Body composition and physical function after progressive resistance and balance training among older adults after stroke: an exploratory randomized controlled trial.

PURPOSE: To evaluate whether improvements in physical function are related to changes in body composition after a three-month progressive resistance and balance exercise program among individuals approximately one to three years after stroke. METHODS: In this randomized controlled trial, 43 community-dwelling subjects (65-85 years, mean age 73 ± 5 years, 73% men) were allocated to a progressive resistance and balance exercise program twice weekly for three months (intervention group [IG], n = 20) or a control group (n = 23). The main outcome measures were fat mass (kg) and fat-free mass (kg), as measured by bioelectrical impedance analyses (Tanita®). Physical function was measured using the six-minute walk test. RESULTS: Complete case analyses revealed reduced fat mass in the IG compared with the control (-1.5 vs. (0).13% of body weight, respectively; effect size =0.62; p = 0.048). In contrast, no between-group difference in fat-free mass was observed. The six-minute walk test was improved (25 vs. -10 m, respectively, effect size =0.69, p = 0.039) at three months in favor of the IG. The reduced fat mass was associated with an improved six-minute walk test (r = 0.48, p = 0.038) in the IG. CONCLUSIONS: Three-month progressive resistance and balance training was associated with reduced fat mass, which was related to improvements in walking capacity in older adults approximately one year after stroke. Implications for rehabilitation This three-month PRB group exercise program supported by motivational discussions and daily home-based exercises indicate the following: • Improved walking capacity was associated with a reduction in fat mass. • IGF-1 is reduced, possibly indicating improved insulin sensitivity.

Short-term and long-term effects of a progressive resistance and balance exercise program in individuals with chronic stroke: a randomized controlled trial.

PURPOSE: To evaluate the effects of progressive resistance and balance (PRB) exercises on physical and psychological functions of post-stroke individuals. MATERIALS AND METHODS: In a randomized controlled trial with follow-up at 3, 6 and 15 months, 67 community-living individuals (76% male; 65-85 years) with a stroke 1-3 years previously were allocated to an intervention group (IG, n = 34; PRB exercises combined with motivational group discussions twice weekly for 3 months) or a control group (CG, n = 33). The primary outcomes were balance (Berg Balance Scale, 0-56 points) and mobility (Short Physical Performance Battery, 0-12 points) at 3 months. The secondary outcomes were 10 m comfortable walking speed, physical activity levels, health-related quality of life, depression and fall-related self-efficacy. RESULTS: At 3 months, the IG exhibited significant improvements in balance (MD 2.5 versus 0 points; effect size [ES], 0.72; p < 0.01) and comfortable walking speed (MD 0.04 versus -0.05 m/s; ES, 0.68; p = 0.01) relative to the CG. A faster walking speed persisted at 6 months. No differences were found for the other outcomes. CONCLUSIONS: In chronic stroke patients, 3 months of PRB exercises and motivational discussions induced improvements in balance at 3 months and in walking speed at 3 and 6 months. Implications for Rehabilitation A progressive resistance and balance exercise program supported by motivational group discussions and one home-based exercise appears to be an effective means of improving the short-term balance and the walking speed in individuals with chronic stroke. People with poor balance and motor function discontinued the study more often and may require additional support. There is a need for powerful and cost-effective strategies that target changes in behavior to obtain long-term changes in physical function after exercising.

Functional performance, nutritional status, and body composition in ambulant community-dwelling individuals 1-3 years after suffering from a cerebral infarction or intracerebral bleeding.

BACKGROUND: Muscle wasting and obesity may complicate the post-stroke trajectory. We investigated the relationships between nutritional status, body composition, and mobility one to 3 years after stroke. METHODS: Among 279 eligible home-dwelling individuals who had suffered a stroke (except for subarachnoid bleeding) 1-3 years earlier, 134 (74 ± 5 years, 69% men) were examined according to the Mini Nutritional Assessment-Short Form (MNA-SF, 0-14 points), including body mass index (BMI, kg/m(2)), body composition by bio-impedance analyses (Tanita BC-545), the Short Physical Performance Battery (SPPB, 0-12 points) combining walking speed, balance, and chair stand capacity, and the self-reported Physical Activity Scale for the Elderly (PASE). RESULTS: BMI ≥ 30 kg/m(2) was observed in 22% of cases, and 14% were at risk for malnutrition according to the MNA-SF. SPPB scores ≤ 8 in 28% of cases indicated high risk for disability. Mobility based on the SPPB was not associated with the fat-free mass index (FFMI) or fat mass index (FMI). Multivariate logistic regression indicated that low mobility, i.e., SPPB ≤ 8 points, was independently related to risk for malnutrition (OR 4.3, CI 1.7-10.5, P = 0.02), low physical activity (PASE) (OR 6.5, CI 2.0-21.2, P = 0.02), and high age (OR 0.36, CI 0.15-0.85, P = 0.02). Sarcopenia, defined as a reduced FFMI combined with SPPB scores ≤ 8 or reduced gait speed (<1 m/s), was observed in 7% of cases. None of the individuals displayed sarcopenic obesity (SO), defined as sarcopenia with BMI > 30 kg/m(2). CONCLUSIONS: Nutritional disorders, i.e., obesity, sarcopenia, or risk for malnutrition, were observed in about one-third of individuals 1 year after stroke. Risk for malnutrition, self-reported physical activity, and age were related to mobility (SPPB), whereas fat-free mass (FFM) and fat mass (FM) were not. Nutrition and exercise treatment could be further evaluated as rehabilitation opportunities after stroke.

Norwegian General Motor Function assessment as an outcome measure for a frail elderly population: A validity study.

AIM: To establish the validity of the Norwegian General Motor Function (NGMF) assessment scale. METHOD: To establish construct and criteria validity, Spearman's rank correlation coefficients were calculated for the NGMF, and age, sex, medical conditions, history of falls and to four functional tests. Content validity was evaluated by asking participating physiotherapists about the usefulness of the items in the scale. Absolute reliability was evaluated by establishing the standard error of measurement and the minimal detectable change at the 95% level of confidence for total scores of the NGMF subscales for dependence, pain and insecurity. RESULTS: Construct validity was established to medical status and medication with subscales dependence and insecurity but not to subscale pain. Criterion validity was established between the NGMF subscales dependence, pain and insecurity, and the Barthel Index, the Falls Efficacy Scale to subscales dependence and insecurity, but not with pain, and the Timed Up-and-Go test, to subscale insecurity. Neither the Chair Stand Test nor registered falls were significantly associated with any of the subscales of the NGMF. Content validity of the NGMF was perceived relevant to work in a geriatric setting and as a communication tool for a multidisciplinary team. Minimal detectable change was calculated for dependence (2.76), pain (4.9) and insecurity (6.1), respectively. CONCLUSION: The construct, criteria and content validity of the NGMF was established.

Physiotherapy and physical functioning post-stroke: exercise habits and functioning 4 years later? Long-term follow-up after a 1-year long-term intervention period: a randomized controlled trial.

INTRODUCTION: Physical activity is mandatory if patients are to remain healthy and independent after stroke. OBJECTIVE: Maintenance of motor function, tone, grip strength, balance, mobility, gait, independence in personal and instrumental activities of daily living, health-related quality-of-life and an active lifestyle 4 years post-stroke. METHODS: A prospective randomized controlled trial. RESULTS: Four years post-stroke, 37 of the 75 participating persons were eligible for follow-up; 19 (54.3%) from the intensive exercise group and 18 (45%) from the regular exercise group. Both groups were performing equally well with no significant differences in total scores on the BI (p = 0.3), MAS (p = 0.4), BBS (p = 0.1), TUG (p = 0.08), 6MWT (p = 0.1), bilateral grip strength (affected hand, p = 0.8; non-affected hand, p = 0.9) nor in the items of NHP (p > 0.005). Independence in performing the IADL was 40%, while 60% had help from relatives or community-based services. CONCLUSION: This longitudinal study shows that persons with stroke in two groups with different exercise regimes during the first year after stroke did not differ in long-term outcomes. Both groups maintained function and had a relatively active life style 4 years after the acute incident. The results underline the importance of follow-up testing and encouragement to exercise, to motivate and sustain physical activity patterns, to maintain physical function, not only in the acute but also in the chronic phase of stroke.

General motor function assessment scale--reliability of a Norwegian version.

PURPOSE: The General Motor Function assessment scale (GMF) measures activity-related dependence, pain and insecurity among older people in frail health. The aim of the present study was to translate the GMF into a Norwegian version (N-GMF) and establish its reliability and clinical feasibility. METHODS: The procedure used in translating the GMF was a forward and backward process, testing a convenience sample of 30 frail elderly people with it. The intra-rater reliability tests were performed by three physiotherapists, and the inter-reliability test was done by the same three plus nine independent colleagues. The statistical analyses were performed with a pairwise analysis for intra- and inter-rater reliability, using Cronbach's α, Percentage Agreement (PA), Svensson's rank transformable method and Cohen's κ. RESULTS: The Cronbach's α coefficients for the different subscales of N-GMF were 0.68 for Dependency, 0.73 for Pain and 0.75 for Insecurity. Intra-rater reliability: The variation in the PA for the total score was 40-70% in Dependence, 30-40% in Pain and 30-60% in Insecurity. The Relative Rank Variant (RV) indicated a modest individual bias and an augmented rank-order agreement coefficient ra of 0.96, 0.96 and 0.99, respectively. The variation in the κ statistics was 0.27-0.62 for Dependence, 0.17-0.35 for Pain and 0.13-0.47 for Insecurity. Inter-rater reliability: The PA between different testers in Dependence, Pain and Insecurity was 74%, 89% and 74%, respectively. The augmented rank-order agreement coefficients were: for Dependence r(a) = 0.97; for Pain, r(a) = 0.99; and for Insecurity, r(a) = 0.99. CONCLUSION: The N-GMF is a fairly reliable instrument for use with frail elderly people, with intra-rater and inter-rater reliability moderate in Dependence and slight to fair in Pain and Insecurity. The clinical usefulness was stressed in regard to its main focus, the frail elderly, and for communication within a multidisciplinary team. Implications for Rehabilitation The Norwegian-General Motor Function Assessment Scale (N-GMF) is a reliable instrument. The N-GMF is an instrument for screening and assessment of activity-related dependence, pain and insecurity in frail older people. The N-GMF may be used as a tool of communication in a multidisciplinary team.

Factors related to performance-based mobility and self-reported physical activity in individuals 1-3 years after stroke: a cross-sectional cohort study.

BACKGROUND: Low mobility and low level of physical activity is common after stroke. The objective of this study was to relate these outcomes to physical, psychological, and demographic determinants. METHODS: In this cross-sectional cohort study, a consecutive sample of 195 community-living individuals, 65-85 years of age (74±5 years, 71% men) with a previous stroke was included. Exclusion criteria were severe aphasia and severe cognitive dysfunction. Mobility status was measured by the Short Physical Performance Battery (SPPB, 0-12 points), and physical activity was measured using the Physical Activity Scale for the Elderly (PASE). RESULTS: Mobility (SPPB, median 9 points) and level of physical activity were low (mean PASE 97±66 points), and walking speed was slow (1.10±.86 m/s), in relation to a healthy population-based sample. In multiple regression analyses, age (P=.001), physical activity (P<.001), fall-related self-efficacy (P=.001), and health-related quality of life (HRQoL) (P=.02) were associated with mobility (SPPB). Mobility (P<.001), HRQoL (P=.014), and fall-related self-efficacy (P=.031) were likewise associated with self-reported physical activity as the dependent variable. The regression models described 42% and 31% of the variance in mobility and physical activity, respectively. CONCLUSIONS: Individuals perceived disabilities that are partly potentially modifiable 1-3 years after stroke. Future poststroke rehabilitation studies need to evaluate if actions to improve fall-related self-efficacy and mobility could promote the physical activity level in this patient population.

Validity and reliability of Polar® RS800CX heart rate monitor, measuring heart rate in dogs during standing position and at trot on a treadmill.

UNLABELLED: The aim of the present study was to assess criterion validity, and relative and absolute reliability of Polar® RS800CX heart rate monitor, compared to simultaneously recorded electrocardiogram (ECG) data, in measuring heart rate of dogs during standing position and at trot on a treadmill. METHODS: Heart beats from Polar® RS800CX and Cardiostore ECG were recorded simultaneously during seven continuous minutes in standing position and at trot, in 10 adult healthy dogs. Polar® data was statistically compared to ECG data for a variety of mean beats per minute (BPM), standard deviation and confidence interval. Criterion validity was calculated by Pearson product moment correlation method and intraclass correlation coefficient (ICC2.1). Relative and absolute reliability were calculated by ICC2.1, the Bland and Altman analysis and standard error of measurement (SEM and SEM%). RESULTS: The correlation, criterion validity, between Polar® and ECG data in standing position was r=0.99 (p<0.0005) and at trot r=0.97 (p<0.0005). Polar® data was not significantly different from ECG data. Mean difference between ECG and uncorrected Polar® data was -0.6 BPM in standing position and -0.6 BPM at trot. Polar® was over- and underestimating ECG data. SEM and SEM% in standing were ±2.6 BPM and 3.0%, at trot ±3.8 BPM and 3.1%, indicating that measurement errors were low. CONCLUSION: This study showed that the criterion validity and the instrument reliability were excellent in Polar® RS800CX heart rate measuring system. The equipment seemed to be valid and reliable in measuring BPM in the dogs studied during submaximal cardiovascular conditions such as in standing position and at trot on a treadmill.

Self-Perceived non-motor aspects of cervical dystonia and their association with disability.

OBJECTIVE: To examine the multivariate association between a model of self-perceived non-motor aspects and disability in cervical dystonia. DESIGN: A prospective and correlational design with two points of assessment. SUBJECTS: All 273 members with cervical dystonia from the Swedish Dystonia Patient Association were invited to participate. METHODS: Data were collected with one self-reported questionnaire. The questionnaire was sent by post on two separate occasions. Disability was the primary outcome variable measured by the Functional Disability Questionnaire. RESULTS: The questionnaire was completed by 180 individuals (66%) on both occasions. The multivariate association between the non-motor model and disability was statistically significant (adjusted R2 0.46, F(7, 149) = 19.76, p = 0.001). This indicated that 46% of the variance in disability was explained by the non-motor model. Self-efficacy appeared to be the most salient predictor of disability. CONCLUSION: The results of this study highlight the need for increasing awareness of self-perceived non-motor aspects among care providers treating patients with cervical dystonia. This presents opportunities for new rehabilitation possibilities that apply a behavioural medicine perspective.

Functional exercise and physical fitness post stroke: the importance of exercise maintenance for motor control and physical fitness after stroke.

It is argued that all stroke patients, indifferent of disability, have the same possibility to improve with training. The aim of the study was to follow and register functional improvements in two groups with different functional capacities at baseline for a period of 36 months. Stroke patients were recruited and divided into groups related to their functional status at baseline. During the acute rehabilitation, both groups received functional task-oriented training, followed by regular self- or therapeutic driven training the first year after stroke and varied exercise patterns the following 24 months. The participants were tested on admission, and at three, six, twelve, and thirty-six months after the onset of stroke. Both groups improved functional activity up to six months which then stabilized up to twelve months to decline somewhat at thirty-six months after stroke. Change scores indicate a greater potential for rehabilitation in the MAS ≤35 in relation to group MAS >35 although the functional capacity was higher in the latter. This indicates the importance of maintaining exercise and training for all persons after stroke.

Responsiveness and validity of the Motor Activity Log in patients during the subacute phase after stroke.

PURPOSE: To investigate the responsiveness and cross-sectional and longitudinal validity of the Motor Activity Log (MAL) in the subacute phase after stroke. METHOD: Data were collected pre-intervention, post-intervention, and at 3-month follow-up evaluations from 30 patients with stroke participating in a randomized trial of forced use. Assessments included MAL, the Fugl-Meyer test, the 16-hole peg test, grip strength, the Action Research Arm Test, and the Motor Assessment Scale. Measurements of responsiveness were effect size, standardized response mean (SRM), and responsiveness ratio (RR). Relationships between the MAL and the other measures were determined with Spearman correlations. RESULTS: The MAL is responsive to change, with effect size, SRM, and RR>1.0 at the 3-month follow-up, and SRM and RR>1.0 at post-intervention. Correlations at the separate test occasions between MAL and the other measures were mostly close to 0.50, which shows fair to moderate construct validity. Correlations between changes in MAL and in the other measures were weaker than cross-sectional relationships. CONCLUSIONS: The MAL is a responsive measure of daily hand use in patients participating in rehabilitation in the subacute phase after stroke. Correlations of construct validity indicate that daily hand use may need to be measured separately from body function and activity capacity, in line with the underlying constructs of International Classification of Functioning, Disability and Health. To strengthen our findings, they should be repeated in larger samples of patients.

Effects of forced use on arm function in the subacute phase after stroke: a randomized, clinical pilot study.

BACKGROUND AND OBJECTIVE: Following stroke, it is common to exhibit motor impairments and decreased use of the upper limb. The objective of the present study was to evaluate forced use on arm function during the subacute phase after stroke. DESIGN: A comparison of standard rehabilitation only and standard rehabilitation together with a restraining sling was made through a randomized, nonblinded, clinical pilot trial with assessments before intervention, after intervention, and at 1- and 3-month follow-ups. SETTING: The present study took place at the departments of rehabilitation medicine, geriatrics, and neurology at a university hospital. PARTICIPANTS: A convenience sample of 30 people 1 to 6 months (mean, 2.4 mo) after stroke was randomized into 2 groups (forced-use group and standard training group) of 15 people each. Twenty-six participants completed the 3-month follow-up. INTERVENTION: All participants received their standard rehabilitation program with training 5 days per week for 2 weeks as inpatients or outpatients. The forced-use group also wore a restraining sling on the nonparetic arm with a target of 6 hours per day. MEASUREMENTS: The Fugl-Meyer (FM) test, the Action Research Arm Test, the Motor Assessment Scale (MAS) (sum of scores for the upper limb), a 16-hole peg test (16HPT), a grip strength ratio (paretic hand to nonparetic hand), and the Modified Ashworth Scale were used to obtain measurements. RESULTS: The changes in the forced-use group did not differ from the changes in the standard training group for any of the outcome measures. Both groups improved over time, with statistically significant changes in the FM test (mean score changed from 52 to 57), MAS (mean score changed from 10.1 to 12.4), 16HPT (mean time changed from >92 seconds to 60 seconds), and grip strength ratio (mean changed from 0.40 to 0.55). LIMITATIONS: The limitations of this pilot study include an extended study time, a nonblinded assessor, a lack of control of treatment content, and a small sample size. CONCLUSIONS: The results of the present pilot study did not support forced use as a reinforcement of standard rehabilitation in the subacute phase after stroke. Forced use did not generate greater improvements with regard to motor impairment and capacity than standard rehabilitation alone. The findings of this effectiveness study will be used to help design future clinical trials with the aim of revealing a definitive conclusion regarding the clinical implementation of forced use for upper-limb rehabilitation.

Is forced use of the paretic upper limb beneficial? A randomized pilot study during subacute post-stroke recovery.

OBJECTIVE: To evaluate the effect of two weeks of forced use of the paretic upper limb, as a supplement to the rehabilitation programme in the subacute phase after stroke, on self-rated use of that limb. DESIGN: A randomized, non-blind, parallel group, clinical, before-and-after trial. A forced use group and a conventional group were followed up one and three months after intervention. SETTING: In- and outpatient units of rehabilitation at a University Hospital. SUBJECTS: Thirty patients were allocated to two groups, 15 in each, 1-6 months (mean 2.4) after stroke onset. Twenty-six patients completed the study. INTERVENTIONS: The patients of both groups participated in two weeks of daily training on weekdays. In addition, the forced use group wore a restraining sling on the non-paretic arm for up to 6 hours per weekday. MAIN MEASURE: The Motor Activity Log; patients scored 0-5 for 30 daily tasks concerning both amount of use and quality of movement. RESULTS: The forced use group tended to achieve larger improvements immediately post-intervention, but this was not clearly demonstrated. The small differences also levelled out up to the three-month follow-up, with both groups earning an approximately 1.0 score point on both scales of the Motor Activity Log. CONCLUSIONS: This pilot study did not reveal any additional benefit of forced use on self-rated performance in daily use of the paretic upper limb. Both groups performed fairly extensive, active training with a similar duration, amount and content.

An evaluation of two different exercise regimes during the first year following stroke: a randomised controlled trial.

The purpose of this randomised controlled trial was to evaluate the effects of two different exercise approaches during the first 12 months post stroke on Instrumental Activities of Daily Living (IADL), motor function, gait performance, balance, grip strength, and muscle tone. This study is a double-blind longitudinal randomised trial of first-time-ever stroke patients. Seventy-five patients were included: 35 in an intervention group and 40 in a self-initiated exercise group. After discharge from acute rehabilitation, patients assigned in the intervention group had physiotherapy for a minimum amount of 80 hours during the first year. Patients in the self-initiated exercise group were not recommended any specific therapy besides treatment when needed. Main outcome measures were Instrumental Activities of Daily Living according to Fillenbaum, Motor Assessment Scale, 6-Minute Walk Test, Berg Balance Scale, Timed Up-and-Go Test, grip strength, Modified Ashworth Scale, and pulse monitoring. The patients were tested on admission, at discharge, and after 3, 6, and 12 months post stroke by an experienced investigator, blinded to group assignment. Twelve months post stroke showed higher levels of independence in all items of the Instrumental Activities of Daily Living Test and improvements in the results of Motor Assessment Scale, 6-Minute Walk Test, Berg Balance Scale, Timed Up-and-Go, and grip strength in both groups. Only a few significant differences were seen between groups, and they were in favour of the self-initiated exercise group (e.g., ability to use the telephone independently). Attending examination sessions following each intervention phase appeared to be strong motivators for training, irrespective of group allocation.

Tibolone low dose (1.25 mg/d) therapy and postural balance in elderly women.

UNLABELLED: Most hip fractures occur in subjects without osteoporosis and are associated with a fall. Conventional menopausal hormone therapy (HT) improves postural balance, which might explain the rapid reduction in hip fracture risk. It is unclear whether tibolone improves postural balance, which might determine its effects on peripheral fracture risk. OBJECTIVE: To study the short-term effects of low-dose tibolone therapy on postural balance in elderly women. METHODS: Eighty healthy women (70 evaluable), aged 60 years or more, were recruited through advertising in the local media. They were randomly allocated to receive either tibolone (1.25 mg/d) or placebo for 6 months. Postural balance was assessed as sway velocity, using a force platform. RESULT(S): Baseline characteristics, including serum estradiol values and postural balance, were similar in the two study groups. On average, the overall dosing compliance was very high, over 97% in both groups. After 6 months, sway velocity had decreased (improved) by 7.6% (-0.97 cm/s; P=0.16 vs. baseline) in the tibolone arm and by 2.5% (-0.30 cm/s; P=0.59 vs. baseline) in the placebo group. The difference 0.67 cm/s was not statistically significant (95% CI -2.44, 1.10; P=0.45). Adjustments for age, serum estradiol level and variable value at baseline, revealed similar results. CONCLUSIONS: Short-term treatment with tibolone (1.25 mg/d), compared to placebo, did not significantly affect postural balance function in elderly women.

Physiotherapy in cervical dystonia: six experimental single-case studies.

The aim of the study was to explore the outcome of a physiotherapy program targeted to improve the quality of life of people with cervical dystonia (CD) by reducing pain, improving awareness of postural orientation, increasing muscle strength, and reducing the effort of moving the head and neck. In six single case studies, the primary outcome measure for each case was the Cervical Dystonia Questionnaire (CDQ) to measure the impact of the program on the individuals' quality of life. Secondary outcome measures were identified for the different components of the physiotherapy program: Visual Analogue Scale (pain); Postural Orientation Index (postural orientation awareness); and Movement Energy Index (effort of moving head and neck). Each of the cases had the severity of their problems scored on the Toronto Western Spasmodic Torticollis Scale. The study period was 26 weeks: 2 weeks' baseline period, 4 weeks' treatment period, and 20 weeks' follow-up. All measures except the Movement Energy Index (MEI) and CDQ-24 were taken three times per week for the first 6 weeks of the study and then once at 3 and 6 months. The MEI was taken once a week during the pretreatment and the treatment periods and during the first 2 weeks of follow-up and also after 3 and 6 months of follow-up. The CDQ-24 was taken once in the pretreatment period, once after completion of treatment, once 2 weeks after treatment, and once at 3 and 6 months of follow-up. Five of the six case studies reported an increase in quality of life at 6-month follow-up, as measured on the CDQ-24. Three of the six cases reported a reduction in pain and severity of the dystonia and had improved scores on the postural orientation measure at 6-month follow-up. All six patients had a reduction in the movement energy scores, but this was not significant. The outcomes of the six case studies would suggest that further investigation is required to show the effectiveness of physiotherapy programs in the management of CD.

Exercise and health-related quality of life during the first year following acute stroke. A randomized controlled trial.

PURPOSE: To evaluate the impact of two different physiotherapy exercise regimes in patients after acute stroke on health-related quality of life (HRQoL) and to investigate how the degree of motor and balance function, gait capacity, activities of daily living and instrumental activities of daily living influenced HRQoL. METHODS: A longitudinal randomized controlled stratified trial of two interventions: the intensive exercise groups with scheduled intensive training during four periods of the first year after stroke and the regular exercise group with self-initiated training. RESULTS: There was a tendency of better HRQoL in the regular exercise group on NHP total score (p = 0.05). Patients with low scores in activities of daily living, balance and motor function and inability to perform 6-minute walk test on admission, scored lower on self-perceived health than patients with high scores and ability to perform the walking test. At 1 year post-stroke, total scores on NHP were moderately associated with motor function (r = -0.63), balance (r = -0.56), gait (r = -0.57), activities of daily living (r = -0.57) and instrumental activities of daily living (r = -0.49-0.58). The physical mobility sub-scale of NHP had the strongest association ranging from r = -0.47-0.82. CONCLUSION: The regular exercise group with self-initiated training seemed to enhance HRQoL more than the intensive exercise group with scheduled intensive training. The degree of motor function, balance, walking capacity and independence in activities of daily living is of importance for perceived HRQoL.

Correlation between clinical assessment and force plate measurement of postural control after stroke.

OBJECTIVES: To explore the correlation between clinical assessment and force plate measurement of postural control after stroke when selected balance tasks are performed under similar spatial and temporal conditions, and to examine the inter-rater agreement of assessment of weight distribution during quiet stance in subjects with stroke. DESIGN: A descriptive and correlational study. METHODS: Clinical assessment of postural control using Berg Balance Scale, video recording for rating of weight distribution, and force plate measurement with the Vifor-system, were performed in 20 subjects with stroke. RESULTS: Mean velocity of displacement of the centre of pressure in the anterior-posterior direction correlated moderately with scores from the Berg Balance Scale items "maintaining a position" in the whole sample (rs = -0.50, p < 0.05). Moderate correlation was found between ratings of each of 3 physiotherapists and centre of pressure's mean position in the frontal plane on the force plate, while the inter-rater agreement was poor. CONCLUSION: Clinical assessment of postural control and weight distribution showed moderate correlation with force plate measurement when the assessments were performed under similar conditions. The data suggest that the reliability of observational postural analysis needs to be improved.

Stroke patients and long-term training: is it worthwhile? A randomized comparison of two different training strategies after rehabilitation.

OBJECTIVE: To find out if there were any differences in improvement and maintenance of motor function, activity of daily living and grip strength between patients with first-ever stroke receiving two different strategies of physical exercise during the first year after stroke. DESIGN: A longitudinal randomized controlled stratified trial. SETTING: Rehabilitation institutions, community, patients' homes and nursing homes. SUBJECTS: Seventy-five male and female first-time-ever stroke patients: 35 in an intensive exercise group and 40 in a regular exercise group. INTERVENTION: The intensive exercise group received physiotherapy with focus on intensive exercises in four periods during the first year after stroke. The regular exercise group patients were followed up according to their subjective needs during the corresponding year. MAIN OUTCOME MEASURES: Motor Assessment Scale, Barthel Index of Activities of Daily Living, and grip strength. RESULTS: Both groups improved significantly up to six months when function stabilized. The groups did not differ significantly on any test occasions. The difference of improvement from admission to discharge was significant in favour of the intensive exercise group, in the Motor Assessment Scale total score (intensive exercise group 7.5; regular exercise group 1.7, P = 0.01), and in the Barthel Index of Activities of Daily Living total score (17.4 versus 8.9, P = 0.04). CONCLUSION: Motor function, activities of daily living functions and grip strength improved initially and were maintained during the first year after stroke in all patients irrespective of exercise regime. This indicates the importance of motivation for regular exercise in the first year following stroke, achieved by regular check-ups.

Hormone therapy and postural balance in elderly women.

OBJECTIVE: Most fractures occur in elderly individuals without osteoporosis, and more than 90% of all hip fractures are associated with a fall. It is unclear whether hormone therapy (HT) can improve postural balance when initiated in elderly women and the effect of endogenous estradiol (E2) levels. DESIGN: Forty healthy women (33 assessable), age 60 years or older, were recruited through advertising in the local media. They were randomly and blindly assigned to receive either estradiol patches (50 microg/24 h) combined with oral medroxyprogesterone acetate (2.5 mg/d) or placebo for 6 months. Postural balance was assessed as sway velocity using a force platform. RESULTS: Low serum E2 levels were associated with greater impairment of sway velocity during the study in the placebo group. After 6 months sway velocity had improved (decreased) in the HT group by 4.3% from baseline and increased in the placebo group by 6.2%. The difference was not significant (1.30 cm/s, 95% CI: -3.0 to 0.4; P = 0.13). However, among women with low serum E2 levels at baseline (less than the median, 35 pmol/L), sway velocity improved in the HT group and deteriorated in the placebo group with a difference of 23% (2.9 cm/s, 95% CI: 0.6-5.1; P = 0.013). There were similar results after adjustment for baseline sway velocity (P = 0.003) and in the intention-to-treat analysis (P = 0.023). There was also a significant interaction between the study group and baseline serum E2 levels with regard to changes in sway velocity (P = 0.014). CONCLUSIONS: In elderly women low endogenous serum E2 levels were associated with greater impairment of postural balance function during the study, whereas HT, as compared with placebo, improved postural balance in women with low serum E2 levels.