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- Langhammer, Birgitta, et al.
(författare)
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An evaluation of two different exercis regimes during the first year following stroke : a randomised controlled trail
- 2009
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Ingår i: Physiotherapy Theory and Practice. - : Informa UK Limited. - 0959-3985 .- 1532-5040. ; 25:2, s. 55-68
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 3. |
- Langhammer, Birgitta, et al.
(författare)
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Baseline walking ability as an indicator of overall walking ability and ADL at 3, 6, and 12 months after acute stroke
- 2022
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Ingår i: European Journal of Physiotherapy. - : Taylor & Francis. - 2167-9169 .- 2167-9177. ; 24:5, s. 311-319
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Tidskriftsartikel (refereegranskat)abstract
- Purpose To evaluate to what extent baseline walking ability was predictive of activity levels and if categorising into groups of ability or capacity was equally informative. Methods The data were collected from a randomised controlled study where the results were neutral. The trial was registered in ClinicalTrials.gov Identifier: NCT00311025. The sample (n = 75) was divided at baseline into two models of sub-groups, one related to ability based on the Functional Ambulation Category (FAC), the other to capacity based on maximal gait speed: <= 0.4, 0.5 - 0.8 and >= 0.8 m/s. Outcome measures used were 6-min Walk-Test, Motor assessment Scale 5 and Barthel Index (BI). Tests were performed baseline on admission, at discharge, 3, 6, and 12 months post debut. Results Both models of walking, ability (FAC) or capacity (gait speed) were significant contributors to BI independence at 3, 6, and 12 months. The capacity model was explanatory for the independence of ADL function with 58, 49, and 54%, respectively, and the ability model was slightly less explanatory with a prediction of 56, 49, and 44%, respectively. Conclusion Baseline walking ability is predictive for independence in ADL, and a quantitative evaluation may be preferable for accuracy.
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| 5. |
- Langhammer, Birgitta, et al.
(författare)
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Exercise and health-related quality of life during the first year following acute stroke : A randomized controlled trial
- 2008
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Ingår i: Brain Injury. - : Informa UK Limited. - 0269-9052 .- 1362-301X. ; 22:2, s. 135-145
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 6. |
- Langhammer, Birgitta, et al.
(författare)
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General motor function assessment scale : reliability of a Norwegian version
- 2014
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 36:20, s. 1704-1712
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Tidskriftsartikel (refereegranskat)abstract
- 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 alpha, Percentage Agreement (PA), Svensson's rank transformable method and Cohen's kappa. Results: The Cronbach's alpha 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 r(a) of 0.96, 0.96 and 0.99, respectively. The variation in the kappa 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.
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| 7. |
- Langhammer, Birgitta, et al.
(författare)
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Norwegian General Motor Function assessment as an outcome measure for a frail elderly population : A validity study
- 2016
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Ingår i: Geriatrics & Gerontology International. - : Wiley. - 1444-1586 .- 1447-0594. ; 16:4, s. 432-439
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 8. |
- Langhammer, Birgitta, et al.
(författare)
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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
- 2014
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Ingår i: Brain Injury. - : Informa UK Limited. - 0269-9052 .- 1362-301X. ; 28:11, s. 1396-1405
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 10. |
- Langhammer, Birgitta, et al.
(författare)
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Stroke patients and long-term training: is it worthwhile? : A randomized comparison of two different training strategies after rehabilitation
- 2007
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Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 21:6, s. 495-510
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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