian Keglovits
- Occupational Therapist, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Emily Somerville
- Occupational Therapist, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Yi-Ling Hu
- Rehabilitation and Participation Science Program, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Jane Conte
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Yan Yan
- Professor, Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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Kwon HY, Ahn SY. Effect of task-oriented training and high-variability practice on gross motor performance and activities of daily living in children with spastic diplegia. J Phys Ther Sci 2016; 28:2843-2848. [PMID: 27821947 PMCID: PMC5088138 DOI: 10.1589/jpts.28.2843] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 06/16/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigates how a task-oriented training and high-variability
practice program can affect the gross motor performance and activities of daily living for
children with spastic diplegia and provides an effective and reliable clinical database
for future improvement of motor performances skills. [Subjects and Methods] This study
randomly assigned seven children with spastic diplegia to each intervention group
including that of a control group, task-oriented training group, and a high-variability
practice group. The control group only received neurodevelopmental treatment for 40
minutes, while the other two intervention groups additionally implemented a task-oriented
training and high-variability practice program for 8 weeks (twice a week, 60 min per
session). To compare intra and inter-relationships of the three intervention groups, this
study measured gross motor performance measure (GMPM) and functional independence measure
for children (WeeFIM) before and after 8 weeks of training. [Results] There were
statistically significant differences in the amount of change before and after the
training among the three intervention groups for the gross motor performance measure and
functional independence measure. [Conclusion] Applying high-variability practice in a
task-oriented training course may be considered an efficient intervention method to
improve motor performance skills that can tune to movement necessary for daily livelihood
through motor experience and learning of new skills as well as change of tasks learned in
a complex environment or similar situations to high-variability practice.
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Affiliation(s)
- Hae-Yeon Kwon
- Department of Physical Therapy, College of Nursing and Healthcare Science, Dong-eui University, Republic of Korea
| | - So-Yoon Ahn
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan, Republic of Korea
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Chiang VCL, Lo KH, Choi KS. Rehabilitation of activities of daily living in virtual environments with intuitive user interface and force feedback. Disabil Rehabil Assist Technol 2016; 12:672-680. [PMID: 27782750 DOI: 10.1080/17483107.2016.1218554] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the feasibility of using a virtual rehabilitation system with intuitive user interface and force feedback to improve the skills in activities of daily living (ADL). METHOD A virtual training system equipped with haptic devices was developed for the rehabilitation of three ADL tasks - door unlocking, water pouring and meat cutting. Twenty subjects with upper limb disabilities, supervised by two occupational therapists, received a four-session training using the system. The task completion time and the amount of water poured into a virtual glass were recorded. The performance of the three tasks in reality was assessed before and after the virtual training. Feedback of the participants was collected with questionnaires after the study. RESULTS The completion time of the virtual tasks decreased during the training (p < 0.01) while the percentage of water successfully poured increased (p = 0.051). The score of the Borg scale of perceived exertion was 1.05 (SD = 1.85; 95% CI = 0.18-1.92) and that of the task specific feedback questionnaire was 31 (SD = 4.85; 95% CI = 28.66-33.34). The feedback of the therapists suggested a positive rehabilitation effect. The participants had positive perception towards the system. CONCLUSIONS The system can potentially be used as a tool to complement conventional rehabilitation approaches of ADL. Implications for rehabilitation Rehabilitation of activities of daily living can be facilitated using computer-assisted approaches. The existing approaches focus on cognitive training rather than the manual skills. A virtual training system with intuitive user interface and force feedback was designed to improve the learning of the manual skills. The study shows that system could be used as a training tool to complement conventional rehabilitation approaches.
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Affiliation(s)
| | - King-Hung Lo
- b Department of Occupational Therapy , Hong Kong Red Cross Princess Alexandra School , Kowloon , Hong Kong
| | - Kup-Sze Choi
- c Centre for Smart Health, School of Nursing , The Hong Kong Polytechnic University , Kowloon , Hong Kong
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Wolf TJ, Polatajko H, Baum C, Rios J, Cirone D, Doherty M, McEwen S. Combined Cognitive-Strategy and Task-Specific Training Affects Cognition and Upper-Extremity Function in Subacute Stroke: An Exploratory Randomized Controlled Trial. Am J Occup Ther 2016; 70:7002290010p1-7002290010p10. [PMID: 26943113 DOI: 10.5014/ajot.2016.017293] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to estimate the effect of Cognitive Orientation to Daily Occupational Performance (CO-OP) compared with usual occupational therapy on upper-extremity movement, cognitive flexibility, and stroke impact in people less than 3 mo after stroke. An exploratory, single-blind randomized controlled trial was conducted with people referred to outpatient occupational therapy services at two rehabilitation centers. Arm movement was measured with the Action Research Arm Test, cognitive flexibility with the Delis-Kaplan Executive Function System Trail Making subtest, and stroke impact with subscales of the Stroke Impact Scale. A total of 35 participants were randomized, and 26 completed the intervention. CO-OP demonstrated measurable effects over usual care on all measures. These data provide early support for the use of CO-OP to improve performance and remediate cognitive and arm movement impairments after stroke over usual care; however, future study is warranted to confirm the effects observed in this trial.
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Affiliation(s)
- Timothy J Wolf
- Timothy J. Wolf, OTD, MSCI, OTR/L, FAOTA, is Associate Professor and Chair, Department of Occupational Therapy, University of Missouri, Columbia;
| | - Helene Polatajko
- Helene Polatajko, PhD, OT Reg. (Ont.), is Professor, Rehabilitation Sciences Institute and Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Carolyn Baum
- Carolyn Baum, PhD, OTR/L, FAOTA, is Professor and Chair, Program in Occupational Therapy, and Professor, Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Jorge Rios
- Jorge Rios, BSc, is Lab Manager, St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Dianne Cirone
- Dianne Cirone, MSc(RS), OT Reg. (Ont.), is Lecturer, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada, and Occupational Therapist, St. John's Rehab Outpatient Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Meghan Doherty
- Meghan Doherty, MSOT, OTR/L, is Clinical Specialist, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Sara McEwen
- Sara McEwen, PhD, is Assistant Professor, Rehabilitation Sciences Institute and Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada, and Scientist, St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
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Saunders DH, Sanderson M, Hayes S, Kilrane M, Greig CA, Brazzelli M, Mead GE. Physical fitness training for stroke patients. Cochrane Database Syst Rev 2016; 3:CD003316. [PMID: 27010219 PMCID: PMC6464717 DOI: 10.1002/14651858.cd003316.pub6] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Levels of physical fitness are low after stroke. It is unknown whether improving physical fitness after stroke reduces disability. OBJECTIVES To determine whether fitness training after stroke reduces death, dependence, and disability and to assess the effects of training with regard to adverse events, risk factors, physical fitness, mobility, physical function, quality of life, mood, and cognitive function. Interventions to improve cognitive function have attracted increased attention after being identified as the highest rated research priority for life after stroke. Therefore we have added this class of outcomes to this updated review. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched February 2015), the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 1: searched February 2015), MEDLINE (1966 to February 2015), EMBASE (1980 to February 2015), CINAHL (1982 to February 2015), SPORTDiscus (1949 to February 2015), and five additional databases (February 2015). We also searched ongoing trials registers, handsearched relevant journals and conference proceedings, screened reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing either cardiorespiratory training or resistance training, or both (mixed training), with usual care, no intervention, or a non-exercise intervention in stroke survivors. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, assessed quality and risk of bias, and extracted data. We analysed data using random-effects meta-analyses. Diverse outcome measures limited the intended analyses. MAIN RESULTS We included 58 trials, involving 2797 participants, which comprised cardiorespiratory interventions (28 trials, 1408 participants), resistance interventions (13 trials, 432 participants), and mixed training interventions (17 trials, 957 participants). Thirteen deaths occurred before the end of the intervention and a further nine before the end of follow-up. No dependence data were reported. Diverse outcome measures restricted pooling of data. Global indices of disability show moderate improvement after cardiorespiratory training (standardised mean difference (SMD) 0.52, 95% confidence interval (CI) 0.19 to 0.84; P value = 0.002) and by a small amount after mixed training (SMD 0.26, 95% CI 0.04 to 0.49; P value = 0.02); benefits at follow-up (i.e. after training had stopped) were unclear. There were too few data to assess the effects of resistance training.Cardiorespiratory training involving walking improved maximum walking speed (mean difference (MD) 6.71 metres per minute, 95% CI 2.73 to 10.69), preferred gait speed (MD 4.28 metres per minute, 95% CI 1.71 to 6.84), and walking capacity (MD 30.29 metres in six minutes, 95% CI 16.19 to 44.39) at the end of the intervention. Mixed training, involving walking, increased preferred walking speed (MD 4.54 metres per minute, 95% CI 0.95 to 8.14), and walking capacity (MD 41.60 metres per six minutes, 95% CI 25.25 to 57.95). Balance scores improved slightly after mixed training (SMD 0.27, 95% CI 0.07 to 0.47). Some mobility benefits also persisted at the end of follow-up. The variability, quality of the included trials, and lack of data prevents conclusions about other outcomes and limits generalisability of the observed results. AUTHORS' CONCLUSIONS Cardiorespiratory training and, to a lesser extent, mixed training reduce disability during or after usual stroke care; this could be mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within post-stroke rehabilitation programmes to improve the speed and tolerance of walking; some improvement in balance could also occur. There is insufficient evidence to support the use of resistance training. The effects of training on death and dependence after stroke are still unclear but these outcomes are rarely observed in physical fitness training trials. Cognitive function is under-investigated despite being a key outcome of interest for patients. Further well-designed randomised trials are needed to determine the optimal exercise prescription and identify long-term benefits.
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Affiliation(s)
- David H Saunders
- Institute for Sport, Physical Education and Health Sciences (SPEHS), University of EdinburghMoray House School of EducationSt Leonards LandHolyrood RoadEdinburghUKEH8 2AZ
| | - Mark Sanderson
- University of the West of ScotlandInstitute of Clinical Exercise and Health ScienceRoom A071A, Almada BuildingHamiltonUKML3 0JB
| | - Sara Hayes
- University of LimerickDepartment of Clinical TherapiesLimerickIreland
| | - Maeve Kilrane
- Royal Infirmary of EdinburghDepartment of Stroke MedicineWard 201 ‐ Stroke UnitLittle FranceEdinburghUKEH16 4SA
| | - Carolyn A Greig
- University of BirminghamSchool of Sport, Exercise and Rehabilitation Sciences, MRC‐ARUK Centre for Musculoskeletal Ageing ResearchEdgbastonBirminghamUKB15 2TT
| | - Miriam Brazzelli
- University of AberdeenHealth Services Research UnitHealth Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Gillian E Mead
- University of EdinburghCentre for Clinical Brain SciencesRoom S1642, Royal InfirmaryLittle France CrescentEdinburghUKEH16 4SA
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Shin JH, Kim MY, Lee JY, Jeon YJ, Kim S, Lee S, Seo B, Choi Y. Effects of virtual reality-based rehabilitation on distal upper extremity function and health-related quality of life: a single-blinded, randomized controlled trial. J Neuroeng Rehabil 2016; 13:17. [PMID: 26911438 PMCID: PMC4765099 DOI: 10.1186/s12984-016-0125-x] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/12/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Virtual reality (VR)-based rehabilitation has been reported to have beneficial effects on upper extremity function in stroke survivors; however, there is limited information about its effects on distal upper extremity function and health-related quality of life (HRQoL). The purpose of the present study was to examine the effects of VR-based rehabilitation combined with standard occupational therapy on distal upper extremity function and HRQoL, and compare the findings to those of amount-matched conventional rehabilitation in stroke survivors. METHODS The present study was a single-blinded, randomized controlled trial. The study included 46 stroke survivors who were randomized to a Smart Glove (SG) group or a conventional intervention (CON) group. In both groups, the interventions were targeted to the distal upper extremity and standard occupational therapy was administered. The primary outcome was the change in the Fugl-Meyer assessment (FM) scores, and the secondary outcomes were the changes in the Jebsen-Taylor hand function test (JTT), Purdue pegboard test, and Stroke Impact Scale (SIS) version 3.0 scores. The outcomes were assessed before the intervention, in the middle of the intervention, immediately after the intervention, and 1 month after the intervention. RESULTS The improvements in the FM (FM-total, FM-prox, and FM-dist), JTT (JTT-total and JTT-gross), and SIS (composite and overall SIS, SIS-social participation, and SIS-mobility) scores were significantly greater in the SG group than in the CON group. CONCLUSIONS VR-based rehabilitation combined with standard occupational therapy might be more effective than amount-matched conventional rehabilitation for improving distal upper extremity function and HRQoL. TRIAL REGISTRATION This study is registered under the title "Effects of Novel Game Rehabilitation System on Upper Extremity Function of Patients With Stroke" and can be located in https://clinicaltrials.gov with the study identifier NCT02029651 .
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Affiliation(s)
- Joon-Ho Shin
- National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea.
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, Samgaksan-ro 58, Gangbuk-gu, Seoul, 142-884, Korea.
| | - Mi-Young Kim
- National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea.
| | - Ji-Yeong Lee
- National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea.
| | - Yu-Jin Jeon
- National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea.
| | - Suyoung Kim
- Department of Law, Hanyang University, Seoul, Korea.
| | | | - Beomjoo Seo
- School of Games, Hongik University, Seoul, Korea.
| | - Younggeun Choi
- Neofect, Yong-in, Korea.
- Department of Applied Computer Engineering, Dankook University, Yong-in, Korea.
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Park J. Effects of task-oriented training on upper extremity function and performance of daily activities in chronic stroke patients with impaired cognition. J Phys Ther Sci 2016; 28:316-8. [PMID: 26957782 PMCID: PMC4756028 DOI: 10.1589/jpts.28.316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 10/21/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to determine the effects of task-oriented training on upper
extremity function and performance of daily activities in chronic stroke patients with
impaired cognition. [Subjects and Methods] In this study, 2 chronic hemiplegic stroke
patients underwent task-oriented training. The training was conducted once a day for 30
minutes, 5 times/week, for 2 weeks. The patients were evaluated 3 times before and after
the task-oriented training. Changes in upper extremity function were assessed using the
manual function test, and changes in the ability to carry out daily activities were
assessed using the functional independence measure. [Results] The patients showed
improvement in both the upper extremity function and ability to perform daily activities
after task-oriented training. [Conclusion] Task-oriented training was proven effective in
improving upper extremity function and ability to perform daily activities in chronic
hemiplegic stroke patients with impaired cognition.
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Affiliation(s)
- JuHyung Park
- Department of Occupational Therapy, Kyungbuk College: 77 Daehak-ro, Yeongju-si, Gyeongbuk 750-712, Republic of Korea
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22
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Hewitt L, Pollack M. Does listening to music in acute stroke improve outcomes? A single-blinded quasi-randomized pilot study. ACTA ACUST UNITED AC 2016. [DOI: 10.5348/d05-2016-23-oa-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Nilsen DM, Gillen G, Geller D, Hreha K, Osei E, Saleem GT. Effectiveness of interventions to improve occupational performance of people with motor impairments after stroke: an evidence-based review. Am J Occup Ther 2015; 69:6901180030p1-9. [PMID: 25553742 DOI: 10.5014/ajot.2015.011965] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We conducted a review to determine the effectiveness of interventions to improve occupational performance in people with motor impairments after stroke as part of the American Occupational Therapy Association's Evidence-Based Practice Project. One hundred forty-nine studies met inclusion criteria. Findings related to key outcomes from select interventions are presented. Results suggest that a variety of effective interventions are available to improve occupational performance after stroke. Evidence suggests that repetitive task practice, constraint-induced or modified constraint-induced movement therapy, strengthening and exercise, mental practice, virtual reality, mirror therapy, and action observation can improve upper-extremity function, balance and mobility, and/or activity and participation. Commonalities among several of the effective interventions include the use of goal-directed, individualized tasks that promote frequent repetitions of task-related or task-specific movements.
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Affiliation(s)
- Dawn M Nilsen
- Dawn M. Nilsen, EdD, OTL, is Assistant Professor of Rehabilitation and Regenerative Medicine (Occupational Therapy), Columbia University, New York, NY;
| | - Glen Gillen
- Glen Gillen, EdD, OTR/L, FAOTA, is Associate Professor of Rehabilitation and Regenerative Medicine (Occupational Therapy), Columbia University, New York, NY
| | - Daniel Geller
- Daniel Geller, MS, MPH, OTR/L, Kimberly Hreha, OTR/L, Ellen Osei, MS, OTR/L, and Ghazala T. Saleem, MS, OTR/L, are Doctoral Students, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Kimberly Hreha
- Daniel Geller, MS, MPH, OTR/L, Kimberly Hreha, OTR/L, Ellen Osei, MS, OTR/L, and Ghazala T. Saleem, MS, OTR/L, are Doctoral Students, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Ellen Osei
- Daniel Geller, MS, MPH, OTR/L, Kimberly Hreha, OTR/L, Ellen Osei, MS, OTR/L, and Ghazala T. Saleem, MS, OTR/L, are Doctoral Students, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Ghazala T Saleem
- Daniel Geller, MS, MPH, OTR/L, Kimberly Hreha, OTR/L, Ellen Osei, MS, OTR/L, and Ghazala T. Saleem, MS, OTR/L, are Doctoral Students, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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Corbetta D, Sirtori V, Castellini G, Moja L, Gatti R. Constraint-induced movement therapy for upper extremities in people with stroke. Cochrane Database Syst Rev 2015; 2015:CD004433. [PMID: 26446577 PMCID: PMC6465192 DOI: 10.1002/14651858.cd004433.pub3] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND In people who have had a stroke, upper limb paresis affects many activities of daily life. Reducing disability is therefore a major aim of rehabilitative interventions. Despite preserving or recovering movement ability after stroke, sometimes people do not fully realise this ability in their everyday activities. Constraint-induced movement therapy (CIMT) is an approach to stroke rehabilitation that involves the forced use and massed practice of the affected arm by restraining the unaffected arm. This has been proposed as a useful tool for recovering abilities in everyday activities. OBJECTIVES To assess the efficacy of CIMT, modified CIMT (mCIMT), or forced use (FU) for arm management in people with hemiparesis after stroke. SEARCH METHODS We searched the Cochrane Stroke Group trials register (last searched June 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library Issue 1, 2015), MEDLINE (1966 to January 2015), EMBASE (1980 to January 2015), CINAHL (1982 to January 2015), and the Physiotherapy Evidence Database (PEDro; January 2015). SELECTION CRITERIA Randomised control trials (RCTs) and quasi-RCTs comparing CIMT, mCIMT or FU with other rehabilitative techniques, or none. DATA COLLECTION AND ANALYSIS One author identified trials from the results of the electronic searches according to the inclusion and exclusion criteria, three review authors independently assessed methodological quality and risk of bias, and extracted data. The primary outcome was disability. MAIN RESULTS We included 42 studies involving 1453 participants. The trials included participants who had some residual motor power of the paretic arm, the potential for further motor recovery and with limited pain or spasticity, but tended to use the limb little, if at all. The majority of studies were underpowered (median number of included participants was 29) and we cannot rule out small-trial bias. Eleven trials (344 participants) assessed disability immediately after the intervention, indicating a non-significant standard mean difference (SMD) 0.24 (95% confidence interval (CI) -0.05 to 0.52) favouring CIMT compared with conventional treatment. For the most frequently reported outcome, arm motor function (28 studies involving 858 participants), the SMD was 0.34 (95% CI 0.12 to 0.55) showing a significant effect (P value 0.004) in favour of CIMT. Three studies involving 125 participants explored disability after a few months of follow-up and found no significant difference, SMD -0.20 (95% CI -0.57 to 0.16) in favour of conventional treatment. AUTHORS' CONCLUSIONS CIMT is a multi-faceted intervention where restriction of the less affected limb is accompanied by increased exercise tailored to the person's capacity. We found that CIMT was associated with limited improvements in motor impairment and motor function, but that these benefits did not convincingly reduce disability. This differs from the result of our previous meta-analysis where there was a suggestion that CIMT might be superior to traditional rehabilitation. Information about the long-term effects of CIMT is scarce. Further trials studying the relationship between participant characteristics and improved outcomes are required.
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Affiliation(s)
- Davide Corbetta
- San Raffaele HospitalUnit of Functional RecoveryVia Olgettina, 48MilanItaly20132
| | - Valeria Sirtori
- San Raffaele HospitalUnit of Functional RecoveryVia Olgettina, 48MilanItaly20132
| | - Greta Castellini
- IRCCS Galeazzi Orthopaedic InstituteUnit of Clinical EpidemiologyMilanItaly
| | - Lorenzo Moja
- IRCCS Galeazzi Orthopaedic InstituteUnit of Clinical EpidemiologyMilanItaly
- University of MilanDepartment of Biomedical Sciences for HealthVia Pascal 36MilanItaly20133
| | - Roberto Gatti
- University Vita‐Salute San RaffaeleSchool of PhysiotherapyVia Olgettina, 58MilanItaly20132
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Park J, Yoo C. Effects of task-oriented training on upper extremity function and performance of daily activities by chronic stroke patients. J Phys Ther Sci 2015; 27:2657-9. [PMID: 26355425 PMCID: PMC4563337 DOI: 10.1589/jpts.27.2657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 05/06/2015] [Indexed: 12/03/2022] Open
Abstract
[Purpose] The aim of this study was to determine the effects that task-oriented training
has on upper extremity function and performance of daily activities by chronic stroke
patients. [Subjects and Methods] Task-oriented training was applied to two chronic
hemiplegic patients in this research. The training was provided to each patient for 30
minutes a day, five times a week for two weeks. The treatment program included six
different types of training that could be performed by the patients themselves. Evaluation
was performed four times, that is, once a week for three weeks before the intervention and
once after the intervention. The change in upper extremity function was measured with the
Manual Function Test, and the change in performance of daily activity was measured with
the Functional Independence Measure. [Results] The upper extremity function of both
subjects was improved after application of task-oriented training. However, in the
performance of daily activities, subject one showed improvement compared to with before
the intervention, whereas subject two showed the same results. [Conclusion] This research
confirmed that two weeks of task-oriented training for chronic stroke patients is effective
for improvement of upper extremity function and performance of daily activities by chronic
stroke patients.
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Affiliation(s)
- JuHyung Park
- Department of Occupational Therapy, Kyungbuk College, Republic of Korea
| | - Chanuk Yoo
- Department of Occupational Therapy, Hanlyo University, Republic of Korea
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Fleet A, Page SJ, MacKay-Lyons M, Boe SG. Modified Constraint-Induced Movement Therapy for Upper Extremity Recovery Post Stroke: What Is the Evidence? Top Stroke Rehabil 2014; 21:319-31. [DOI: 10.1310/tsr2104-319] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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McEwen S, Polatajko H, Baum C, Rios J, Cirone D, Doherty M, Wolf T. Combined Cognitive-Strategy and Task-Specific Training Improve Transfer to Untrained Activities in Subacute Stroke: An Exploratory Randomized Controlled Trial. Neurorehabil Neural Repair 2014; 29:526-36. [PMID: 25416738 DOI: 10.1177/1545968314558602] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to estimate the effect of the Cognitive Orientation to daily Occupational Performance (CO-OP) approach compared with usual outpatient rehabilitation on activity and participation in people <3 months poststroke. METHODS An exploratory, single-blind, randomized controlled trial, with a usual-care control arm, was conducted. Participants referred to 2 stroke rehabilitation outpatient programs were randomized to receive either usual care or CO-OP. The primary outcome was actual performance of trained and untrained self-selected activities, measured using the Performance Quality Rating Scale (PQRS). Additional outcomes included the Canadian Occupational Performance Measure (COPM), the Stroke Impact Scale Participation Domain, the Community Participation Index, and the Self-Efficacy Gauge. RESULTS A total of 35 eligible participants were randomized; 26 completed the intervention. Post intervention, PQRS change scores demonstrated that CO-OP had a medium effect over usual care on trained self-selected activities (d = 0.5) and a large effect on untrained activities (d = 1.2). At a 3-month follow-up, PQRS change scores indicated a large effect of CO-OP on both trained (d = 1.6) and untrained activities (d = 1.1). CO-OP had a small effect on COPM and a medium effect on the Community Participation Index perceived control and on the Self-Efficacy Gauge. CONCLUSION CO-OP was associated with a large treatment effect on follow-up performances of self-selected activities and demonstrated transfer to untrained activities. A larger trial is warranted.
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Affiliation(s)
- Sara McEwen
- Sunnybrook-St John's Rehab, Toronto, ON, Canada University of Toronto, Toronto, ON, Canada
| | | | - Carolyn Baum
- Washington University School of Medicine, St Louis, MI, USA
| | - Jorge Rios
- Sunnybrook-St John's Rehab, Toronto, ON, Canada
| | - Dianne Cirone
- Sunnybrook-St John's Rehab, Toronto, ON, Canada University of Toronto, Toronto, ON, Canada
| | - Meghan Doherty
- Washington University School of Medicine, St Louis, MI, USA
| | - Timothy Wolf
- Washington University School of Medicine, St Louis, MI, USA
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Pollock A, Farmer SE, Brady MC, Langhorne P, Mead GE, Mehrholz J, van Wijck F. Interventions for improving upper limb function after stroke. Cochrane Database Syst Rev 2014; 2014:CD010820. [PMID: 25387001 PMCID: PMC6469541 DOI: 10.1002/14651858.cd010820.pub2] [Citation(s) in RCA: 337] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Improving upper limb function is a core element of stroke rehabilitation needed to maximise patient outcomes and reduce disability. Evidence about effects of individual treatment techniques and modalities is synthesised within many reviews. For selection of effective rehabilitation treatment, the relative effectiveness of interventions must be known. However, a comprehensive overview of systematic reviews in this area is currently lacking. OBJECTIVES To carry out a Cochrane overview by synthesising systematic reviews of interventions provided to improve upper limb function after stroke. METHODS SEARCH METHODS We comprehensively searched the Cochrane Database of Systematic Reviews; the Database of Reviews of Effects; and PROSPERO (an international prospective register of systematic reviews) (June 2013). We also contacted review authors in an effort to identify further relevant reviews. SELECTION CRITERIA We included Cochrane and non-Cochrane reviews of randomised controlled trials (RCTs) of patients with stroke comparing upper limb interventions with no treatment, usual care or alternative treatments. Our primary outcome of interest was upper limb function; secondary outcomes included motor impairment and performance of activities of daily living. When we identified overlapping reviews, we systematically identified the most up-to-date and comprehensive review and excluded reviews that overlapped with this. DATA COLLECTION AND ANALYSIS Two overview authors independently applied the selection criteria, excluding reviews that were superseded by more up-to-date reviews including the same (or similar) studies. Two overview authors independently assessed the methodological quality of reviews (using a modified version of the AMSTAR tool) and extracted data. Quality of evidence within each comparison in each review was determined using objective criteria (based on numbers of participants, risk of bias, heterogeneity and review quality) to apply GRADE (Grades of Recommendation, Assessment, Development and Evaluation) levels of evidence. We resolved disagreements through discussion. We systematically tabulated the effects of interventions and used quality of evidence to determine implications for clinical practice and to make recommendations for future research. MAIN RESULTS Our searches identified 1840 records, from which we included 40 completed reviews (19 Cochrane; 21 non-Cochrane), covering 18 individual interventions and dose and setting of interventions. The 40 reviews contain 503 studies (18,078 participants). We extracted pooled data from 31 reviews related to 127 comparisons. We judged the quality of evidence to be high for 1/127 comparisons (transcranial direct current stimulation (tDCS) demonstrating no benefit for outcomes of activities of daily living (ADLs)); moderate for 49/127 comparisons (covering seven individual interventions) and low or very low for 77/127 comparisons.Moderate-quality evidence showed a beneficial effect of constraint-induced movement therapy (CIMT), mental practice, mirror therapy, interventions for sensory impairment, virtual reality and a relatively high dose of repetitive task practice, suggesting that these may be effective interventions; moderate-quality evidence also indicated that unilateral arm training may be more effective than bilateral arm training. Information was insufficient to reveal the relative effectiveness of different interventions.Moderate-quality evidence from subgroup analyses comparing greater and lesser doses of mental practice, repetitive task training and virtual reality demonstrates a beneficial effect for the group given the greater dose, although not for the group given the smaller dose; however tests for subgroup differences do not suggest a statistically significant difference between these groups. Future research related to dose is essential.Specific recommendations for future research are derived from current evidence. These recommendations include but are not limited to adequately powered, high-quality RCTs to confirm the benefit of CIMT, mental practice, mirror therapy, virtual reality and a relatively high dose of repetitive task practice; high-quality RCTs to explore the effects of repetitive transcranial magnetic stimulation (rTMS), tDCS, hands-on therapy, music therapy, pharmacological interventions and interventions for sensory impairment; and up-to-date reviews related to biofeedback, Bobath therapy, electrical stimulation, reach-to-grasp exercise, repetitive task training, strength training and stretching and positioning. AUTHORS' CONCLUSIONS Large numbers of overlapping reviews related to interventions to improve upper limb function following stroke have been identified, and this overview serves to signpost clinicians and policy makers toward relevant systematic reviews to support clinical decisions, providing one accessible, comprehensive document, which should support clinicians and policy makers in clinical decision making for stroke rehabilitation.Currently, no high-quality evidence can be found for any interventions that are currently used as part of routine practice, and evidence is insufficient to enable comparison of the relative effectiveness of interventions. Effective collaboration is urgently needed to support large, robust RCTs of interventions currently used routinely within clinical practice. Evidence related to dose of interventions is particularly needed, as this information has widespread clinical and research implications.
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Affiliation(s)
- Alex Pollock
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Sybil E Farmer
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Marian C Brady
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Peter Langhorne
- University of GlasgowAcademic Section of Geriatric MedicineLevel 2, New Lister BuildingGlasgow Royal InfirmaryGlasgowUKG31 2ER
| | - Gillian E Mead
- University of EdinburghCentre for Clinical Brain SciencesRoom S1642, Royal InfirmaryLittle France CrescentEdinburghUKEH16 4SA
| | - Jan Mehrholz
- Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbHWissenschaftliches InstitutAn der Wolfsschlucht 1‐2KreischaGermany01731
| | - Frederike van Wijck
- Glasgow Caledonian UniversityInstitute for Applied Health Research and the School of Health and Life SciencesGlasgowUK
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Adie K, Schofield C, Berrow M, Wingham J, Freeman J, Humfryes J, Pritchard C. Does the use of Nintendo Wii Sports™ improve arm function and is it acceptable to patients after stroke? Publication of the Protocol of the Trial of Wii™ in Stroke - TWIST. Int J Gen Med 2014; 7:475-81. [PMID: 25336985 PMCID: PMC4199966 DOI: 10.2147/ijgm.s65379] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Many stroke patients experience loss of arm function requiring rehabilitation, which is expensive, repetitive, and does not always translate into "real life." Nintendo Wii Sports™ (Wii™) may offer task-specific training that is repetitive and motivating. The Trial of Wii™ in Stroke (TWIST) is designed to investigate feasibility, efficacy, and acceptability using Wii™ to improve affected arm function for patients after stroke. METHOD This is a randomized controlled trial (RCT), incorporating a qualitative study and health economics analysis that compares playing Wii™ versus arm exercises in patients receiving standard rehabilitation in a home setting within 6 months of stroke with a motor deficit of less than 5 on the MRC (Medical Research Council) scale (arm). In this study, we expect to randomize 240 participants. OUTCOME MEASURES Primary outcome is change in affected arm function at 6 weeks follow-up in intervention and control group using the Action Research Arm Test. Secondary outcomes include occupational performance using the Canadian Occupational Performance Measure, quality of life using the Stroke Impact Scale, cost effectiveness analysis, and a qualitative study investigating factors that influence use of Wii™ for patients and carers. CONCLUSION TWIST is the first UK RCT assessing the feasibility, cost effectiveness, and acceptability of Wii™ in stroke rehabilitation. The trial has been registered with ISRCTN 06807619 and UK CRN 11030. Results of the study will be published after completion of study in August 2014.
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Affiliation(s)
- Katja Adie
- Royal Cornwall Hospital Trust, Cornwall, UK
| | | | - Margie Berrow
- Peninsula Clinical Trials Unit, Plymouth University Schools of Medicine and Dentistry, Plymouth, Devon, UK
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DePaul VG, Wishart LR, Richardson J, Thabane L, Ma J, Lee TD. Varied Overground Walking Training Versus Body-Weight-Supported Treadmill Training in Adults Within 1 Year of Stroke. Neurorehabil Neural Repair 2014; 29:329-40. [DOI: 10.1177/1545968314546135] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Although task-related walking training has been recommended after stroke, the theoretical basis, content, and impact of interventions vary across the literature. There is a need for a comparison of different approaches to task-related walking training after stroke. Objective: To compare the impact of a motor-learning-science–based overground walking training program with body-weight-supported treadmill training (BWSTT) in ambulatory, community-dwelling adults within 1 year of stroke onset. Methods: In this rater-blinded, 1:1 parallel, randomized controlled trial, participants were stratified by baseline gait speed. Participants assigned to the Motor Learning Walking Program (MLWP) practiced various overground walking tasks under the supervision of 1 physiotherapist. Cognitive effort was encouraged through random practice and limited provision of feedback and guidance. The BWSTT program emphasized repetition of the normal gait cycle while supported on a treadmill and assisted by 1 to 3 therapy staff. The primary outcome was comfortable gait speed at postintervention assessment (T2). Results: In total, 71 individuals (mean age = 67.3; standard deviation = 11.6 years) with stroke (mean onset = 20.9 [14.1] weeks) were randomized (MLWP, n = 35; BWSTT, n = 36). There was no significant between-group difference in gait speed at T2 (0.002 m/s; 95% confidence interval [CI] = −0.11, 0.12; P > .05). The MLWP group improved by 0.14 m/s (95% CI = 0.09, 0.19), and the BWSTT group improved by 0.14 m/s (95% CI = 0.08, 0.20). Conclusions: In this sample of community-dwelling adults within 1 year of stroke, a 15-session program of varied overground walking-focused training was not superior to a BWSTT program of equal frequency, duration, and in-session step activity.
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Affiliation(s)
- Vincent G. DePaul
- McMaster University, Hamilton, ON, Canada
- St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- University Health Network, Toronto, ON, Canada
| | | | | | | | - Jinhui Ma
- McMaster University, Hamilton, ON, Canada
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Song CS. Effects of Task-oriented Approach on Affected Arm Function in Children with Spastic Hemiplegia Due to Cerebral Palsy. J Phys Ther Sci 2014; 26:797-800. [PMID: 25013269 PMCID: PMC4085194 DOI: 10.1589/jpts.26.797] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 07/03/2013] [Indexed: 12/03/2022] Open
Abstract
[Purpose] The purpose of the present study was to examine the effects of task-oriented
approach on motor function of the affected arm in children with spastic hemiplegia due to
cerebral palsy. [Subjects] Twelve children were recruited by convenience sampling from 2
local rehabilitation centers. The present study utilized a one-group pretest-posttest
design. All of children received task-oriented training for 6 weeks (40 min/day, 5
days/week) and also underwent regular occupational therapy. Three clinical tests, Box and
Block Test (BBT), Manual Ability Measure (MAM-16), and Wee Functional Independence Measure
(WeeFIM) were performed 1 day before and after training to evaluate the effects of the
training. [Results] Compared with the pretest scores, there was a significant increase in
the BBT, MAM-16, and WeeFIM scores of the children after the 6-week practice period.
[Conclusion] The results of this study suggest that a task-oriented approach to treatment
of the affected arm improves functional activities, such as manual dexterity and fine
motor performance, as well as basic daily activities of patients with spastic hemiplegia
due to cerebral palsy.
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Affiliation(s)
- Chiang-Soon Song
- Department of Occupational Therapy, Chungnam Provincial Cheongyang College, Republic of Korea
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Scrivener K, Schurr K, Sherrington C. Responsiveness of the ten-metre walk test, Step Test and Motor Assessment Scale in inpatient care after stroke. BMC Neurol 2014; 14:129. [PMID: 24934859 PMCID: PMC4068979 DOI: 10.1186/1471-2377-14-129] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 06/10/2014] [Indexed: 11/10/2022] Open
Abstract
Background Responsiveness of a measurement tool is its ability to detect change over time. The aim of this study was to determine the responsiveness and floor/ceiling effects of the ten-metre walk test (10mWT), Step Test and Motor Assessment Scale (MAS) lower limb items. Methods An inception cohort study was conducted, including 190 stroke survivors admitted to a comprehensive stroke unit. The 10mWT, Step Test and MAS were administered within 48 hours of admission and repeated in the 48 hours before discharge. Responsiveness was analysed with Effect Size (ES), Standardised Response Mean (SRM) and a median-based Effect Size (mES). Floor/ceiling effects were calculated as the percentage of participants scoring the lowest/highest possible scores. Results Responsiveness of each outcome measure varied according to the statistic used. Values for the 10mWT were ES 1.44, SRM 0.93, mES 0.45; the step test ES 1.99, SRM 0.88, mES 0.36; MAS sit-to-stand (item 4) score ES 1.27, SRM 1.00, mES 0.50; and for MAS item 5 (walking) ES 1.43, SRM 1.10, mES 0.50. The MAS item 3 (sitting balance) was moderately responsive in all analyses (ES 0.72, SRM 0.71, mES 0.50). The MAS mobility score (summed items 3-5) consistently showed large responsiveness (ES 1.42, SRM 1.16, mES 0.92). The Step Test had the highest proportion of participants who didn’t change (46%) and item 4 of the MAS showed the largest ceiling effect on discharge (44%). Conclusions Most measures were able to detect change in motor performance during inpatient stroke rehabilitation but the MAS mobility score was the only measure that demonstrated large responsiveness and no marked floor or ceiling effects.
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Affiliation(s)
- Katharine Scrivener
- Musculoskeletal Division, The George Institute of Global Health, The University of Sydney, PO Box M201 Missenden Road, Sydney 2050 NSW, Australia.
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Veerbeek JM, van Wegen E, van Peppen R, van der Wees PJ, Hendriks E, Rietberg M, Kwakkel G. What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS One 2014; 9:e87987. [PMID: 24505342 PMCID: PMC3913786 DOI: 10.1371/journal.pone.0087987] [Citation(s) in RCA: 675] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/30/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Physical therapy (PT) is one of the key disciplines in interdisciplinary stroke rehabilitation. The aim of this systematic review was to provide an update of the evidence for stroke rehabilitation interventions in the domain of PT. METHODS AND FINDINGS Randomized controlled trials (RCTs) regarding PT in stroke rehabilitation were retrieved through a systematic search. Outcomes were classified according to the ICF. RCTs with a low risk of bias were quantitatively analyzed. Differences between phases poststroke were explored in subgroup analyses. A best evidence synthesis was performed for neurological treatment approaches. The search yielded 467 RCTs (N = 25373; median PEDro score 6 [IQR 5-7]), identifying 53 interventions. No adverse events were reported. Strong evidence was found for significant positive effects of 13 interventions related to gait, 11 interventions related to arm-hand activities, 1 intervention for ADL, and 3 interventions for physical fitness. Summary Effect Sizes (SESs) ranged from 0.17 (95%CI 0.03-0.70; I(2) = 0%) for therapeutic positioning of the paretic arm to 2.47 (95%CI 0.84-4.11; I(2) = 77%) for training of sitting balance. There is strong evidence that a higher dose of practice is better, with SESs ranging from 0.21 (95%CI 0.02-0.39; I(2) = 6%) for motor function of the paretic arm to 0.61 (95%CI 0.41-0.82; I(2) = 41%) for muscle strength of the paretic leg. Subgroup analyses yielded significant differences with respect to timing poststroke for 10 interventions. Neurological treatment approaches to training of body functions and activities showed equal or unfavorable effects when compared to other training interventions. Main limitations of the present review are not using individual patient data for meta-analyses and absence of correction for multiple testing. CONCLUSIONS There is strong evidence for PT interventions favoring intensive high repetitive task-oriented and task-specific training in all phases poststroke. Effects are mostly restricted to the actually trained functions and activities. Suggestions for prioritizing PT stroke research are given.
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Affiliation(s)
- Janne Marieke Veerbeek
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Erwin van Wegen
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Roland van Peppen
- Department of Physiotherapy, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Philip Jan van der Wees
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Erik Hendriks
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Marc Rietberg
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- Department of Neurorehabilitation, Reade Center for Rehabilitation and Rheumatology, Amsterdam, The Netherlands
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Rocca MA, Turconi AC, Strazzer S, Absinta M, Valsasina P, Beretta E, Copetti M, Cazzagon M, Falini A, Filippi M. MRI predicts efficacy of constraint-induced movement therapy in children with brain injury. Neurotherapeutics 2013; 10:511-9. [PMID: 23605556 PMCID: PMC3701764 DOI: 10.1007/s13311-013-0189-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Using resting state (RS) functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI), we identified the predictors of clinical improvement following constraint-induced movement therapy (CIMT) in pediatric patients with chronic hemiplegia.From 14 children with congenital or acquired brain injury and 10 sex- and age-matched healthy controls, brain dual-echo, DTI and RS fMRI sequences were acquired before CIMT. The Quality of Upper Extremities Skills Test and the Gross Motor Function Measure (GMFM) were administered at baseline, at the end of CIMT (10 weeks), and after 6 months. Mean diffusivity and fractional anisotropy (FA) were measured in the lesion responsible for the clinical symptomatology, the affected and unaffected corticospinal tract (CST), motor transcallosal fibers, and uncinate fasciculus (as an internal control). Independent component analysis was used to identify the sensorimotor RS network. The ability of baseline MRI variables to predict clinical changes over time was assessed using multivariate linear models. At baseline, patients had increased mean diffusivity in the symptomatic lesion and decreased FA in the symptomatic lesion, affected corticospinal tract, and motor transcallosal fibers. A reduced RS functional connectivity was found in the bilateral cerebellum, left precentral gyrus, and right secondary sensorimotor cortex. At follow up, Quality of Upper Extremities Skills Test and GMFM scales improved significantly. Baseline average lesion FA predicted clinical improvement at week 10, and baseline functional connectivity of the right secondary sensorimotor cortex and cerebellum predicted GMFM improvement at month 6. DTI and RS fMRI offer promising and objective markers to predict clinical outcomes following CIMT in pediatric patients with congenital or acquired hemiplegia.
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Affiliation(s)
- Maria A. Rocca
- />Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Anna C. Turconi
- />IRCCS Eugenio Medea, La Nostra Famiglia, Bosisio Parini, Lecco Italy
| | - Sandra Strazzer
- />IRCCS Eugenio Medea, La Nostra Famiglia, Bosisio Parini, Lecco Italy
| | - Martina Absinta
- />Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Valsasina
- />Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Elena Beretta
- />IRCCS Eugenio Medea, La Nostra Famiglia, Bosisio Parini, Lecco Italy
| | - Massimiliano Copetti
- />Biostatistics Unit, IRCCS-Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia Italy
| | - Monica Cazzagon
- />IRCCS Eugenio Medea, La Nostra Famiglia, Pasian di Prato, Udine Italy
| | - Andrea Falini
- />Department of Neuroradiology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- />Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Galea MP. Physical modalities in the treatment of neurological dysfunction. Clin Neurol Neurosurg 2012; 114:483-8. [DOI: 10.1016/j.clineuro.2012.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 01/09/2012] [Indexed: 10/14/2022]
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van de Port IGL, Wevers LEG, Lindeman E, Kwakkel G. Effects of circuit training as alternative to usual physiotherapy after stroke: randomised controlled trial. BMJ 2012; 344:e2672. [PMID: 22577186 PMCID: PMC3349299 DOI: 10.1136/bmj.e2672] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To analyse the effect of task oriented circuit training compared with usual physiotherapy in terms of self reported walking competency for patients with stroke discharged from a rehabilitation centre to their own home. DESIGN Randomised controlled trial with follow-up to 24 weeks. SETTING Multicentre trial in nine outpatient rehabilitation centres in the Netherlands PARTICIPANTS Patients with stroke who were able to walk a minimum of 10 m without physical assistance and were discharged from inpatient rehabilitation to an outpatient rehabilitation clinic. Patients were randomly allocated to circuit training or usual physiotherapy, after stratification by rehabilitation centre, with an online randomisation procedure. INTERVENTION Patients in the intervention group received circuit training in 90 minute sessions twice a week for 12 weeks. The training included eight different workstations in a gym and was intended to improve performance in tasks relating to walking competency. The control group received usual outpatient physiotherapy. MAIN OUTCOME MEASURES The primary outcome was the mobility domain of the stroke impact scale (SIS, version 3.0). Secondary outcomes were standing balance, self reported abilities, gait speed, walking distance, stair climbing, instrumental activities of daily living, fatigue, anxiety, and depression. Differences between groups were analysed according to the intention to treat principle. All outcomes were assessed by blinded observers in a repeated measurement design lasting 24 weeks. RESULTS 126 patients were included in the circuit training group and 124 in the usual care group (control), with data from 125 and 117, respectively, available for analysis. One patient from the circuit training group and seven from the control group dropped out. Circuit training was a safe intervention, and no serious adverse events were reported. There were no significant differences between groups for the stroke impact scale mobility domain (β=0.05 (SE 0.68), P=0.943) at 12 weeks. Circuit training was associated with significantly higher scores in terms of gait speed (0.09 m/s (SE 0.02), P<0.001), walking distance (20.0 m (SE 7.4), P=0.007), and modified stairs test (-1.6 s (SE 0.7), P=0.015). There were no significant differences between groups for the other secondary outcomes, except for the leisure domain of the Nottingham extended activities of daily living and the memory and thinking domain of the stroke impact scale. With the exception of gait speed (-0.04 m/s (SE 0.02), P=0.040), there were no significant differences between groups at follow-up. CONCLUSION Task oriented circuit training can safely replace usual physiotherapy for patients with stroke who are discharged from inpatient rehabilitation to the community and need further training in gait and gait related activities as an outpatient. TRIAL REGISTRATION Dutch Trial Register (NTR1534).
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Könönen M, Tarkka IM, Niskanen E, Pihlajamäki M, Mervaala E, Pitkänen K, Vanninen R. Functional MRI and motor behavioral changes obtained with constraint-induced movement therapy in chronic stroke. Eur J Neurol 2011; 19:578-86. [PMID: 22040308 DOI: 10.1111/j.1468-1331.2011.03572.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The clinical benefits of intensive stroke rehabilitation vary individually. We used multimodal functional imaging to assess the relationship of clinical gain and imaging changes in patients with chronic stroke whose voluntary motor control improved after constraint-induced movement therapy (CIMT). METHODS Eleven patients (37.6 ± 36.8 months from stroke) were studied by functional MRI (fMRI), transcranial magnetic stimulation (TMS), and behavioral assessment of hand motor control (Wolf Motor Function Test) before and after 2 weeks of CIMT. Individual and group-level changes in imaging and behavioral parameters were investigated. RESULTS Increase in fMRI activation in the sensorimotor areas was greater amongst those subjects who had poor hand motor behavior before therapy and/or whose motor behavior improved notably because of therapy than amongst subjects with relatively good motor behavior already before therapy. The magnitude of CIMT-induced changes in task-related fMRI activation differed between lesioned and non-lesioned hemispheres, and the fMRI laterality index was different for paretic and non-paretic hand tasks. The corticospinal conduction time in TMS was significantly decreased after CIM therapy. CONCLUSIONS Alterations in sensorimotor cortical activations (fMRI) and corticospinal conductivity (TMS) were observed after intensive rehabilitation in patients with chronic stroke. Activation and functional changes in fMRI and TMS correlated significantly with the degree of clinical improvement in hand motor behavior. The present data advance the understanding of the functional underpinnings of motor recovery, which may be obtained even years after the stroke.
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Affiliation(s)
- M Könönen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
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Khan CM, Oesch PR, Gamper UN, Kool JP, Beer S. Potential effectiveness of three different treatment approaches to improve minimal to moderate arm and hand function after stroke – a pilot randomized clinical trial. Clin Rehabil 2011; 25:1032-41. [DOI: 10.1177/0269215511399795] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To test a study design and explore the feasibility and potential effects of conventional neurological therapy, constraint induced therapy and therapeutic climbing to improve minimal to moderate arm and hand function in patients after a stroke. Method: A pilot study with six-month follow-up in patients after stroke with minimal to moderate arm and hand function admitted for inpatient rehabilitation was performed. Participants were randomly allocated to one of three treatment approaches. Main outcomes were improvement of arm and hand function and adverse effects. Results: 283 patients with stroke were screened for inclusion over a two-year period, out of which fourtyfour were included. All patients could be treated according to the protocol. Improvement of arm and hand function was significantly higher in conventional neurological therapy and constraint induced therapy compared with therapeutic climbing at discharge, and at six months follow-up ( P < 0.05, effect size = 0.56–0.76). No significant differences in arm and hand function were observed between constraint induced therapy and conventional neurological therapy. Constraint induced therapy participants were significantly less at risk of developing shoulder pain at six months follow-up compared with the other participants ( P < 0.05, effect size = 0.82 and 1.79, respectively). Conclusions: The study design needs adaptation to accommodate the stringent inclusion criteria leading to prolonged study duration. Constraint induced therapy seems to be the optimal approach to improve arm and hand function and minimize the risk of shoulder pain for patients with minimal to moderate arm hand function after stroke in the intermediate term.
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Affiliation(s)
- Christine Meier Khan
- Department of Neurology and Neurorehabilitation, Rehabilitation Center Valens, Switzerland
| | - Peter R Oesch
- Department of Research, Rehabilitation Center Valens, Switzerland
| | - Urs N Gamper
- Department of Neurology and Neurorehabilitation, Rehabilitation Center Valens, Switzerland
| | - Jan P Kool
- Zurich University of Applied Science, School of Physiotherapy, Switzerland
| | - Serafin Beer
- Department of Neurology and Neurorehabilitation, Rehabilitation Center Valens, Switzerland
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Many participants in inpatient rehabilitation can quantify their exercise dosage accurately: an observational study. J Physiother 2011; 57:117-22. [PMID: 21684493 DOI: 10.1016/s1836-9553(11)70022-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
QUESTION Are inpatients undergoing rehabilitation who appear able to count exercises able to quantify accurately the amount of exercise they undertake? DESIGN Observational study. PARTICIPANTS Inpatients in an aged care rehabilitation unit and a neurological rehabilitation unit, who appeared able to count their exercises during a 1-2 min observation by their treating physiotherapist. MEASUREMENTS Participants were observed for 30 min by an external observer while they exercised in the physiotherapy gymnasium. Both the participants and the observer counted exercise repetitions with a hand-held tally counter and the two tallies were compared. RESULTS Of the 60 people admitted for aged care rehabilitation during the study period, 49 (82%) were judged by their treating therapist to be able to count their own exercise repetitions accurately. Of the 30 people admitted for neurological rehabilitation during the study period, 20 (67%) were judged by their treating therapist to be able to count their repetitions accurately. Of the 69 people judged to be accurate, 40 underwent observation while exercising. There was excellent agreement between these participants' counts of their exercise repetitions and the observers' counts, ICC (3,1) of 0.99 (95% CI 0.98 to 0.99). Eleven participants (28%) were in complete agreement with the observer. A further 19 participants (48%) varied from the observer by less than 10%. CONCLUSION Therapists were able to identify a group of rehabilitation participants who were accurate in counting their exercise repetitions. Counting of exercise repetitions by therapist-selected patients is a valid means of quantifying exercise dosage during inpatient rehabilitation.
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Abstract
BACKGROUND Circuit class therapy (CCT) offers a supervised group forum for people after stroke to practise tasks, enabling increased practise time without increasing staffing. OBJECTIVES To examine the effectiveness and safety of CCT on mobility in adults with stroke. SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register (last searched October 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2009), MEDLINE (1950 to November 2008), EMBASE (1980 to November 2008), CINAHL (1982 to November 2008) and 14 other electronic databases (to November 2008). We also searched proceedings from relevant conferences, reference lists and unpublished theses; contacted authors of published trials and other experts in the field; and searched relevant clinical trials and research registers. SELECTION CRITERIA Randomised or quasi-randomised controlled trials including people over 18 years old diagnosed with stroke of any severity, at any stage, or in any setting, receiving CCT. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, assessed methodological quality and extracted data. MAIN RESULTS We included six trials involving 292 participants. Participants were long-term stroke survivors living in the community or receiving inpatient rehabilitation. All could walk 10 metres with or without assistance. Four studies measured walking capacity and three measured gait speed, demonstrating that CCT was superior to the comparison intervention (Six Minute Walk Test: mean difference (MD), fixed 76.57 metres, 95% confidence interval (CI) 38.44 to 114.70, P < 0.0001; gait speed: MD, fixed 0.12 m/s, 95% CI 0.00 to 0.24, P = 004). Two studies measured balance, showing a superior effect in favour of CCT (Step Test: MD, fixed 3.00 steps, 95% CI 0.08 to 5.91, P = 0.04; activities-specific balance and confidence: MD, fixed 7.76, 95% CI 0.66 to 14.87, P = 0.03). Studies also measured other balance items showing no difference in effect. Length of stay (two studies) showed a significant effect in favour of CCT (MD, fixed -19.73 days, 95% CI -35.43 to -4.04, P = 0.01). Only two studies measured adverse events (falls during therapy): all were minor. AUTHORS' CONCLUSIONS CCT is safe and effective in improving mobility for people after moderate stroke and may reduce inpatient length of stay. Further research is required, investigating quality of life, participation and cost-benefits, that compares CCT to standard care and that also investigates the differential effects of stroke severity, latency and age.
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Affiliation(s)
- Coralie English
- University of South Australia (City East)Centre for Allied Health EvidenceNorth TerraceAdelaideAustralia5000
| | - Susan L Hillier
- University of South Australia (City East)Centre for Allied Health EvidenceNorth TerraceAdelaideAustralia5000
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Moore TL, Killiany RJ, Pessina MA, Moss MB, Rosene DL. Assessment of motor function of the hand in aged rhesus monkeys. Somatosens Mot Res 2010; 27:121-30. [PMID: 20653499 PMCID: PMC6504938 DOI: 10.3109/08990220.2010.485963] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In the elderly, intact motor functions of the upper extremity are critical for the completion of activities of daily living. Many studies have provided insight into age-related changes in motor function. However, the precise nature and extent of motor impairments of the upper extremity remains unclear. In the current study we have modified two tasks to assess hand/digit function in both young and aged rhesus monkeys. We tested monkeys from 9 to 26 years of age on these tasks to determine the level of fine motor performance across the adult age range. Compared to young monkeys (9-12 years of age), aged monkeys (15-26 years of age) were mildly impaired on fine motor control of the digits. These findings are consistent with previous studies that have found age-related impairment in fine motor function. However, the magnitude and extent of impairment in the current study does differ from previous findings and is likely due to methodological differences in the degree of task complexity.
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Affiliation(s)
- Tara L Moore
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA 02118, USA.
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Abstract
Loss of functional movement is a common consequence of stroke for which a wide range of interventions has been developed. In this Review, we aimed to provide an overview of the available evidence on interventions for motor recovery after stroke through the evaluation of systematic reviews, supplemented by recent randomised controlled trials. Most trials were small and had some design limitations. Improvements in recovery of arm function were seen for constraint-induced movement therapy, electromyographic biofeedback, mental practice with motor imagery, and robotics. Improvements in transfer ability or balance were seen with repetitive task training, biofeedback, and training with a moving platform. Physical fitness training, high-intensity therapy (usually physiotherapy), and repetitive task training improved walking speed. Although the existing evidence is limited by poor trial designs, some treatments do show promise for improving motor recovery, particularly those that have focused on high-intensity and repetitive task-specific practice.
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van de Port IGL, Wevers L, Roelse H, van Kats L, Lindeman E, Kwakkel G. Cost-effectiveness of a structured progressive task-oriented circuit class training programme to enhance walking competency after stroke: the protocol of the FIT-Stroke trial. BMC Neurol 2009; 9:43. [PMID: 19674485 PMCID: PMC2736157 DOI: 10.1186/1471-2377-9-43] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 08/13/2009] [Indexed: 01/19/2023] Open
Abstract
Background Most patients who suffer a stroke experience reduced walking competency and health-related quality of life (HRQoL). A key factor in effective stroke rehabilitation is intensive, task-specific training. Recent studies suggest that intensive, patient-tailored training can be organized as a circuit with a series of task-oriented workstations. Primary aim of the FIT-Stroke trial is to evaluate the effects and cost-effectiveness of a structured, progressive task-oriented circuit class training (CCT) programme, compared to usual physiotherapeutic care during outpatient rehabilitation in a rehabilitation centre. The task-oriented CCT will be applied in groups of 4 to 6 patients. Outcome will be defined in terms of gait and gait-related ADLs after stroke. The trial will also investigate the generalizability of treatment effects of task-oriented CCT in terms of perceived fatigue, anxiety, depression and perceived HRQoL. Methods/design The multicentre single-blinded randomized trial will include 220 stroke patients discharged to the community from inpatient rehabilitation, who are able to communicate and walk at least 10 m without physical, hands-on assistance. After discharge from inpatient rehabilitation, patients in the experimental group will receive task-oriented CCT two times a week for 12 weeks at the physiotherapy department of the rehabilitation centre. Control group patients will receive usual individual, face-to-face, physiotherapy. Costs will be evaluated by having each patient keep a cost diary for the first 24 weeks after randomisation. Primary outcomes are the mobility part of the Stroke Impact Scale (SIS-3.0) and the EuroQol. Secondary outcomes are the other domains of SIS-3.0, lower limb muscle strength, walking endurance, gait speed, balance, confidence not to fall, instrumental ADL, fatigue, anxiety, depression and HRQoL. Discussion Based on assumptions about the effect of intensity of practice and specificity of treatment effects, FIT-Stroke will address two key aims. The first aim is to investigate the effects of task-oriented CCT on walking competency and HRQoL compared to usual face-to-face physiotherapy. The second aim is to reveal the cost-effectiveness of task-oriented CCT in the first 6 months post stroke. Both aims were recently recommended as priorities by the American Hearth Association and Stroke Council. Trial registration This study is registered in the Dutch Trial Register as NTR1534.
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Affiliation(s)
- Ingrid G L van de Port
- Centre of Excellence for Rehabilitation Medicine Utrecht, Rehabilitation Centre De Hoogstraat, Utrecht, The Netherlands.
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Hubbard IJ, Parsons MW, Neilson C, Carey LM. Task-specific training: evidence for and translation to clinical practice. Occup Ther Int 2009; 16:175-89. [DOI: 10.1002/oti.275] [Citation(s) in RCA: 256] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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