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Normann B1,2, Arntzen EC1, Sivertsen M1
1Nordland Hospital Trust, Department of Physiotherapy, Bodoe, Norway, 2UiT The Arctic University of Norway, Department of Health and Care Sciences, Faculty of Health Sciences, Tromsoe, Norway
Background: One third of stroke viktims suffer permanently reduced function in activities of daily living resulting in a huge socioeconomic burden. Physiotherapy is effective in improving balance and walking, but no single approach has been proven superior. Anticipatory postural adjustments (APA´s) and trunk muscle strength are typically reduced after a stroke, leading to more use of reactive strategies and an increased risk of falling. I-CoreDIST is a new, innovative intervention targeting the underlying components of balance. Core activation is enhanced and integral in all exercises. If feasible, his study has potential to improve rehabilitation during acute and subacute phases of a stroke, aiming to reduce the individual's disabilities and risk of falling.
Purpose: To investigate the feasibility and preliminary effects of new physiotherapy and multidisciplinary intervention emphasising core stability training integrated in functional activity in acute and subacute rehabilitation after a stroke supported by clinical Skype sessions at discharge from the stroke unit to coordinate transfers between health care levels.
Methods: A baseline-, 4- and 12-week post-test design. 13 individuals with acute stroke were eligible and admitted to the study 1 or 2 days post admittance to the stroke unit. Participants rreceived I-CoreDIST 5-6 days/week for 30-60 min as inpatients and three times a week as outpatients, for 12 weeks. Primary outcomes: Trunk Impairment Scale-Norwegian Version (TIS-NV) and Swedish Postural Assessment Scale for Stroke-Norwegian Version (SwePASS-NV). Secondary outcomes: The Mini-BESTest, 10m Walk Test, 2min Walk Test, ActiGraphWgt3X-BT monitors and Questback. Linear mixed models and non-parametric tests were used in analysis
Results: The TIS-NV demonstrated significant within-group improvements: mean difference 2.36 points at 4 weeks (p¼.006) and 5.09 points at 12 weeks (p .000) compared to baseline. The SwePASS-NV showed significant within-group improvements compared to baseline: mean difference 6.91 points at 4 weeks (p¼.005) and 9.64 points at 12 weeks (p .000). Wilcoxons signed rank test for MiniBestest, 10 MWT, preferred and fast speed and 2MWT (p=0.017) indicated that 12 week test ranks were statistically significantly higher than baseline ranks and for 4 week test ranks for secondary outcomes except for 10MWT slow speed. Ranks at 4 week testing were not statistically significantly higher than baseline ranks for any secondary outcomes. Data from the activity monitors showed that the participants averagely engaged in light activity for 8% of the day (1 day=24 hours) at baseline, 13% at 4 weeks and 16.3% of the time at 12 weeks. For moderate activity mean time was 0.14% at baseline, 0.5 % at 4 weeks and 0.8 % at 12 weeks. Vigorous activity is not occurring. Skype sessions were valuable but not applicable prior to discharge.
Conclusion(s): I-CoreDIST is feasible and indicate effects. Skype sessions should be re-scheduled. Physical activity levels remain low for the 12 week period despite significant improvements in gait.
Randomised controlled trials are warranted.
Implications: Proven effective, the intervention may be implemented in standard post-stroke care in the specialist and municipalities at a low cost, and contribute to reduce the individual and societal burden and improve quality of health services. Physical activity should be emphasised.
Keywords: Physiotherapy, Stroke, Core stability
Funding acknowledgements: The study was funded by the Northern Norway Regional Health Authority.
Purpose: To investigate the feasibility and preliminary effects of new physiotherapy and multidisciplinary intervention emphasising core stability training integrated in functional activity in acute and subacute rehabilitation after a stroke supported by clinical Skype sessions at discharge from the stroke unit to coordinate transfers between health care levels.
Methods: A baseline-, 4- and 12-week post-test design. 13 individuals with acute stroke were eligible and admitted to the study 1 or 2 days post admittance to the stroke unit. Participants rreceived I-CoreDIST 5-6 days/week for 30-60 min as inpatients and three times a week as outpatients, for 12 weeks. Primary outcomes: Trunk Impairment Scale-Norwegian Version (TIS-NV) and Swedish Postural Assessment Scale for Stroke-Norwegian Version (SwePASS-NV). Secondary outcomes: The Mini-BESTest, 10m Walk Test, 2min Walk Test, ActiGraphWgt3X-BT monitors and Questback. Linear mixed models and non-parametric tests were used in analysis
Results: The TIS-NV demonstrated significant within-group improvements: mean difference 2.36 points at 4 weeks (p¼.006) and 5.09 points at 12 weeks (p .000) compared to baseline. The SwePASS-NV showed significant within-group improvements compared to baseline: mean difference 6.91 points at 4 weeks (p¼.005) and 9.64 points at 12 weeks (p .000). Wilcoxons signed rank test for MiniBestest, 10 MWT, preferred and fast speed and 2MWT (p=0.017) indicated that 12 week test ranks were statistically significantly higher than baseline ranks and for 4 week test ranks for secondary outcomes except for 10MWT slow speed. Ranks at 4 week testing were not statistically significantly higher than baseline ranks for any secondary outcomes. Data from the activity monitors showed that the participants averagely engaged in light activity for 8% of the day (1 day=24 hours) at baseline, 13% at 4 weeks and 16.3% of the time at 12 weeks. For moderate activity mean time was 0.14% at baseline, 0.5 % at 4 weeks and 0.8 % at 12 weeks. Vigorous activity is not occurring. Skype sessions were valuable but not applicable prior to discharge.
Conclusion(s): I-CoreDIST is feasible and indicate effects. Skype sessions should be re-scheduled. Physical activity levels remain low for the 12 week period despite significant improvements in gait.
Randomised controlled trials are warranted.
Implications: Proven effective, the intervention may be implemented in standard post-stroke care in the specialist and municipalities at a low cost, and contribute to reduce the individual and societal burden and improve quality of health services. Physical activity should be emphasised.
Keywords: Physiotherapy, Stroke, Core stability
Funding acknowledgements: The study was funded by the Northern Norway Regional Health Authority.
Topic: Neurology: stroke; Disability & rehabilitation
Ethics approval required: Yes
Institution: Regional Committee for Medical and Health Research Ethics in Norway
Ethics committee: Regional Committee for Medical and Health Research Ethics in Norway
Ethics number: REK Nord: 2015/1776
All authors, affiliations and abstracts have been published as submitted.
