None listed
Conditions
Brief summary
The purpose of this project is to investigate the effectiveness of physiotherapy treatment interventions aimed at improving ability to walk safely outdoors following stroke. This project is a pilot study that will compare the effectiveness of two physiotherapy interventions for regaining the ability to walk outdoors. The structured task practice is an evidence based approach focusing on repeated practice of the different tasks involved in walking outdoors, such as walking on slopes and crossing gutters. The alternative interventions are based on the Bobath Concept, a treatment approach that focuses on the development of postural stability to improve balance and walking function. Participants for the pilot study will be sought from patients who are currently undergoing rehabilitation (either inpatient or outpatient) following stroke and who have recently achieved the ability to walk with supervision indoors. Thirty participants will be recruited for the pilot study. Participants will have baseline assessments including the adapted six minute walk test, their walking velocity (over the central 6 metres of a 10 metre track), the time taken to ascend and descend a flight of stairs and scores on the Berg Balance Scale (an ordinal scale assessing ability to perform 14 balance tasks) by a blind assessor. Participants will be randomised to either of the two interventions. Patients are blinded to which group they have been randomised. Both interventions will require the participant to attend six one hour physiotherapy sessions over a two week period. In the structured task practice intervention, participants will practice activities such as walking on slopes, going up and down a single step, and walking on uneven ground. In the Bobath Concept intervention, the postural stability of the participant will be assessed and individualised treatment programs established, aimed at improving postural stability. These sessions will include activities in standing and walking to enhance standing balance, patterns of muscle activation and postural responses. The sessions will incorporate some task practice to a maximum of 1/6 of the treatment time. The baseline assessments will be repeated following the intervention stage.Analysis of the pilot data will enable accurate power calculations for a larger multi centre trial.
Interventions
A) Bobath Intervention - Intervention Group
Each group receives 6 x 1 hour treatment sessions within a 2 week period.
Therapists must have at least 5 years postgraduate experience and at least two years experience in the fields of rehabilitation or neurology. The therapsit providing Intervention A must have completed a Basic Bobath Course and at least two Advanced Bobath Courses.
During the intervention period the participant does not receive any other physiotherapy aimed at improving mobil
A) Bobath Intervention - Intervention Group Each group receives 6 x 1 hour treatment sessions within a 2 week period. Therapists must have at least 5 years postgraduate experience and at least two years experience in the fields of rehabilitation or neurology. The therapsit providing Intervention A must have completed a Basic Bobath Course and at least two Advanced Bobath Courses. During the intervention period the participant does not receive any other physiotherapy aimed at improving mobility, postur, balance or lower limb function.
Sponsors
St Vincents Health
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
First or recurrent stroke diagnosis, haemorrhage or infarct. Between four weeks and sixteen weeks post stroke at commencement of trial. Currently participating in an inpatient or outpatient rehabilitation program. Able to walk 15 metres indoors on a level surface, with or without an aid, with supervision.
Exclusion criteria
Premorbid mobility limited to walking indoors only. Inability to follow single stage verbal commands with visual prompts sufficient to complete the required assessments. Able to walk safely outdoors without supervision. Mobility disability due primarily to pathologies other than stroke.
Outcome results
None listed