Exercise to Enhance Mobility and Prevent Falls After Stroke

Dean, Catherine M.; Rissel, Chris; Sherrington, Catherine; Sharkey, Michelle; Cumming, Robert G.; Lord, Stephen R.; Barker, Ruth; Kirkham, Catherine; O'Rourke, Sandra

doi:10.1177/1545968312441711

Cited by 118 publications

(112 citation statements)

References 37 publications

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“…[622][623][624] A 2009 meta-analysis and recent systematic review concluded that circuit class therapy was a safe and effective method for improving mobility after stroke. 623,625 Treadmill training in the context of task-specific training may be used with or without body weight support or therapists to assist the paretic lower extremity in stepping.…”

Section: Dicksteinmentioning

confidence: 99%

Guidelines for Adult Stroke Rehabilitation and Recovery

Winstein¹,

Stein²,

Arena

et al. 2016

Stroke

2,097

840

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e98Purpose-The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. Results-Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness

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Section: Dicksteinmentioning

confidence: 99%

Guidelines for Adult Stroke Rehabilitation and Recovery

Winstein¹,

Stein²,

Arena

et al. 2016

Stroke

2,097

840

View full text Add to dashboard Cite

show abstract

“…The five remaining trials (33,35,28,29,34) included at least one behaviour change technique as defined by the CALO-RE taxonomy (32). Table 2 provides an overview of the studies included in the review.…”

Section: Resultsmentioning

confidence: 99%

“…Seven separate trials fully met the inclusion criteria (33,11,25,12,13,31,14). One of these trials had more than one treatment arm (11,34) and so both were included in our review: a) the early Locomotor Training Programme (LTP) on a treadmill ('Duncan 2011a LTP') (34) and b) the Home Exercise Programme ('Duncan 2011b HEP') (34).…”

Section: Resultsmentioning

confidence: 99%

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Can We Improve Real World Walking After Stroke? A Systematic Review and Meta-Analysis

Stretton

Mudge²,

McPherson³

et al. 2014

Archives of Physical Medicine and Rehabilitation

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Abstract:Objective: This study aimed to determine effectiveness of current interventions to improve real world walking for people with stroke and specifically whether benefits are sustained. Data sources: EBSCO Megafile, AMED, Cochrane, Scopus, PEDRO, OTSeeker and Psychbite databases were searched to identify relevant studies. Review methods: Proximity searching with key words such as ambulat*, walk*, gait, mobility*, activit* was used. Randomised controlled trials that used measures of real world walking were included. Two reviewers independently assessed methodological quality using the Cochrane Risk of Bias Tool and extracted the data. Results: Nine studies fitting the inclusion criteria were identified, most of high quality. A positive effect overall was found indicating a small effect of interventions on real world walking (SMD 0.29 [0.17, 0.41]). Five studies provided follow-up data at > 3-6 months which demonstrated sustained benefits (SMD 0.32 [0.16, 0.48]). Sub group analysis revealed studies using exercise alone were not effective 0.49]) but those incorporating behavioural change techniques (SMD 0.27 [0.12, 0.41]) were. Conclusions:A small but significant effect was found for current interventions and benefits can be sustained. Interventions which include behaviour change techniques appear more effective at improving real world walking habits than exercise alone.

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“…The caution about the application of exercise as a single intervention to high-risk groups is also emphasised by our recent trials in which those in the intervention groups showed enhanced mobility but no significant reduction in falls. This was the case in: frail older people with a program targeting frailty rather than falls that included home exercise (incidence rate ratio (IRR) 1.12, 95% CI 0.78 to 1.63, p = 0.53); 17,18 long-term stroke survivors with a weekly exercise class (IRR 0.96, 95% CI 0.59 to 1.51); 19 and older people recently discharged from hospital with a home exercise program. 20 In the latter trial, there was a significantly higher rate of falls in the exercise group (IRR 1.43, 95% CI 1.07 to 1.93, p = 0.017).…”

Section: Exercise Interventionsmentioning

confidence: 99%