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Sorinola IO1, White CM1, Burgess C1, Rudd AG2, Jones G2, Walmsley N2, Petty J1
1King's College London, Department of Public Health Sciences, School of Population Health & Environmental Sciences, London, United Kingdom, 2Guy's and St Thomas' NHS Foundation Trust, Care of Elderly, London, United Kingdom
Background: Previous studies have found up to 40% of stroke survivors do not regain independence in walking ability at 6 months. This is even worse in individuals with severe stroke where the probability of regaining walking ability has been reported to be very poor. Improving trunk function has been suggested as a way of optimising overall functional recovery but this has not been explored in individuals with severe stroke.
Purpose: This study explored the acceptability and feasibility of providing additional trunk training (ATT) to individuals with severe stroke during early rehabilitation. This is with the view to identify the issues that could affect a definitive clinical trial.
Methods: Twenty-one (21) adults within day 3 and 7 of a single or multiple ischaemic or haemorrhagic stroke lesions, with significant trunk deficit evidenced by an inability to sit independently for 30 seconds at day 3, able to understand and follow a one-stage command, without severe symptoms of dizziness or positional vertigo or significant pre-morbid levels of disability (Modified Rankin Score > 2) and medically stable were recruited. They were given up to 16 hours of ATT in addition to usual stroke rehabilitation. Assessments using the Trunk Impairment Scale (TIS), Modified Rivermead Mobility Index (MRMI), Stroke Specific Quality of Life (SSQOL) and Euroqol (EQ-5D) were conducted at baseline, at the end of ATT and after 6 months. Feasibility outcomes of recruitment, intervention delivery and completeness of outcome measures were also assessed. Also, participants, their care-givers and physiotherapists were interviewed to explore their views on the acceptability of ATT.
Results:
Feasibility: 578 individuals with stroke were screened for eligibility but only 144 (24.9%) had severe trunk deficits, of which 31 (5.4%) were eligible for recruitment. 68% of eligible participants consented to participate. A total of 7.7 ± 5.8 hours of ATT was delivered over an average of 5.6 weeks (range 1 -15 weeks). Mean change (SD) in outcome measures at post treatment was 7.9±7.1 (TIS); 12.4±9.6 (MRMI); 26.4±19.7 (SSQOL) and at 6 months follow-up were: 6.9±7.1 (TIS); 18±13.5 (MRMI); 31.3±37.0 (SSQOL); 13.6±43.0 (EQ5D-VAS). Attrition was less than 10%.
Acceptability: Majority of participants, their care-givers and treating physiotherapists were happy with ATT intervention, reported beneficial improvements in trunk control, sitting balance and functional activities. There were also significant challenges with scheduling, fatigue, cognitive and physical impairments.
Conclusion(s): Additional trunk training was feasible to deliver during the early stroke rehabilitation to suitable participants, acceptable to participants their physiotherapists and the selected outcome measures were acceptable to participants and responsive to ATT. However, there is a need to optimise eligibility rates by reviewing inclusion exclusion criteria and intervention delivery for future definitive trial.
Implications: A definitive clinical trial on ATT needs to be critically considered to ensure deliverability.
Keywords: Stroke, Rehabilitation, Trunk Exercises
Funding acknowledgements: National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0214-33076).
Purpose: This study explored the acceptability and feasibility of providing additional trunk training (ATT) to individuals with severe stroke during early rehabilitation. This is with the view to identify the issues that could affect a definitive clinical trial.
Methods: Twenty-one (21) adults within day 3 and 7 of a single or multiple ischaemic or haemorrhagic stroke lesions, with significant trunk deficit evidenced by an inability to sit independently for 30 seconds at day 3, able to understand and follow a one-stage command, without severe symptoms of dizziness or positional vertigo or significant pre-morbid levels of disability (Modified Rankin Score > 2) and medically stable were recruited. They were given up to 16 hours of ATT in addition to usual stroke rehabilitation. Assessments using the Trunk Impairment Scale (TIS), Modified Rivermead Mobility Index (MRMI), Stroke Specific Quality of Life (SSQOL) and Euroqol (EQ-5D) were conducted at baseline, at the end of ATT and after 6 months. Feasibility outcomes of recruitment, intervention delivery and completeness of outcome measures were also assessed. Also, participants, their care-givers and physiotherapists were interviewed to explore their views on the acceptability of ATT.
Results:
Feasibility: 578 individuals with stroke were screened for eligibility but only 144 (24.9%) had severe trunk deficits, of which 31 (5.4%) were eligible for recruitment. 68% of eligible participants consented to participate. A total of 7.7 ± 5.8 hours of ATT was delivered over an average of 5.6 weeks (range 1 -15 weeks). Mean change (SD) in outcome measures at post treatment was 7.9±7.1 (TIS); 12.4±9.6 (MRMI); 26.4±19.7 (SSQOL) and at 6 months follow-up were: 6.9±7.1 (TIS); 18±13.5 (MRMI); 31.3±37.0 (SSQOL); 13.6±43.0 (EQ5D-VAS). Attrition was less than 10%.
Acceptability: Majority of participants, their care-givers and treating physiotherapists were happy with ATT intervention, reported beneficial improvements in trunk control, sitting balance and functional activities. There were also significant challenges with scheduling, fatigue, cognitive and physical impairments.
Conclusion(s): Additional trunk training was feasible to deliver during the early stroke rehabilitation to suitable participants, acceptable to participants their physiotherapists and the selected outcome measures were acceptable to participants and responsive to ATT. However, there is a need to optimise eligibility rates by reviewing inclusion exclusion criteria and intervention delivery for future definitive trial.
Implications: A definitive clinical trial on ATT needs to be critically considered to ensure deliverability.
Keywords: Stroke, Rehabilitation, Trunk Exercises
Funding acknowledgements: National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0214-33076).
Topic: Neurology: stroke; Disability & rehabilitation; Professional practice: other
Ethics approval required: Yes
Institution: NHS Health Research Authority
Ethics committee: East of England - Essex Research Ethics Committee
Ethics number: 15/EE/0317
All authors, affiliations and abstracts have been published as submitted.
