The Effectiveness of Additional Core Stability Exercises in Improving Dynamic Sitting Balance, Gait and Functional Rehabilitation for Subacute Stroke Patients (CORE-Trial): Study Protocol for a Randomized Controlled Trial.

BACKGROUND: Trunk impairment produces disorders of motor control, balance and gait. Core stability exercises (CSE) are a good strategy to improve local strength of trunk, balance and gait. Methods and analysis: This is a single-blind multicenter randomized controlled trial. Two parallel groups are compared, and both perform the same type of therapy. A control group (CG) (n = 110) performs conventional physiotherapy (CP) (1 h per session) focused on improving balance. An experimental group (EG) (n = 110) performs CSE (30 min) in addition to CP (30 min) (1 h/session in total). EG is divided in two subgroups, in which only half of patients (n = 55) perform CSE plus transcutaneous electrical nerve stimulation (TENS). Primary outcome measures are dynamic sitting, assessed by a Spanish version of Trunk Impairment Scale and stepping, assessed by Brunel Balance Assessment. Secondary outcomes are postural control, assessed by Postural Assessment Scale for Stroke patients; standing balance and risk of fall assessed by Berg Balance Scale; gait speed by BTS G-Walk (accelerometer); rate of falls, lower-limb spasticity by Modified Ashworth Scale; activities of daily living by Barthel Index; and quality of life by EQ-5D-5L. These are evaluated at baseline (T0), at three weeks (T1), at five weeks (end of the intervention) (T2), at 17 weeks (T3) and at 29 weeks (T4). Study duration per patient is 29 weeks (a five-week intervention, followed by a 24-week post-intervention).

Impact of mHealth technology on adherence to healthy PA after stroke: a randomized study.

BACKGROUND: Physical activity (PA) is a key health behavior in people with stroke including risk reduction of recurrent stroke. Despite the beneficial effects of PA, many community-dwelling stroke survivors are physically inactive. Information and communication technologies are emerging as a possible method to promote adherence to PA. OBJECTIVE: The aim of this study is to investigate the effectiveness of a mobile-health (mHealth) App in improving levels of PA. METHODS: Forty-one chronic stroke survivors were randomized into an intervention group (IG) n=24 and a control group (CG) n=17. Participants in the IG were engaged in the Multimodal Rehabilitation Program (MMRP) that consisted on supervising adherence to PA through a mHealth app, participating in an 8-week rehabilitation program that included: aerobic, task-oriented, balance and stretching exercises. Participants also performed an ambulation program at home. The CG received a conventional rehabilitation program. Outcome variables were: adherence to PA, (walking and sitting time/day), walking speed (10MWT); walking endurance (6MWT); risk of falling (TUG); ADLs (Barthel); QoL (Eq-5D5L) and participant's satisfaction. RESULTS: At the end of the intervention, community ambulation increased more in IG (38.95 min; SD: 20.37) than in the CG (9.47 min; SD: 12.11) (p≤.05). Sitting time was reduced by 2.96 (SD 2.0) hours/day in the IG and by 0.53 (SD 0.24) hours in the CG (p≤.05). CONCLUSIONS: The results suggest that mHealth technology provides a novel way to promote adherence to home exercise programs post stroke. However, frequent support and guidance of caregiver is required to ensure the use of mobile devices.

Walking speed as a predictor of community mobility and quality of life after stroke.

Background: Community mobility (CM) is considered a part of community reintegration that enhances Quality of Life (QoL). Achieving an appropriate gait speed is essential in attaining an independent outdoor ambulation and satisfactory CM. Objective: The aim of this study was to identify whether gait speed is a predictor of CM and QoL in patients with stroke following a multimodal rehabilitation program (MRP). Methods: This was a baseline control trial with 6-months follow-up in an outpatient rehabilitation setting at a university hospital. Twenty-six stroke survivors completed the MRP (24 sessions, 2 days/wk, 1 hr/session). The MRP consisted of aerobic exercise, task-oriented exercises, balance exercises and stretching. Participants also performed an ambulation program at home. Outcome variables were: walking speed (10-m walking test) and QoL (physical and psychosocial domains of Euroquol and Sickness Impact Profile). Results: At the end of the intervention, comfortable and fast walking speed increased by an average of 0.16 (SD 0.21) (*p < .05) and 0.40 (SD 0.51) (**p < .001) m/s, respectively. After the intervention, all participants achieved independent outdoor ambulation with an increase of 34.14 of walking minutes/day in the community and a decrease of sitting time of 95.45 minutes/day. Regarding QoL there were increased mean scores on the physical and psychosocial dimensions of Euroquol and the Sickness Impact Profile, respectively (**p < .001). Conclusions: The results suggest that improved walking speed after the MRP is associated with CM and higher scores in QoL. These findings support the need to implement rehabilitation programs to promote increased speed.

Efectividad de un programa de rehabilitación basado en ejercicio multimodal de intensidad moderada-baja para supervivientes de ictus / Effectiveness of a multimodal low-moderate intensity exercise rehabilitation program for stroke survivors

Introducción: la cantidad de personas que sobreviven a un accidente cerebrovascular aumenta cada año. Las personas con ictus sufren déficits neurológicos y un desacondicionamiento físico que compromete la capacidad para caminar, las actividades básicas de la vida diaria y la calidad de vida relacionada con la salud (CdVRS). El objetivo de este estudio fue determinar los efectos de un programa de rehabilitación multimodal de 12 semanas de duración, basado en ejercicios de intensidad baja- moderada, en la velocidad de deambulación, la resistencia al caminar y la adherencia a la actividad física. Material y métodos: estudio observacional de medidas repetidas. La intervención consistió en 24 sesiones de 1 hora de duración dos días alternos por semana. Se reclutó un total de 31 participantes que se evaluaron al inicio, después de la intervención y a los seis meses. Resultados: veinticinco participantes completaron el programa de rehabilitación. Al final de la intervención se detectaron mejoras significativas de la velocidad de deambulación (10MWT p≤0.004*), resistencia al caminar (6MWT p≤0.000**) y adherencia (minutos de caminata/día p≤0.000**). Estos resultados se mantuvieron a los seis meses. Los participantes manifestaron una satisfacción general con el programa de rehabilitación del 94% en relación a los siguientes ítems: condición física, capacidad para caminar, equilibrio, expectativas cumplidas, satisfacción con el programa, satisfacción con la autoeficacia, estrategias aprendidas para mejorar la calidad de vida, momento adecuado para participar en el programa y lo recomendarían a terceras personas. Conclusiones: Promover la actividad física de intensidad baja-moderada puede ser una estrategia de rehabilitación interesante para los supervivientes de ictus

Introduction: The amount of people who survive a stroke is increasing annually. Persons with stroke suffer neurological deficits and a physical deconditioning that compromise walking ability, basic activities of daily living and health-related quality of life (HRQoL). The aim of the study was to determine the effects of a 12-week multimodal low-moderate intensity exercise rehabilitation program on walking speed, walking endurance and adherence to physical activity. Material and methods: An observational repeated-measures design was used. The intervention consisted of 24 sessions of 1 hour per session two alternative days a week. A total of 31 participants were recruited and were evaluated at baseline, post-intervention and at six months follow up. Results: Twenty-five participants completed the rehabilitation program. Significant improvements were found at the end of the intervention and those were maintained at six months on walking speed (10MWT *p≤0.004), walking endurance (6MWT **p≤0.000) and adherence (walking min/day **p≤0.000). Participants reported an overall satisfaction with the rehabilitation program of 94%: fitness, walking capacity, balance, accomplished expectations, satisfaction with the rehabilitation program, satisfaction with self-efficacy, learned strategies to improve QoL, adequate timing and would recommend the low-moderate intensity exercise rehabilitation program. Conclusions: Promoting low-moderate intensity physical activity may be an interesting rehabilitation strategy for stroke survivors