ABSTRACT
OBJECTIVES: Bobath based (BB) and movement science based (MSB) physiotherapy interventions are widely used for patients after stroke. There is little evidence to suggest which is most effective. This single-blind randomised controlled trial evaluated the effect of these treatments on movement abilities and functional independence. METHODS: A total of 120 patients admitted to a stroke rehabilitation ward were randomised into two treatment groups to receive either BB or MSB treatment. Primary outcome measures were the Rivermead Motor Assessment and the Motor Assessment Scale. Secondary measures assessed functional independence, walking speed, arm function, muscle tone, and sensation. Measures were performed by a blinded assessor at baseline, and then at 1, 3, and 6 months after baseline. Analysis of serial measurements was performed to compare outcomes between the groups by calculating the area under the curve (AUC) and inserting AUC values into Mann-Whitney U tests. RESULTS: Comparison between groups showed no significant difference for any outcome measures. Significance values for the Rivermead Motor Assessment ranged from p = 0.23 to p = 0.97 and for the Motor Assessment Scale from p = 0.29 to p = 0.87. CONCLUSIONS: There were no significant differences in movement abilities or functional independence between patients receiving a BB or an MSB intervention. Therefore the study did not show that one approach was more effective than the other in the treatment of stroke patients.
Subject(s)
Movement Disorders/therapy , Physical Therapy Modalities , Stroke Rehabilitation , Stroke/complications , Aged , Female , Hospitalization , Humans , Male , Movement Disorders/diagnosis , Movement Disorders/etiology , Stroke/mortality , Surveys and Questionnaires , Treatment OutcomeABSTRACT
OBJECTIVE: To identify similarities and differences between a Bobath-based (BB) and a movement science-based (MSB) approach. DESIGN: Direct observation by a trained observer was used to record behaviours during treatments. SETTING: An acute stroke ward. SUBJECTS: Twenty-two stroke patients. INTERVENTIONS: Behaviours were recorded during 12 treatment sessions by three therapists, for each treatment approach. Physical and communication behaviours were recorded in pre-defined categories. The equipment used was recorded and a semi-structured interview conducted with the therapist after treatment to identify follow-up actions by the therapist. MAIN OUTCOME MEASURES: Frequency of occurrence of each category was compared between the approaches. RESULTS: Treatment in the BB group contained more social conversation (p = 0.004), and more use of physiotherapy equipment (p = 0.02) and a physiotherapy assistant (p = 0.01). In the MSB group there was more detailed feedback given to the patient (p = 0.002) more use of everyday objects in training (p = 0.001), therapists more frequently listed specific components as the patient's main problems (p = 0.003) and relatives were involved more in positioning to stretch muscles (p = 0.03). Training walking was given more emphasis in the BB group and training of sit-to-stand in the MSB group. CONCLUSIONS: The study indicates that there are differences in content between the Bobath-based and movement science-based approaches to treatment.
Subject(s)
Outcome and Process Assessment, Health Care , Physical Therapy Modalities/methods , Physical Therapy Modalities/standards , Stroke Rehabilitation , Aged , Aged, 80 and over , Chi-Square Distribution , Humans , Male , Middle Aged , Observer Variation , Randomized Controlled Trials as Topic , Reproducibility of Results , Statistics, Nonparametric , Surveys and Questionnaires , Task Performance and AnalysisABSTRACT
The cytotoxicity of chloropolypyridyl ruthenium complexes of structural formulas [Ru(terpy)-(bpy)Cl]Cl, cis-[Ru(bpy)2Cl2], and mer-[Ru(terpy)Cl3] (terpy = 2,2':6'2"-terpyridine, bpy = 2,2'-bipyridyl) has been studied in murine and human tumor cell lines. The results show that mer-[Ru(terpy)Cl3] exhibits a remarkably higher cytotoxicity than the other complexes. Moreover, investigations of antitumor activity in a standard tumor screen have revealed the highest efficiency for mer-[Ru(terpy)Cl3]. In a cell-free medium, the ruthenium complexes coordinate to DNA preferentially at guanine residues. The resulting adducts can terminate DNA synthesis by thermostable VentR DNA polymerase. The reactivity of the complexes to DNA, their efficiency to unwind closed, negatively supercoiled DNA, and a sequence preference of their DNA adducts (studied by means of replication mapping) do not show a correlation with biological activity. On the other hand, the cytotoxic mer-[Ru(terpy)Cl3] exhibits a significant DNA interstrand cross-linking, in contrast to the inactive complexes which exhibit no such efficacy. The results point to a potential new class of metal-based antitumor compounds acting by a mechanism involving DNA interstrand cross-linking.
