Background and Purpose-To study the longitudinal relationship of functional change in walking ability and change in time-dependent covariates and to develop a multivariate regression model to predict longitudinal change of walking ability. Methods-A total of 101 acute stroke patients with first-ever ischemic middle cerebral artery strokes was used as the population. Prospective cohort study based on 18 repeated measurements over time during the first poststroke year. Baseline characteristics as well as longitudinal information from functional ambulation categories (FAC), Fugl-Meyer leg score (FM-leg), Motricity index leg score (MI-leg), letter cancellation task (LCT), Fugl-Meyer balance (FMbalance), and timed balance test (TBT) were obtained. Intervention consisted of a basic rehabilitation program with additional arm, leg, or air splint therapy. Main outcome measure constituted change scores on FAC over time. Results-In total, 1532 of the 1717 change scores were available for regression analysis. The regression model showed that TBT change scores were the most important factor in predicting improvement on FAC (␤ϭ0.094; PϽ0.001) followed by changes scores on FM-leg (␤ϭ0.014; PϽ0.001) and reduction in LCT omissions (␤ϭϪ0.010; PϽ0.001) and MI leg test (␤ϭ0.001; PϽ0.001). In addition, time itself was significantly negatively associated with improvement (␤ϭϪ0.002; PϽ0.001). Conclusion-Improvement in standing balance control is more important than improvement in leg strength or synergism to achieve improvement in walking ability, whereas reduction in visuospatial inattention is independently related to improvement of gait. Finally, time itself is an independent covariate that is negatively associated with change on FAC, suggesting that most pronounced improvements occur earlier after stroke.

Background and Purpose-There is increasing interest in the potential benefits of circuit class training after stroke, but its effectiveness is uncertain. Our aim was to systematically review randomized, controlled trials of task-oriented circuit class training on gait and gait-related activities in patients with stroke. Methods-A computer-aided literature search was performed to identify randomized, controlled trials in which the experimental group received task-oriented circuit class training focusing on the lower limb. Studies published up to March 2008 were included. The methodological quality of each study was assessed and studies with the same outcome variable were pooled by calculating the summary effect sizes using fixed or random effects models. Results-Six of the 445 studies screened, comprising 307 participants, were included. Physiotherapy Evidence Database scores ranged from 4 to 8 points with a median of 7.5 points. The meta-analysis demonstrated significant homogeneous summary effect sizes in favor of task-oriented circuit class training for walking distance (0.43; 95% CI, 0.17 to 0.68; PϽ0.001), gait speed (0.35; 95% CI, 0.08 to 0.62; Pϭ0.012), and a timed up-and-go test (0.26; 95% CI, 0.00 to 0.51; Pϭ0.047). Nonsignificant summary effect sizes in favor of task-oriented circuit class training were found for the step test and balance control. Conclusions-This meta-analysis supports the use of task-oriented circuit class training to improve gait and gait-related activities in patients with chronic stroke. Further research is needed to investigate the cost-effectiveness and its effects in the subacute phase after stroke, taking comorbidity into account, and to investigate how to help people maintain and improve their physical abilities after their rehabilitation program ends.

Background and Purpose-Few studies have focused on long-term changes in the caregiving experience after stroke. This study assessed changes in the psychosocial functioning of spouses (burden, depressive symptoms, harmony in the relationship between patient and spouse, and social relations) during the first 3 years after stroke and identified predictors of the course of spouses' psychosocial functioning based on the characteristics of patients and spouses with special emphasis on coping style. Methods-We examined 211 couples shortly after the patient's admission to a rehabilitation center, 197 2 months after discharge, 187 1 year poststroke, and 121 3 years poststroke. Burden was assessed using the Caregiver Strain Index, depressive symptoms with the Goldberg Depression Scale, harmony in the relationship with the Interactional Problem Solving Inventory, and social relations with the Social Support List. Multilevel regression analyses were performed. Results-A significant effect of time (PϽ0.01) was found for all 4 aspects of spouses' psychosocial functioning. Although burden decreased, harmony in the relationship and social relations also decreased. The depression score showed a nonlinear pattern with an initial decrease but a long-term increase. All outcomes were significantly related to caregiver coping strategies. A total of 15% to 27% of the variance in psychosocial functioning could be explained. Conclusions-Follow-up of spouses of patients with stroke requires not only assessment of burden, but also other aspects of psychosocial functioning like harmony in the relationship, depression, and social relations, because our results show negative long-term consequences of stroke for these aspects of caregiver quality of life.

One prominent deficit resulting from stroke is visuo-spatial neglect, which has been associated with slower and more attenuated recovery patterns of sensory-motor impairment as well as limitations in activities of daily living (ADL). The aim of the current study was to further specify the relationship between neglect and recovery of different domains of ADL. One hundred eighty four patients were assessed with the Functional Independence Measure in the first week of inpatient rehabilitation, and again at 6, 12, and 36 months post-stroke. On average, neglect patients scored significantly lower on Self-care, Transfers, and Locomotion compared to non-neglect patients, but these differences became smaller with progress of time. Overall, no differences between groups were found for Sphincter control and Cognition. Patients with more severe neglect scored significantly lower on Self-care and Transfers compared to patients with mild neglect. During rehabilitation, it would be of importance to test for independence in ADL domains in neglect in order to define realistic treatment goals. The current findings could be taken into account in early multidisciplinary intervention planning in the sub-acute phase, to optimize regaining ADL.

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Ankle injuries, especially ankle sprains, are a common problem in sports and medical care. Ankle sprains result in pain and absenteeism from work and/or sports participation, and can lead to physical restrictions such as ankle instability. Nowadays, treatment of ankle injury basically consists of taping the ankle. The purpose of this review is to evaluate the effectiveness of ankle braces as a treatment for acute ankle sprains compared with other types of functional treatments such as ankle tape and elastic bandages. A computerized literature search was conducted using PubMed, EMBASE, CINAHL and the Cochrane Clinical Trial Register. This review includes randomized controlled trials in English, German and Dutch, published between 1990 and April 2009 that compared ankle braces as a treatment for lateral ankle sprains with other functional treatments. The inclusion criteria for this systematic review were (i) individuals (sports participants as well as non-sports participants) with an acute injury of the ankle (acute ankle sprains); (ii) use of an ankle brace as primary treatment for acute ankle sprains; (iii) control interventions including any other type of functional treatment (e.g. Tubigrip™, elastic wrap or ankle tape); and (iv) one of the following reported outcome measures: re-injuries, symptoms (pain, swelling, instability), functional outcomes and/or time to resumption of sports, daily activities and/or work. Eight studies met all inclusion criteria. Differences in outcome measures, intervention types and patient characteristics precluded pooling of the results, so best evidence syntheses were conducted. A few individual studies reported positive outcomes after treatment with an ankle brace compared with other functional methods, but our best evidence syntheses only demonstrated a better treatment result in terms of functional outcome. Other studies have suggested that ankle brace treatment is a more cost-effective method, so the use of braces after acute ankle sprains should be considered. Further research should focus on economic evaluation and on different types of ankle brace, to examine the strengths and weaknesses of ankle braces for the treatment of acute ankle sprains.

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