None listed
Conditions
Brief summary
Introduction: Despite the popularity of CCT, there are gaps in knowledge as to whether the intervention improves gait parameters of mobility domain, balance, community reintegration level and quality of life of stroke survivors. Based on the gaps, a research question worth asked is; Is group circuit class therapy effective in improving mobility, balance community reintegration level and health related quality of life of community dwelling stroke survivors? Based on these gaps, primary purpose of the study is to determine the outcomes of circuit class therapy on mobility specifically gait parameters, balance, community reintegration and health related quality of life of community dwelling stroke survivors. This study hypothesis that CCT may improve mobility specifically gait parameters, balance, community reintegration and heath related quality of life among stroke survivors more significantly compared to usual therapy. Research Design: Assessor blinded Randomized controlled trial (RCT) Study Site: Rehabilitation Department, University Kebangsaan Malaysia Medical Centre (UKMMC). Study Population: Community dwelling sub-acute and chronic stroke survivors. Subacute stage of stroke is categorised as above 7 days to 6 months post stroke and chronic stage which exceeds 6 months Sample Size Calculation: G-power was used to calculate sample size, Total patients recruited were 40. Recruitment and randomization: Convenience sampling were used to recruit participants. Randomization were performed using sealed opaque envelope using block randomisation method of block of 4 to randomise patients into either intervention group or control group. Outcome measures: Instrumented Timed Up and Go test (ITUG), Berg Balance Scale (BBS), Reintegration to Normal Living Index (RNLI) and EuroQoL-5-Dimensions Statistical analysis: Mixed Model ANOVA using SPSS version 20. RESULTS: The mean age of the participants was 58.68+/-10.12 years. Results shown that there was a significant time effect for TUG score (p=0.009), BBS (p<0.001), community reintegration (p=0.010) and HRQoL (p=0.004). Clinically, greater improvement were observed for iTUG score, community reintegration and HRQoL following CCT compared to usual therapy (mean and standard deviation difference within group); recorded as 4.17 +/- 0.80s versus 1.36 +/- 0.75s, 9.67 +/ -2.03 units versus 2.20+/-2.03 units and 0.13 +/- 0.02 units versus 0.03 +/- 0.03 units respectively. However, no significant group effect were found for all outcome variables (p>0.05). The results shown that CCT is as effective as usual therapy in improving functional mobility, balance, community reintegration and HRQoL.
Interventions
The intervention group received CCT focusing on practice of task-oriented activities for 60 – 90 minutes, once a week for total of 12 weeks, CCT exercise components include: aerobic walking, sit to stand, step-up, heel lift, standing with base of support (BOS) constrained, obstacle walking course, tandem walking and task oriented training of upper limb task as its name suggests is an upper limb task. After the completion of all stations, only patients in high function group were given the oppor
The intervention group received CCT focusing on practice of task-oriented activities for 60 – 90 minutes, once a week for total of 12 weeks, CCT exercise components include: aerobic walking, sit to stand, step-up, heel lift, standing with base of support (BOS) constrained, obstacle walking course, tandem walking and task oriented training of upper limb task as its name suggests is an upper limb task. After the completion of all stations, only patients in high function group were given the opportunity to participate in games such as badminton or Ping-Pong. Intensity of the exercise depends on the patient's ability within the allocated 5 minutes for each stations except for aerobic walking exercise which begins with 20 minutes and progressed up 40 minutes by the end of the 12th week.. Intensity performed by patients were recorded and it was ensured that the intensity was progressed every week in terms of number of repetitions, using weights and increasing the complexity level of the task such as counting backward while performing tandem walk.. Therapist administered the treatment in group format of six to eight in each group and participants were given one to two minutes transition time between each stations. Participants were categorized into two sub-groups; low functioning (Modified Rankin Scale of score 3) and high functioning groups (Modified Rankin Scale of score 2 and below). In high functioning group of eight participants, two groups was further formed with one therapist to four patients (1:4). In low functioning group of six participants, two groups with three participants in each group with the ratio of one therapist to three participants (1:3) were formed. Adherence was monitored by maintaining attendance of each patient every session. Patient who failed to attend to the therapy session were followed up by phone calls and a gentle reminder of the next session.
Sponsors
Nor Azlin Mohd Nordin
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
Inclusion criteria of this study were clinically diagnosed stroke confirmed with computed tomography (CT) scan, scores 3 and less on Modified Rankin Scale (MRS) (score 3: Moderate disability that requires only minimal help and have the ability to walk without physical assistance; score 2; slight disability which causes the inability perform all the previous activities but able to take care of own affair without assistance; score 1: No significant disability which means despite symptoms patient able to carry out activities; score 0: no symptoms), more than one week post stroke onset, ischaemic or haemorrhagic type of stroke, able to provide informed consent
Exclusion criteria
Exclusion criteria of this study were score of 16 and above on Center for epidemiology studies-Depression Scale (CES-D which indicates a cut off score and clinical diagnosis of major depression), score of 24 and below on Mini Mental State Exam MMSE, which indicates the presence of cognitive impairment, other medical conditions that precludes participation in the study including aphasia, recent injuries and fractures, past event of myocardial infarction, severe deep vein thrombosis, severe neurological disorder, recent major illness that requires hospitalisation (acute stage), multiple neurological comorbidity, severe musculosketal disorder and stroke patients with mobility condition due to other conditions.
Outcome results
None listed