SWEAT2 Study: Effectiveness of Trunk Training on Gait and Trunk Kinematics After Stroke: A Randomized Controlled Trial

Abstract

Objective Trunk training after stroke is an effective method for improving mobility, yet underlying associations leading to the observed mobility carryover effects are unknown. The purposes of this study were to investigate the effectiveness of trunk training for gait and trunk kinematics and to find explanatory variables for the mobility carryover effects. Methods This study was an assessor-masked randomized controlled trial. Participants received either additional trunk training (n = 19) or cognitive training (n = 20) after subacute stroke. Outcome measures were the Tinetti Performance-Oriented Mobility Assessment (POMA), the Trunk Impairment Scale, spatiotemporal gait parameters, center-of-mass excursions, and trunk and lower limb kinematics during walking. Multivariate analysis with post hoc analysis was performed to observe treatment effects. Correlation and an exploratory regression analysis were used to examine associations with the mobility carryover effects. Results Significant improvements after trunk training, compared with the findings for the control group, were found for the Trunk Impairment Scale, Tinetti POMA, walking speed, step length, step width, horizontal/vertical center-of-mass excursions, and trunk kinematics. No significant differences were observed in lower limb kinematics. Anteroposterior excursions of the trunk were associated with 30% of the variability in the mobility carryover effects. Conclusions Carryover effects of trunk control were present during ambulation. Decreased anteroposterior movements of the thorax were the main variable explaining higher scores on the Tinetti POMA Gait subscale. However, the implementation and generalizability of this treatment approach in a clinical setting are laborious and limited, necessitating further research. Impact Trunk training is an effective strategy for improving mobility after stroke. Regaining trunk control should be considered an important treatment goal early after stroke to adequately prepare patients for walking.

The Effectiveness of Additional Core Stability Exercises in Improving Dynamic Sitting Balance, Gait and Functional Rehabilitation for Subacute Stroke Patients (CORE-Trial): Study Protocol for a Randomized Controlled Trial

“…The earlier these patients can be autonomous, the less time they will be inactive [ 80 ], and in this way the adverse effects of immobilisation can be reduced [ 81 ]. Additional trunk rehabilitation is beneficial in improving gait performance in sub-acute stroke [ 82 ]. Therefore, if the results of this study are positive, we recommend to incorporate these exercises as early as possible in a stroke rehabilitation program.…”

SWEAT2 study: effectiveness of trunk training on muscle activity after stroke. A randomized controlled trial

“…The original trial was registered (ID: NCT02708888), obtained approval from the local ethics committee and performed following the CONSORT guidelines (21). In addition to the extended version of the protocol which is available online (22), further details of the protocol and results of the primary outcome measures can be found in the original SWEAT² study (2).…”

“…Trunk training after stroke is not only an effective method for improving clinically assessed trunk control, standing balance and mobility (1), it also results in relevant kinematic changes in trunk motion during ambulation (2). The Stroke Recovery and Rehabilitation Roundtable of 2017 and 2019 recommends that biomechanical analysis is the best tool to measure motor recovery (3,4), stating that trials should include both clinical and kinematic measures to assess the effectiveness of interventions.…”

“…The Stroke Recovery and Rehabilitation Roundtable of 2017 and 2019 recommends that biomechanical analysis is the best tool to measure motor recovery (3,4), stating that trials should include both clinical and kinematic measures to assess the effectiveness of interventions. The SWEAT² trial (Stroke Walking Explained After Trunk Training) is the first study considering a more biomechanical approach by investigating the effectiveness of trunk training on lower limb and trunk kinematics (5). Results of this randomized controlled trial concluded that participants receiving trunk training walked with less thoracic flexion and anteroposterior displacements; increased rotational amplitudes and dissociation while also improving pelvic control in the frontal plane.…”

“…Therefore, to fully understand the recovery process behind trunk rehabilitation it was imperative to perform a secondary analysis on the same dataset (SWEAT² study) with regard to various muscle activity variables (5). This allows us to better comprehend the link between improved kinematic behaviour and muscular activity after trunk exercises.…”