Balance and walking after three different models of stroke rehabilitation: early supported discharge in a day unit or at home, and traditional treatment (control)

Abstract

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).

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“…Several interventions regarding balance and trunk control had been investigated, including weight-shift training on an unstable surface [17], balance control training [18], and gait training with rhythmic auditory stimulation [19]. The majority of published studies reported positive results but traditional rehabilitation programmes tend to be tedious and resource-intensive and require specialized facilities or equipment [20–22]. Given that stroke prevalence is rising every year, there is an urgent need to identify intervention methods which are both cost-effective and safe.…”

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“…Physiotherapy roles: The most commonly reported physiotherapist role (in 46.7% of included studies) was conducting baseline and outcome measure assessments for the study . These assessments included the modified Barthel Index and Rankin Scale, Borg rating scale, Mini Mental State Examination, nine‐hole peg test, Katz ADL index, 10m walk test and Sickness Impact profile, among others.…”

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