Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep 19:3:987601.
doi: 10.3389/fresc.2022.987601. eCollection 2022.

Effect of innovative vs. usual care physical therapy in subacute rehabilitation after stroke. A multicenter randomized controlled trial

Marianne Sivertsen  1   2 , Ellen Christin Arntzen  2   3 , Karl Bjørnar Alstadhaug  2   4 , Britt Normann  2   3
Affiliations

Effect of innovative vs. usual care physical therapy in subacute rehabilitation after stroke. A multicenter randomized controlled trial

Marianne Sivertsen et al. Front Rehabil Sci. .

Abstract

Background: Research on stroke rehabilitation often addresses common difficulties such as gait, balance or physical activity separately, a fragmentation contrasting the complexity in clinical practice. Interventions aiming for recovery are needed. The purpose of this study was to investigate effects of a comprehensive low-cost physical therapy intervention, I-CoreDIST, vs. usual care on postural control, balance, physical activity, gait and health related quality of life during the first 12 weeks post-stroke.

Methods: This prospective, assessor-masked randomized controlled trial included 60 participants from two stroke units in Norway. Participants, who were randomized to I-CoreDIST (n = 29) or usual care physical therapy (n = 31), received 5 sessions/week when in-patients or 3 sessions/week as out-patients. Primary outcomes were the Trunk Impairment Scale-modified Norwegian version (TISmodNV) and activity monitoring (ActiGraphsWgt3X-BT). Secondary outcomes were the Postural Assessment Scale for Stroke, MiniBesTEST, 10-meter walk test, 2-minute walk test, force-platform measurements and EQ5D-3L. Stroke specific quality of life scale was administered at 12 weeks. Linear regression and non-parametric tests were used for statistical analysis.

Results: Five participants were excluded and seven lost to follow-up, leaving 48 participants in the intention-to-treat analysis. There were no significant between-group effects for primary outcomes: TIS-modNV (p = 0,857); daily average minutes of sedative (p = 0.662), light (p = 0.544) or moderate activity (p = 0.239) and steps (p = 0.288), or secondary outcomes at 12 weeks except for significant improvements on EQ5D-3L in the usual care group. Within-group changes were significant for all outcomes in both groups except for activity levels that were low, EQ5D-3L favoring the usual care group, and force-platform data favoring the intervention group.

Conclusions: Physical therapy treatment with I-CoreDIST improved postural control, balance, physical activity and gait during the first 12 weeks after a stroke but is not superior to usual care.

Keywords: balance; gait; health related quality of life; physical activity; physical therapy; rehabilitation; stroke; trunk control.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The flow of patients through the study.
Figure 2
Figure 2
Example of exercise aiming for optimal adaptation to the base of support, an active core as well as enhancement of concentric and eccentric mucle activity in the neck.
Figure 3
Figure 3
Example of exercise aiming for optimal adaptation to the base of support, an active core, activity in large muscle groups in a standing position while challenging postural control and balance.
Figure 4
Figure 4
Example of exercise that aim for optimal adaptation to the base of support, an active core while practicing transferring the centre of gravity forward as in a sit to stand transfer.
Figure 5
Figure 5
SSQOL-scores.
See this image and copyright information in PMC

References

    1. Haley WE, Roth DL, Kissela B, Perkins M, Howard G. Quality of life after stroke: a prospective longitudinal study. Qual Life Res. (2011) 20(6):799–806. 10.1007/s11136-010-9810-6 - DOI - PMC - PubMed
    1. Sjoholm A, Skarin M, Churilov L, Nilsson M, Bernhardt J, Linden T. Sedentary behaviour and physical activity of people with stroke in rehabilitation hospitals. Stroke Res Treat. (2014) 2014:591897. 10.1155/2014/591897 - DOI - PMC - PubMed
    1. Barrett M, Snow JC, Kirkland MC, Kelly LP, Gehue M, Downer MB, et al. Excessive sedentary time during in-patient stroke rehabilitation. Top Stroke Rehabil. (2018) 25(5):366–74. 10.1080/10749357.2018.1458461 - DOI - PubMed
    1. Fini NA, Holland AE, Keating J, Simek J, Bernhardt J. How physically active are people following stroke? Systematic review and quantitative synthesis. Phys Ther. (2017) 97(7):707–17. 10.1093/ptj/pzx038 - DOI - PubMed
    1. Saunders DH, Mead GE, Fitzsimons C, Kelly P, van Wijck F, Verschuren O, et al. Interventions for reducing sedentary behaviour in people with stroke. Cochrane Database Syst Rev. (2021) (6). 10.1002/14651858.CD012996.pub2 - DOI - PMC - PubMed

LinkOut - more resources