High-intensity locomotor training during inpatient rehabilitation improves the discharge ambulation function of patients with stroke. A systematic review with meta-analysis.

OBJECTIVE: To evaluate the evidence of high-intensity locomotor training on outcomes related to gait and balance for patients with stroke in inpatient rehabilitation. METHODS: Four databases were searched (PubMed, CINAHL, Web of Science, and MedLINE) for articles published prior to 13 June 2023. Studies of adults (>18 years old) with a diagnosis of stroke who received a high-intensity locomotor intervention while admitted to an inpatient rehabilitation facility were included. A functional outcome in the domain of gait speed, gait endurance, or balance must have been reported. Following the screening of 1052 studies, 43 were selected for full-text review. Studies were assessed for risk of bias using the tool appropriate to the study type. Gait speed, gait endurance, and balance outcome data were extracted for further analysis. RESULTS: Eight studies were selected with risk of bias ratings as moderate (4), high (2), and low (2). Six studies were analyzed in the meta-analysis (N = 635). A random-effects model analyzed between-group differences. Standard mean differences demonstrated that high-intensity locomotor training produces a moderate effect on gait endurance (0.50) and gait speed (0.41) and a negligible effect on balance (0.08) compared with usual care. CONCLUSIONS: The meta-analysis supports the use of high-intensity locomotor training over usual care for improving gait speed and gait endurance during inpatient post-stroke. Future studies should investigate dose-response relationships of high-intensity locomotor training in this setting. PROSPERO REGISTRATION: #CRD42022341329.

Severe Pain in Veteran Students.

BACKGROUND: Severe pain is prevalent in military veterans. Veteran students face significant challenges in attaining academic success. Understanding the impact of pain on learning of veteran students is very important to better advocate for veteran students and promote social responsibility and cultural competence. OBJECTIVE: The objective of the research was to determine pain in veteran students compared to nonveteran students. DESIGN: The research design was a cross-sectional non-experimental survey. METHODS: The survey included a total of 6 questions adapted from the National Health Interview Survey and was administered using SurveyGizmo. RESULTS: Veteran students are 4.3 times more likely to report severe pain than nonveteran students. 98.6% veteran students reported pain and 22.2% had severe pain. 25.0% of veteran students reported the ability to carry out daily work limited by pain. Only 4.2% of veteran students reported sufficient resources on campus helping them deal with pain, while 58.3% reported sufficient resources off campus. CONCLUSIONS: Veteran students had statistically significantly more severe pain. They were more limited by pain in carrying out daily work and reported fewer resources to help them cope with pain. The data can inform strategies for advocacy activities of physical therapists and assessment for culturally competent education.

An exploration of trunk reposition error in subjects with acute stroke: An observational design.

BACKGROUND & OBJECTIVE: Trunk reposition error (TRE) is a component of trunk control, yet has not been reported in acute stroke. The purpose of this study was to quantify TRE in acute stroke and report this with related rehabilitation outcomes. METHODS: Sixty subjects, 30 with acute stroke and 30 healthy controls, completed this study. Subjects with acute stroke were measured before and after an in-patient acute rehabilitation stay. MEASURES: TRE using an electromagnetic tracking device, Berg Balance Scale, Postural Assessment Scale for Stroke, and Functional Independence Measures. Pre-post measures were analyzed with paired t-tests. Between-group measures were analyzed with independent w-tests. RESULTS: There were significant between group differences (acute stroke vs. controls) for all functional outcome measures (P < 0.001) and for three-dimensional TRE (P = 0.001). There were significant improvements in all functional outcome measures following an in-patient rehabilitation stay (P < 0.001). All measures of TRE reduced but did not achieve significance. CONCLUSION: TRE was not as severely impaired as anticipated and was variable based on plane of measure. Time in a rehabilitation setting produced significant improvements in functional outcomes but TRE improvements were not as robust. These results indicate a need for further investigation of the strength of the interrelationship between TRE and function.

Establishing the reliability and concurrent validity of physical performance tests using virtual reality equipment for community-dwelling healthy elders.

PURPOSE: The aim of this study was to determine the reliability and concurrent validity of commonly used physical performance tests using the OmniVR Virtual Rehabilitation System for healthy community-dwelling elders. METHOD: Participants (N = 40) were recruited by the authors and were screened for eligibility. The initial method of measurement was randomized to either virtual reality (VR) or clinically based measures (CM). Physical performance tests included the five times sit to stand, Timed Up and Go (TUG), Forward Functional Reach (FFR) and 30-s stand test. A random number generator determined the testing order. The test-re-test reliability for the VR and CM was determined. Furthermore, concurrent validity was determined using a Pearson product moment correlation (Pearson r). RESULTS: The VR demonstrated excellent reliability for 5 × STS intraclass correlation coefficient (ICC) = 0.931(3,1), FFR ICC = 0.846(3,1) and the TUG ICC = 0.944(3,1). The concurrent validity data for the VR and CM (ICC 3, k) were moderate for FFR ICC = 0.682, excellent 5 × STS ICC = 0.889 and excellent for the TUG ICC = 0.878. The concurrent validity of the 30-s stand test was good ICC = 0.735(3,1). CONCLUSIONS: This study supports the use of VR equipment for measuring physical performance tests in the clinic for healthy community-dwelling elders. IMPLICATIONS FOR REHABILITATION: Virtual reality equipment is not only used to treat balance impairments but it is also used to measure and determine physical impairments through the use of physical performance tests. Virtual reality equipment is a reliable and valid tool for collecting physical performance data for the 5 × STS, FFR, TUG and 30-s stand test for healthy community-dwelling elders.

Cognitive and physical performance in patients with asymptomatic carotid artery disease.

The purpose of this study was to determine if patients with asymptomatic carotid artery stenosis and occlusion demonstrate deficits in cognitive and physical performance. The relationship between cognitive measures and performance of instrumental activities of daily living was examined. Seventy-nine patients with asymptomatic carotid artery stenosis of moderate and severe degrees or occlusion were tested. Cognition was assessed via the repeatable battery for the assessment of neuropsychological status (RBANS) and the executive interview (EXIT). Physical performance was assessed via the physical performance test (PPT) and the Lawton instrumental activities of daily living (IADL). Deficits in the RBANS visuospatial/constructional, attention, language and delayed memory domains were found for patients with occlusion. Deficits in all RBANS domains were found for the moderate stenosis subgroup, and deficits in all domains except language were found in the severe subgroup. No deficit was found in executive function in any group. Additionally, deficits were related to sidedness of involvement with visuospatial/constructional deficits related to right sided disease, and deficits in all cognitive domains except language were found in left sided and bilateral disease. Decreased performance on the PPT was identified in all three subgroups with the lowest scores in the moderate stenosis subgroup and the highest scores in the severe stenosis subgroup. The Lawton IADL did not identify any decrease in performance. Deficits in cognitive and physical function were found in this observational study of patients with asymptomatic carotid artery stenosis and occlusion, indicating that asymptomatic patients may not be truly asymptomatic. These areas of function and the potential change in their status need to be considered when patients are being evaluated for interventions to manage their carotid artery disease.

Implementation of the comprehensive assessment toolbox for stroke in a medical system.

The need for outcome assessment in stroke management is a critical part of specialized stroke unit development. The Comprehensive Assessment Toolbox for Stroke was developed for this reason. This study describes the implementation of the Toolbox across a medical system as part of a stroke center of excellence. Toolbox data were collected from 2002 to 2004. Demographic data were analyzed. Patients were categorized by stroke severity. Outcome assessment tools were compared via paired sample t tests. Also, data were analyzed using multivariate methods followed by univariate analysis of variance. Patients improved in outcomes from admission through their hospital stays. Clinically significant improvements were made in the mild and moderately affected groups. The severe stroke group improved the least. Tracking patient outcomes in a consistent way helps with program assessment and comparison. Patients leave rehabilitation at a dependent level in many functional areas.

Use of the physical performance test to assess preclinical disability in subjects with asymptomatic carotid artery disease.

BACKGROUND AND PURPOSE: The purpose of this study was to determine whether subjects with asymptomatic carotid artery stenosis and occlusion demonstrate deficits in physical performance compared with a comparison group. These deficits may indicate that a person is demonstrating preclinical disability. SUBJECTS: Seventy-one subjects with no known disease and 39 subjects with asymptomatic carotid artery stenosis of moderate and severe degrees or with occlusion were included. METHODS: Physical performance was assessed with the 9-item and 7-item versions of the Physical Performance Test (PPT). Individual tasks also were timed for the subjects with disease. RESULTS: There were significant differences between the comparison group and the subjects with carotid artery stenosis on the 9-item PPT (P<.00) and on the 7-item PPT (P<.03). Subjects with asymptomatic carotid artery stenosis and occlusion demonstrated less than optimal performance on the PPT (9-item PPT, mean=27 of 36; 7-item PPT, mean=21 of 28). Subjects with moderate stenosis were the slowest in performing the task of simulated eating. DISCUSSION AND CONCLUSION: Subjects with asymptomatic carotid artery stenosis and occlusion exhibited changes in function, as indicated by their performance on the PPT relative to that of a comparison group. This finding may be indicative of preclinical disability, indicating that these people are symptomatic. This indication may affect the medical and surgical options that can be considered for their care.