Additional core stability exercises for subacute stroke patients

Posted on February 8, 2017

Tags: , , , , , , ,

This blog is a critical appraisal of a randomised controlled trial investigating the effect of additional core stability exercises on improving dynamic sitting balance and trunk control for subacute stroke patients.

Background:

Stroke is a worldwide healthcare problem and is the most common cause of disability in adults (Cabanas-Valdes et al. 2013).  Balance problems and impaired trunk control (the ability to control your torso) are common after suffering a stroke and this can contribute to an increased risk of falls and dependency in activities of daily living (Tyson et al. 2006).

Introduction:

The purpose of the study was to investigate the effect of including additional core stability exercises on top of a general therapy programme for improving dynamic sitting balance and trunk control for subacute stroke patients.

The researchers recruited 229 participants, but 143 participants did not meet the inclusion criteria for different reasons and 6 declined to participate. Therefore, 80 participants were involved in this study.

This study consisted of an experimental group and a control group. Both groups followed the general rehabilitation therapy programme for stroke patients (consisting of 1 hour treatment a day, 5 times a week) provided by their rehabilitation centre. In addition, the experimental group received 15 minutes of core stability exercises, totalling in 6.15 hours.

The 80 participants were randomly assigned to the intervention or control group. Randomisation was managed by an external person uninvolved in the treatment or follow-up of the participants. The study was carried out over a 5-week period and data was collected pre-and post-treatment by a blinded assessor.

The primary outcomes were dynamic sitting balance and trunk control which were measured by the Trunk Impairment Scale (Spanish version) and Function in Sitting Test. Secondary outcome measures were standing balance, gait, and activities of daily living measured by the Berg Balance Scale, Tinetti Test, Brunel Balance Assessment, Postural Assessment Scale for Stroke and Barthel Index.

Results:

Patients in both the control and intervention groups improved, from pre- to post-treatment. That is, those receiving conventional therapy and those receiving conventional therapy plus additional core stability exercises had improvements in their dynamic sitting balance, trunk control, standing balance, gait and activities of daily living.

For both the primary and secondary outcome measures, there was a statistically significant difference between the two groups post-intervention, p<0.05. Patients in the experimental group significantly improved in all outcome measures (expect for the sitting section in the Brunel Balance Scale (P=0.020)) compared to the control group.

Strengths and weaknesses:

Conclusion:

In conclusion, both the control and intervention groups saw statistically significant improvements on all outcomes (except the Brunel Balance Assessment sitting section) from pre- to post-treatment. That is, both conventional therapy and conventional therapy plus additional core stability exercises led to significant improvements in trunk control, mobility and activities of daily living. But additional core stability exercises led to improvements over and above those obtained through conventional therapy alone. Therefore, this study shows that incorporating additional core stability exercises may lead to meaningful additional improvements, which can may be generalizable to a wider population.

Future research:

The improvements in trunk control, mobility and activities of daily living were only observed in the short-term (5 weeks) and there was no long-term follow up of the participants. Therefore, future research needs to be carried out to determine if these results were maintained in the long-term. Ideally, future research needs to be carried out with a larger sample size, over a longer time period, with both groups receiving the same amount of therapy or treatment.

References:

BOOTH, C. M. and TANNOCK, I. F., 2014. Randomised controlled trials and population-based observational research: Partners in the evolution of medical evidence. British Journal of Cancer [online]. February, vol. 110, no. 3, pp. 551-555 [viewed 8 January 2017]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3915111/

CABANAS-VALDÉS, R., BAGUR-CALAFAT, C., GIRABENT-FARRÉS, M., CABALLERO-GÓMEZ, F.M., HERNÁNDEZ-VALIÑO, M. and CUCHÍ, G.U., 2015. The effect of additional core stability exercises on improving dynamic sitting balance and trunk control for subacute stroke patients: A randomized controlled trial. Clinical Rehabilitation [online]. October, vol. 30, no. 10, pp. 934-944. [viewed 8 January 2017]. Available from: http://cre.sagepub.com/content/early/2015/10/06/0269215515609414.full.pdf+html

CABANAS-VALDÉS, R., CUCHÍ, G.U. and BAGUR-CALAFAT, C., 2013. Trunk training exercises approaches for improving trunk performance and functional sitting balance in patients with stroke: A systematic review. NeuroRehabilitation [online]. December, vol. 33, no. 4, pp. 575-592. [viewed 8 January 2017]. Available from: https://www.researchgate.net/publication/256480848_Trunk_training_exercises_approaches_for_improving_trunk_performance_and_functional_sitting_balance_in_patients_with_stroke_A_systematic_review

KENDALL, J. M., 2003. Designing a research project: Randomised controlled trials and their principles. Emergency Medicine Journal [online]. January, vol. 20, no. 2, pp. 164–168 [viewed 8 January 2017]. Available from: http://emj.bmj.com/content/20/2/164.full.pdf+html

KIM, J. and SHIN, W., 2014. How to do random allocation (randomization). Clinics in Orthopedic Surgery [online]. February, vol. 6, no. 1, pp. 103-109 [viewed 8 January 2017]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3942596/

TYSON, S.F., HANLEY, M., CHILLALA, J., SELLEY, A. and TALLIS, R,C. 2006. Balance Disability After Stroke. Physical Therapy [online]. January, vol. 86, no. 1, pp. [viewed 8 January 2017]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16386060

 

Helena Braderup Klinge

A physiotherapy student at Queen Margaret University, Edinburgh.

More Posts - Website

Related Post

creative commons license
Additional core stability exercises for subacute stroke patients by Helena Braderup Klinge is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Unless otherwise stated, all images used within the blog are not available for reuse or republication as they are purchased for Students 4 Best Evidence from shutterstock.com.

Leave a Reply

Your email address will not be published. Required fields are marked *