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de Sousa DG1,2,3, Harvey LA2,3, Dorsch S4, Jamieson S5, Murphy A5, Varettas B5, Giaccari S5
1Graythwaite Rehabilitation Centre, Ryde Hospital, Northern Sydney Local Health District, Eastwood, Australia, 2John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, Australia, 3Sydney Medical School Northern, University of Sydney, Sydney, Australia, 4Faculty of Health Sciences, Australian Catholic University, Sydney, Australia, 5Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Australia
Background: After stroke many people cannot stand up independently due to motor impairments such as weakness and poor coordination. The inability to stand up can be very disabling and can increase burden of care. To improve their ability to stand up, people after stroke require repetitive sit-to-stand training. There is some indication that large amounts of repetitive practice improves functional outcome after stroke. However, providing large amounts of repetitive sit-to-stand training to people after stroke presents a significant challenge, because it can require more than one therapist to assist and people early after stroke may not be able to tolerate large amounts of repetitive sit-to-stand training.
Purpose: The aim of this study was to investigate the feasibility of providing large amounts of repetitive sit-to-stand training to people early after stroke.
Methods: A multi-centre randomised controlled trial was conducted in two Sydney hospitals. Descriptive data from 30 participants have been analysed and are presented here (not including the primary and secondary analysis of effects). Experimental participants received a 2-week package of exercises for increasing the amount of sit-to-stand training, in addition to usual care. This package also included a range of strategies to provide participants with additional opportunities to practice standing up during physiotherapy sessions and after-hours. These strategies included: carer training, using exercise diaries, individualised after-hours exercise programs, weekend therapy, and semi-supervised practice in the physiotherapy gym. A survey was conducted with participants and carers at two weeks to understand barriers to performing extra practice after-hours.
Results: Thirty participants with a mean (SD) Modified Rankin Scale score of 4 (0.5) completed the study. There were no serious adverse events. The mean (SD) amount of sit-to-stand repetitions were 1327 (741) (experimental group) versus 358 (244) (control group). The mean (SD) amount of time in physiotherapy sessions was 1922 minutes (396) (experimental group) versus 984 minutes (131) (control group). In the experimental group, fatigue (45%) was the main reason participants did not participate in the intended 3 hours of physiotherapy per day. In the control group, fatigue (38%) and scheduling issues (35%) were the main reasons participants did not participate in the intended 2 hours of physiotherapy per day. Participants in the experimental group performed a median (IQR) 55 repetitions (0 to 261) of exercise after-hours. The main reason reported by carers and participants for not performing an after-hours exercise program was lack of availability of a carer to assist the participant (43%).
Conclusion(s): Large amounts of repetitive sit-to-stand training is feasible, safe, and tolerated in people early after stroke. Strategies to increase the amount of training after-hours are useful, but highly dependent on availability of carers to supervise practice. Whereas, the amount of training performed during physiotherapy sessions is dependent on fatigue levels of patients, and thoughtful and adaptable scheduling around other therapies or medical investigations.
Implications: The results from this study provide physiotherapists with insights into how much sit-to-stand training is possible early after stroke, and what strategies can be used to increase the amount of training people perform.
Keywords: Stroke, sit-to-stand training, dosage
Funding acknowledgements: North Shore Ryde Hospital Service Rehabilitation Research Grant
Purpose: The aim of this study was to investigate the feasibility of providing large amounts of repetitive sit-to-stand training to people early after stroke.
Methods: A multi-centre randomised controlled trial was conducted in two Sydney hospitals. Descriptive data from 30 participants have been analysed and are presented here (not including the primary and secondary analysis of effects). Experimental participants received a 2-week package of exercises for increasing the amount of sit-to-stand training, in addition to usual care. This package also included a range of strategies to provide participants with additional opportunities to practice standing up during physiotherapy sessions and after-hours. These strategies included: carer training, using exercise diaries, individualised after-hours exercise programs, weekend therapy, and semi-supervised practice in the physiotherapy gym. A survey was conducted with participants and carers at two weeks to understand barriers to performing extra practice after-hours.
Results: Thirty participants with a mean (SD) Modified Rankin Scale score of 4 (0.5) completed the study. There were no serious adverse events. The mean (SD) amount of sit-to-stand repetitions were 1327 (741) (experimental group) versus 358 (244) (control group). The mean (SD) amount of time in physiotherapy sessions was 1922 minutes (396) (experimental group) versus 984 minutes (131) (control group). In the experimental group, fatigue (45%) was the main reason participants did not participate in the intended 3 hours of physiotherapy per day. In the control group, fatigue (38%) and scheduling issues (35%) were the main reasons participants did not participate in the intended 2 hours of physiotherapy per day. Participants in the experimental group performed a median (IQR) 55 repetitions (0 to 261) of exercise after-hours. The main reason reported by carers and participants for not performing an after-hours exercise program was lack of availability of a carer to assist the participant (43%).
Conclusion(s): Large amounts of repetitive sit-to-stand training is feasible, safe, and tolerated in people early after stroke. Strategies to increase the amount of training after-hours are useful, but highly dependent on availability of carers to supervise practice. Whereas, the amount of training performed during physiotherapy sessions is dependent on fatigue levels of patients, and thoughtful and adaptable scheduling around other therapies or medical investigations.
Implications: The results from this study provide physiotherapists with insights into how much sit-to-stand training is possible early after stroke, and what strategies can be used to increase the amount of training people perform.
Keywords: Stroke, sit-to-stand training, dosage
Funding acknowledgements: North Shore Ryde Hospital Service Rehabilitation Research Grant
Topic: Neurology: stroke
Ethics approval required: Yes
Institution: Northern Sydney Local Health District
Ethics committee: Northern Sydney Local Health District Human Research Ethics Committee
Ethics number: HREC/16/HAWKE/252
All authors, affiliations and abstracts have been published as submitted.
