BackgroundFunctional Strength Training (FST) could enhance recovery late after stroke. The aim of this study was to evaluate the feasibility of a subsequent fully powered, randomized controlled trial.MethodsThe study was designed as a randomized, observer-blind trial. Both interventions were provided for up to one hour a day, four days a week, for six weeks. Evaluation points were before randomization (baseline), after six weeks intervention (outcome), and six weeks thereafter (follow-up). The study took place in participants’ own homes. Participants (n = 52) were a mean of 24.4 months after stroke with a mean age of 68.3 years with 67.3% male. All had difficulty using their paretic upper (UL) and lower limb (LL). Participants were allocated to FST-UL or FST-LL by an independent randomization service. The outcome measures were recruitment rate, attrition rate, practicality of recruitment strategies, occurrence of adverse reactions, acceptability of FST, and estimation of sample size for a subsequent trial. Primary clinical efficacy outcomes were the Action Research Arm Test (ARAT) and the Functional Ambulation Categories (FAC). Analysis was conducted using descriptive statistics and thematic analysis of participants’ views of FST. A power calculation used estimates of clinical efficacy variance to estimate sample size for a subsequent trial.ResultsThe screening process identified 1,127 stroke survivors of whom 52 (4.6%) were recruited. The recruitment rate was higher for referral from community therapists than for systematic identification of people discharged from an acute stroke unit. The attrition rate was 15.5% at the outcome and follow-up time-points. None of the participants experienced an adverse reaction. The participants who remained in the study at outcome had received 68% of the total possible amount of therapy. Participants reported that their experience of FST provided a sense of purpose and involvement and increased their confidence in performing activities. The power calculation provides estimation that 150 participants in each group will be required for a subsequent clinical trial.ConclusionsThis study found that a subsequent clinical trial was feasible with modifications to the recruitment strategy to be used.Trial registrationControlled-trials.com ISCTN71632550, 30 January 2009.
Low back pain presents a major challenge to health care professionals within both primary and secondary care. Spinal manipulation therapy is one option from a range of treatment techniques which until recently has lacked credibility, in part due to a dearth of published, plausible explanations of the mechanisms through which it works. Such explanations are starting to emerge but rigorous evaluations of spinal manipulation therapy over other treatment modalities remain few in number. This paper builds on the review by MohseniBandpei et al. (Mohseni-Bandpei MA, Stephenson R, Richardson B. Spinal manipulation in the treatment of low back pain: a review of the literature with particular emphasis on randomised controlled trials. Phys Ther Rev 1998;3:185-94), by reviewing literature in particular randomised controlled trials published in the field since that date. It is concluded that the efficacy of manipulation for patients with acute or chronic low back pain remains unconvincing and that the literature remains blighted by inconsistency of definitions of interventions and by methodological flaws.
Background: Frozen shoulder syndrome remains largely of unknown etiology and selecting the best evidence-based practice remains a challenge for physiotherapists. Objectives: The objective for this review was to explore existing studies from January 2000 to September 2009 in order to highlight optimal physiotherapy interventions for the treatment of frozen shoulder syndrome. A search of five databases was performed using the relevant search terms frozen shoulder, adhesive capsulitis, physiotherapy, physical therapy and rehabilitation. Major findings: Five papers were selected for review and variations in quality scores were observed. Results showed that mobilization techniques, both with and without exercise, were effective in improving shoulder range of movement and functional ability. High-grade, end-range mobilizations and mobilizations with movement had the best outcomes. Supervised neglect was shown to be favourable over intense physiotherapy in achieving near pain free function at 24 months. Finally, deep heating with stretching was superior to superficial heating with stretching and to stretching alone, in terms of shoulder range of movement and function. Conclusions: Although results provide support for a range of treatment strategies, the methodological quality is variable and firm conclusions are difficult to establish. Until an increase in high-quality studies with similar interventions and outcome measures exist, comparisons are not possible and identifying the best evidence-based practice will remain problematic within the musculoskeletal physiotherapy field.
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