Efficacy of Functional Strength Training on Restoration of Lower-Limb Motor Function Early After Stroke: Phase I Randomized Controlled Trial

Cooke, Emma; Tallis, Raymond; Clark, Allan; Pomeroy, Valerie M.

doi:10.1177/1545968309343216

Cited by 76 publications

(98 citation statements)

References 21 publications

(26 reference statements)

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“…9 Of the 80 trials included in this review, only 3 [16][17][18] reported a therapy dosage >22 hours. Therefore, the additional therapy time provided to participants in the circuit class therapy arm of our trial exceeds the therapy contrast reported in the majority of previous therapy dosage studies.…”

Section: Discussionmentioning

confidence: 99%

Circuit Class Therapy and 7-Day-Week Therapy Increase Physiotherapy Time, But Not Patient Activity

English,

Bernhardt,

Hillier

2014

Stroke

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1. more time spent in physiotherapy sessions, 2. more time spent active in physiotherapy sessions, 3. the same amount of time spent active outside of therapy sessions, 4. more time in the therapy areas, and 5. less time alone.Background and Purpose-The optimum model of physiotherapy service delivery for maximizing active task practice during rehabilitation after stroke is unknown. The purpose of the study was to examine the relative effectiveness of 2 alternative models of physiotherapy service delivery against a usual care control with regard to increasing patient activity. Methods-Substudy within a large 3-armed randomized controlled trial, which compared 3 different models of physiotherapy service delivery, was provided for 4 weeks during subacute, inpatient rehabilitation (n=283). The duration of all physiotherapy sessions was recorded. In addition, 32 participants were observed at 10-minute intervals for 1 weekday and 1 weekend day between 8:00 Am and 4:30 pm. At each observation, we recorded physical activity, location, and people present. Results-participants receiving 7-day-week and circuit class therapy received an additional 3 hours and 22 hours of physiotherapy time, respectively, when compared with usual care. participants were standing or walking for a median of 8.2% of observations. On weekdays, circuit class therapy participants spent more time in therapy-related activity (10.2% of observations) when compared with usual care participants (6.1% of observations). On weekends, 7-day therapy participants spent more time in therapy-related activity (4.2% of observations) when compared with both usual care and circuit class therapy participants (0% of observations for both groups). Activity levels outside of therapy sessions did not differ between groups. Conclusions-A greater dosage of physiotherapy time did not translate into meaningful increases in physical activity across the day. Clinical Trial Registration-URL: http://www.anzctr.org.au/. Unique identifier: ACTRN12610000096055.(Stroke. 2014;45:3002-3007.)

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Section: Discussionmentioning

confidence: 99%

Circuit Class Therapy and 7-Day-Week Therapy Increase Physiotherapy Time, But Not Patient Activity

English,

Bernhardt,

Hillier

2014

Stroke

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“…20 -22,25,27,29 Besides, because a standardized and universally accepted definition of "intensity" (or dose) is lacking, 2 operationalization in terms of workload input and output is difficult. 32,33 The intended and actually applied therapy time was reported in 4 publications and illustrates that the actual contrast in training time is approximately 75% of the preplanned contrast, 20,22,23,25 which may be explained by factors such as fatigue in the early phase poststroke, patients' schedules, or lack of staffing. Recording the actual therapy time was not common, and 7 of 14 studies did not provide any data about the applied therapy time.…”

Section: Downloaded Frommentioning

confidence: 99%

“…17-20,23-26,28 -30 In these studies, the additional therapy consisted of, for example, overground walking, 28 backward walking, 30 standing practice, 17,23 treadmill training, 24 or functional strength training. 20 The intervention period ranged from 2 21,26 to 20 weeks 25 with a frequency of 3 18,19,23,24,30 to 5 sessions 17,21,22,25,28,29 per week. The total intended additional therapy time ranged from 270 30 to 3000 minutes (Supplemental Table I).…”

Section: Study Identificationmentioning

confidence: 99%

Effects of Augmented Exercise Therapy on Outcome of Gait and Gait-Related Activities in the First 6 Months After Stroke

Veerbeek

Koolstra

Ket

et al. 2011

Stroke

160

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Background and Purpose-The purpose of this study was to determine the effects of augmented exercise therapy on gait, gait-related activities, and (basic and extended) activities of daily living within the first 6 months poststroke. Methods-A systematic literature search in electronic databases from 1990 until October 2010 was performed. Randomized controlled trials were included in which the experimental group spent augmented time in lower-limb exercise therapy compared with the control group. Outcomes were gait, gait-related activities, and (extended) activities of daily living.Results from individual studies were pooled by calculating the summary effect sizes. Subgroup analyses were applied for a treatment contrast of Ն16 hours, timing poststroke, type of control intervention, and methodological quality. Results-Fourteen (Nϭ725) of 4966 identified studies were included. Pooling resulted in small to moderate significant summary effect sizes in favor of augmented exercise therapy for walking ability, comfortable and maximum walking speed, and extended activities of daily living. No significant effects were found for basic activities of daily living. Subgroup analysis did not show a significant effect modification. Conclusions-Dose-response trials in stroke rehabilitation are heterogeneous. The present meta-analysis suggests that increased time spent on exercise of gait and gait-related activities in the first 6 months poststroke results in significant small to moderate effects in terms of walking ability, walking speed, and extended activities of daily living. High-quality dose-response exercise therapy trials are needed with identical treatment goals but incremental levels of intensity. (Stroke. 2011;42:3311-3315.)Key Words: dose-response Ⅲ exercise therapy Ⅲ intensity Ⅲ meta-analysis Ⅲ stroke S troke rehabilitation is characterized by early initiated, intensive, and ongoing training, in which task and context specificity play an important role. 1,2 There is indirect evidence that complex rehabilitation interventions may prevent inactivity-related complications and enhance functional recovery after stroke. [3][4][5][6][7] However, the underlying mechanisms that drive these benefits are still poorly understood. 5 To optimize rehabilitation services for patients with stroke, a better understanding of the dose-response relationship between exercise therapy and functional outcome is needed. 1,2 A number of systematic reviews have demonstrated that augmented task-specific training defined as either additional time spent in exercise therapy 1,8 or increased number of repetitions 8,9 enhance outcome of gait-related activities, activities of daily living (ADL), and health-related quality of life. 10 French and colleagues' review showed that repetitive task-oriented training resulted in modest improvements of lower-limb function but not of upper-limb function. 9 Another meta-analysis suggested that augmented practice of at least 16 hours in the first 6 months poststroke was needed to gain a mean improvement in ADL o...

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“…Merely two of the thirteen participants in this study increased less than the minimally detectable change in walking speed. Other, frequently used, physiotherapy interventions for improving balance or gait, such as circuit training, functional strength training and body weight supported treadmill training, showed comparable increases for gait speed in patients within three months after stroke [50][51][52]. It is important to notice that the VR training intervention, just like the interventions described above, was part of the regular rehabilitation program.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Effectiveness of Virtual Reality Training on Balance and Gait Recovery Early after Stroke: A Pilot Study

Rooij¹,

Port²,

Meijer³

2017

Int J Phys Med Rehabil

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Objective: To investigate the feasibility and effectiveness of virtual reality training for improving balance and/or gait during inpatient rehabilitation of patients within 12 weeks after stroke. Methods:Sixteen patients within 12 weeks after stroke and dependent gait as categorised with a Functional Ambulation Category score of 2 or 3 were included in this longitudinal pilot study. Participants received eight 30-min sessions of virtual reality training during four weeks as part of the regular inpatient rehabilitation program. Feasibility was assessed using compliance with the training, adverse events, experiences of the participants and the physiotherapists; and effectiveness with the Berg Balance Scale, centre of pressure velocity, Functional Ambulation Category and 10-meter walking test.Results: Participants positively evaluated the intervention and enjoyed the training sessions. Also, physiotherapists observed the training as feasible and beneficial for improving balance or gait. Compliance with the training was 88% and no serious adverse events occurred. The Berg Balance Scale, anterior-posterior centre of pressure velocity, Functional Ambulation Category and 10-meter walking test showed significant improvement after four weeks of training (p<0.05). Conclusion:This study demonstrates that virtual reality training in patients early after stroke is feasible and may be effective in improving balance and/or gait ability.

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Efficacy of Functional Strength Training on Restoration of Lower-Limb Motor Function Early After Stroke: Phase I Randomized Controlled Trial

Cited by 76 publications

References 21 publications

Circuit Class Therapy and 7-Day-Week Therapy Increase Physiotherapy Time, But Not Patient Activity

Circuit Class Therapy and 7-Day-Week Therapy Increase Physiotherapy Time, But Not Patient Activity

Effects of Augmented Exercise Therapy on Outcome of Gait and Gait-Related Activities in the First 6 Months After Stroke

Feasibility and Effectiveness of Virtual Reality Training on Balance and Gait Recovery Early after Stroke: A Pilot Study

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