Posted on February 24, 2017
Stroke is classified as the second largest cause of death worldwide, and the fourth largest in the UK. Stroke is also a major cause of disability. Around 50% of all stroke survivors are left with a permanent debilitating disability.
Typically, research on stroke has focused on the impact of stroke on quality of life and of the likelihood of being predisposed to related fatal health conditions/events following stroke.
One factor which might be partly responsible for the poor prognosis of stroke patients may be the privation of high quality evidence to guide clinicians working with these patients within a multi disciplinary team.
The purpose of the study was to investigate whether additional task-related practice (either upper limb or mobility tasks) could improve functional outcomes during inpatient stroke rehabilitation.
The researchers recruited 30 stroke patients. The patients were then randomly assigned to either a upper limb or a mobility group for additional task-related practice. All participants also received their usual rehabilitation in addition to either the upper limb or mobility tasks.
Randomisation was achieved by a person independent from the study drawing a sealed opaque envelope that specified group allocation. Physiotherapists were blinded from participant group allocations.
Mobility group activities commenced with a warm-up, followed by endurance tasks using stationary bikes and treadmills, as well as tasks such as step-ups, obstacle course walking, standing balance, stretching, and strengthening using traditional gymnasium equipment.
Upper limb group activities commenced with a warm-up followed by tasks to improve reach and grasp, hand-eye coordination activities, stretching, and strengthening using gym equipment.
The primary outcome measures used within the study were:
1) The Jebsen Taylor Hand Function Test (JTHFT). This assesses fine motor skills, and-
2) Two arm items of the Motor Assessment Scale (MAS), assessing everyday motor function (e.g. movement of arms and legs).
3) Three mobility measures, including:
These outcomes were measured initially, at 4 weeks and at 6 months after the start of the study.
According to this study, the practice of additional task-related practice (both upper limb and mobility groups) alongside standard stroke rehabilitation care led to functional gains compared to stand care. Both groups improved significantly between pre- and post-tests on all three of the mobility measures. However, only the upper limb group signficantly improved on the JTHFT and MAS upper arm items.
At 4 weeks post-test, the mobility group had significantly better 6MWT scores than the upper limb group.
These findings provide support for the use of task-related training during stroke rehabilitation.
To critically appraise the study in greater detail, the Critically Appraisal Skills Programme tool was used as a parameter. The study had a clearly defined focus in relation to the study population, interventions, participant group allocations and outcome measures used.
This study found statistically significant improvements in functional ability through the inclusion of additional task-related training (i.e. on top of standard care). Nevertheless, more research needs to be conducted, with a larger sample size and participants of different ages. That way, greater insight can be gained into whether this additional training has clinically important benefits in the treatment and rehabilitation of stroke patients.
Dite, W . (2002). A clinical test of stepping and change of direction to identify multiple falling older adults.. Archives of Physical Medicine and Rehabilitation. 83 (1), 1560-1571.
Luengo-Fernandez,R. (2013). Quality of life after TIA and stroke: Ten-year results of the Oxford Vascular Study. Neurology. 18 (1), 81.
Salbach, NM. (2001). A task-orientated intervention enhances walking distance and speed in the first year post stroke. A randomized controlled trial. Clinical Rehabilitation. 18 (1), 509-519.
Sonoda, S. (1999). Critical reviews in physical and rehabilitation medicine. Recovery of stroke. 11 (2), 76-100.
Department of Health, Social Services and Public Safety. (2014). QOF Achievement Data. . Available: www.dhsspsni.gov.uk/index/statistics/qof/qof-achievement.htm.. Last accessed 14 jan 2017
Mallick, A. (2010). The epidemiology of childhood stroke. Eur J Paediatr Neurol.. 3 (1), 197-205.
Furie, KL. (2011). Guidelines for the Prevention of Stroke in Patients with Stroke or Transient Ischemic Attack. Stroke. Guidelines for the Prevention of Stroke in Patients with Stroke or Transient Ischemic Attack. Stroke. 1 (42), 227-275.
*A 95% confidence interval can be understood as representing a range within which we can be 95% certain that the true effect lies. The width of the confidence interval for an individual study depends to a large extent on the sample size. (Salbach et al., 2004)