Physiotherapy needs assessment of people with stroke following discharge from hospital, stratified by acute functional independence measure score.

PURPOSE: To determine the physiotherapy-related needs of people with stroke at discharge, 6 months after discharge, and 1 year after discharge from hospital, and to examine the results stratified by participants' acute Functional Independence Measure (FIM) scores. METHODS: A total of 241 adults with recent stroke were recruited into this longitudinal cohort study. As well as participating in a semi-structured interview that included questions about mobility needs and barriers, participants were asked to complete and return a closed-ended needs-assessment survey. RESULTS: During the interview, participants reported needs and barriers related to motor control, walking, stairs, fatigue, prevention of falls, and access to physiotherapy services. The survey identified many more needs, including transfers, wheelchair use, higher-level balance and mobility skills, and access to physiotherapy and suitable exercise facilities. Frequencies of needs and barriers tended to be lower among participants with higher acute FIM scores. There was no consistent trend for needs and barriers to decrease over time. CONCLUSIONS: Over the first year after discharge from hospital, people with stroke report a large and varied number of persistent mobility-related needs. Physiotherapists have a role to play in advocating for adequate follow-up services and informing health policy with respect to the needs of their patients with stroke.

Objectif : Établir les besoins en physiothérapie des personnes ayant subi un accident vasculaire cérébrale (AVC) lors de leur congé de l'hôpital, 6 mois après leur congé et 1 an après leur congé, et examiner les résultats stratifiés en fonction des pointages de mesure de l'autonomie fonctionnelle aigüe (Functional Independence Measure, FIM). Méthodologie : On a recruté en tout 241 adultes ayant récemment subi un ACV pour cette étude longitudinale de cohorte. En plus de participer à une entrevue semi-structurée comprenant des questions sur leurs besoins et sur les obstacles en matière de mobilité, les participants ont dû remplir et retourner un sondage d'évaluation des besoins avec questions fermées. Résultats : Au cours de l'entrevue, les participants ont fait part de besoins et d'obstacles liés au contrôle de leur motricité, à la marche, aux escaliers, à la fatigue, à la prévention des chutes et à l'accès à des services de physiothérapie. Le sondage a permis d'établir de nombreux autres besoins, dont la nécessité de transferts, l'utilisation d'un fauteuil roulant, un plus grand équilibre et de plus grandes habiletés motrices ainsi que l'accès à la physiothérapie et à des installations adaptées à leurs besoins en exercice. La fréquence des besoins et des obstacles avait tendance à diminuer chez les participants qui avaient obtenu des pointages plus élevés à l'échelle FIM. On n'a observé aucune tendance constante de diminution des besoins et des obstacles au fil du temps. Conclusions : Au cours de la première année suivant le congé de l'hôpital, les personnes qui ont subi un AVC font état d'un grand nombre de besoins variés et persistants en matière de mobilité. Les physiothérapeutes doivent faire pression pour des services de suivi adéquat et doivent contribuer à l'inclusion des besoins des patients qui ont subi un AVC dans les politiques en matière de santé.

A pilot study of the incidence of post-thoracotomy pulmonary complications and the effectiveness of pre-thoracotomy physiotherapy patient education.

PURPOSE: To estimate the incidence and examine the pattern of post-thoracotomy pulmonary complications (PPC) that are amenable to physiotherapy treatment and to estimate the effect size of a pre-thoracotomy physiotherapy education session compared to no preoperative physiotherapy for reducing PPC. METHODS: Forty-two patients undergoing thoracotomy participated in this two-group retrospective-prospective cohort study. The preop group (n=22) received physiotherapy education prior to surgery and the no preop group (n=20) did not receive preoperative physiotherapy education. Chest radiographs were examined for PPC for 5 days postoperatively. Incidences of PPC were determined. The effect size was based on a grand count of PPC. RESULTS: The 5-day incidence of atelectasis, collapse, consolidation, and other complications was 85.0%, 39.0%, 31.7%, and 38.1%, respectively. Patterns of PPC showed large increases at days 2 and 3. The effect size for pre-thoracotomy physiotherapy education was zero. CONCLUSIONS: In our sample, incidence of PPC was high and did not substantially differ based on whether or not preoperative education was provided.

Muscle weakness and falls in older adults: a systematic review and meta-analysis.

OBJECTIVES: To evaluate and summarize the evidence of muscle weakness as a risk factor for falls in older adults. DESIGN: Random-effects meta-analysis. SETTING: English-language studies indexed in MEDLINE and CINAHL (1985-2002) under the key words aged and accidental falls and risk factors; bibliographies of retrieved papers. PARTICIPANTS: Fifty percent or more subjects in a study were aged 65 and older. Studies of institutionalized and community-dwelling subjects were included. MEASUREMENTS: Prospective cohort studies that included measurement of muscle strength at inception (in isolation or with other factors) with follow-up for occurrence of falls. METHODS: Sample size, population, setting, measure of muscle strength, and length of follow-up, raw data if no risk estimate, odds ratios (ORs), rate ratios, or incidence density ratios. Each study was assessed using the validity criteria: adjustment for confounders, objective definition of fall outcome, reliable method of measuring muscle strength, and blinded outcome measurement. RESULTS: Thirty studies met the selection criteria; data were available from 13. For lower extremity weakness, the combined OR was 1.76 (95% confidence interval (CI)=1.31-2.37) for any fall and 3.06 (95% CI=1.86-5.04) for recurrent falls. For upper extremity weakness the combined OR was 1.53 (95% CI=1.01-2.32) for any fall and 1.41 (95% CI=1.25-1.59) for recurrent falls. CONCLUSION: Muscle strength (especially lower extremity) should be one of the factors that is assessed and treated in older adults at risk for falls. More clinical trials are needed to isolate whether muscle-strengthening exercises are effective in preventing falls.

Progressive resistance strengthening exercises after stroke: a single-blind randomized controlled trial.

OBJECTIVE: To determine the effectiveness of progressive resistance strengthening exercises to improve gross motor function and walking in patients receiving intensive rehabilitation after stroke. DESIGN: Randomized controlled trial. SETTING: Five inpatient rehabilitation programs affiliated with teaching hospitals. PARTICIPANTS: Inclusion criteria included less than 6 months poststroke and recovery of the leg stages 3 to 5 on the Chedoke-McMaster Stroke Assessment (CMSA). INTERVENTIONS: Both groups received conventional physical therapy programs. In addition, the experimental group performed 9 lower-extremity progressive resistance exercises 3 times a week for the duration of their stay, whereas the control group did the same exercises and for the same duration but without resistance. MAIN OUTCOME MEASURES: The Disability Inventory of the CMSA and the 2-minute walk test (2MWT) at baseline, 4 weeks, discharge, and 6 months after discharge. RESULTS: Over the length of stay, the rate of change in the Disability Inventory was.27 points per day in the experimental group and.29 points per day in the control group; the between-group difference was -.02 points per day (95% confidence interval [CI], -.10 to.06; P=.62). At discharge, the rate of change in the 2MWT was -.01 m in the experimental group and.15m in the control group; the between-group difference was -.16 m (95% CI, -.37 to.05; P=.14). CONCLUSIONS: Progressive resistance strengthening exercises as applied in our study were not effective when compared with the same exercises given without resistance.