The findings indicate that balance and gait can be improved after physiotherapy based on the Bobath concept, but this should be further evaluated in larger controlled trials of patients with MS.

Purpose: To translate the Trunk Impairment Scale (TIS), a measure of trunk control in patients with stroke, into Norwegian (TIS-NV), and to explore its construct validity, internal consistency, intertester and test-retest reliability. Method:The TIS was translated according to international guidelines. 201 patients with acute stroke were recruited for the validity study, and 50 inpatients with acquired brain lesions were recruited for the study of intertester and test-retest reliability.Construct validity was analysed using explorative factor analysis, confirmatory factor analysis and item response theory, internal consistency with Cronbach's alpha test, and intertester and test-retest reliability with kappa and intraclass correlation coefficient tests. Results:The back-translated version of TIS-NV was validated by the original developer. The subscale Static sitting balance was removed from the test. Six testlets were hierarchically constructed by combining items from the subscales Dynamic sitting balance and Coordination, and renamed modified TIS-NV (TIS-modNV). After these modifications the TIS-modNV fitted well to a locally dependent unidimensional item response theory model. The test demonstrated good construct validity, excellent internal consistency, as well as high intertester and test-retest reliability for the total score. Conclusions:The TIS-modNV is a valid and reliable scale for use in clinical practice and research.3 Main textPatients with disability due to neurological lesions constitute one of the greatest challenges for society and health services in developed countries [1]. The most common cause of brain damage in adults is stroke, and in Norway approximately 15.000 persons suffer a stroke each year [2]. Rehabilitation should be beneficial for the individual patient as well as for society [3], and adequate assessment tools are needed to examine relevant functional aspects.Impaired balance is a common physical deficit post stroke [4;5], and improved balance has been found to be associated with improved rehabilitation outcomes [6], ability to perform daily activities [7], and walking [8]. Impaired balance increases the risk of falls [9], and may thus imply social problems and high economic costs [10].The trunk seems particularly important for balance as it stabilizes the pelvis and spinal column [11], being a prerequisite for coordinated use of the extremities in functional activities such as reaching and gait [12]. Impaired trunk control seems common post stroke [13], and trunk control assessed in patients early after stroke has been found predictive of long-term functional improvement [14;15] Even if previous studies using CTT have given important psychometric information, there are several problems with the assumptions underlying CTT such as sample dependency, item equivalence and standard error of measurement [25]. If the data can meet certain rather strict assumptions, Item Response Theory (IRT) overcomes many of these limitations [26;27]. IRT also provides rather sophisticated psyc...

BackgroundStroke causes lasting disability and the burden of stroke is expected to increase substantially during the next decades. Optimal rehabilitation is therefore mandatory. Early supported discharge (ESD) has previously shown beneficial, but all major studies were carried out more than ten years ago. We wanted to implement and study the results of ESD in our community today with comparisons between ESD and treatment as usual, as well as between two different ESD models.MethodsPatients with acute stroke were included during a three year period (2008–11) in a randomised controlled study comparing two different ESD models to treatment as usual. The two ESD models differed by the location of treatment: either in a day unit or in the patients’ homes. Patients in the ESD groups were followed by a multi-disciplinary ambulatory team in the stroke unit and discharged home as early as possible. The ESD models also comprised treatment by a multi-disciplinary community health team for up to five weeks and follow-up controls after 3 and 6 months. Primary outcome was modified Rankin Scale (mRS) at six months.ResultsThree-hundred-and-six patients were included. mRS scores and change scores were non-significantly better in the two ESD groups at 3 and 6 months. Within-group improvement from baseline to 3 months was significant in the ESD 1 (p = 0.042) and ESD 2 (p = 0.001) groups, but not in the controls. More patients in the pooled ESD groups were independent at 3 (p = 0.086) and 6 months (p = 0.122) compared to controls and there also was a significant difference in 3 month change score between them (p = 0.049). There were no differences between the two ESD groups. Length of stay in the stroke unit was 11 days in all groups.ConclusionsPatients in the ESD groups tended to be more independent than controls at 3 and 6 months, but no clear statistically significant differences were found. The added effect of supported discharge and improved follow-up seems to be rather modest. The improved stroke treatment of today may necessitate larger patient samples to demonstrate additional benefit of ESD.Clinical trial registrationUnique identifier: NCT00771771

ObjectiveTo compare the effects on balance and walking of three models of stroke rehabilitation: early supported discharge with rehabilitation in a day unit or at home, and traditional uncoordinated treatment (control).DesignGroup comparison study within a randomised controlled trial.SettingHospital stroke unit and primary healthcare.ParticipantsInclusion criteria: a score of 2–26 on National Institutes of Health Stroke Scale, assessed with Postural Assessment Scale for Stroke (PASS), and discharge directly home from the hospital stroke unit.InterventionsTwo intervention groups were given early supported discharge with treatment in either a day unit or the patient's own home. The controls were offered traditional, uncoordinated treatment.Outcome measuresPrimary: PASS. Secondary: Trunk Impairment Scale—modified Norwegian version; timed Up-and-Go; 5 m timed walk; self-reports on problems with walking, balance, ADL, physical activity, pain and tiredness. The patients were tested before randomisation and 3 months after inclusion.ResultsFrom a total of 306 randomised patients, 167 were tested with PASS at baseline and discharged directly home. 105 were retested at 3 months: mean age 69 years, 63 men, 27 patients in day unit rehabilitation, 43 in home rehabilitation and 35 in a control group. There were no group differences, either at baseline for demographic and test data or for length of stroke unit stay. At 3 months, there was no group difference in change on PASS (p>0.05). Some secondary measures tended to show better outcome for the intervention groups, that is, trunk control, median (95% CI): day unit, 2 (0.28 to 2.31); home rehabilitation, 4 (1.80 to 3.78); control, 1 (0.56 to 2.53), p=0.044; and for self-report on walking, p=0.021 and ADL, p=0.016.ConclusionsThere was no difference in change between the groups for postural balance, but the secondary outcomes indicated that improvement of trunk control and walking was better in the intervention groups than in the control group.Trial registrationThis study is part of the Early Supported Discharge after Stroke in Bergen, ClinicalTrials.gov (NCT00771771).

fatigue was associated with HRQoL at baseline. Improvement in fatigue seemed to be related to other factors than improvement in physical performance. A broader strategy including both physical and psychological dimensions seems to be needed to improve fatigue over the long-term.

The results indicate that MS patients without heat intolerance have additional benefits from physiotherapy in a warm climate.

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