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- Leavy, Breiffni, et al.
(författare)
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Outcome evaluation of highly challenging balance training for people with Parkinson disease : A multicenter effectiveness-implementation study
- 2020
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Ingår i: Journal of Neurologic Physical Therapy. - 1557-0576 .- 1557-0584. ; 44:1, s. 15-22
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: In order for people with Parkinson disease (PwPD) to benefit from neurorehabilitation research, interventions tested in research settings require assessment in real-world clinical practice. There is little evidence for whether efficacious exercise interventions for PwPD remain effective when transferred to standard clinical settings. The aim of this study was to assess the clinical effectiveness of the adapted HiBalance program on balance control and gait among PwPD.METHODS: Participants (n = 117) with mild-moderate Parkinson disease were consecutively included into either the 10-week HiBalance group training (n = 61) or the control (n = 56) group. The main outcome was balance performance (Mini-BESTest). Secondary outcomes were comfortable gait speed (10-m Walk Test); functional mobility (Timed Up and Go [TUG] test) and dual-task interference (cognitive TUG test); physical activity level (steps per day); perceived balance confidence (Activities-specific Balance Confidence scale) and perceived walking difficulty (Walk-12G) and self-rated health (EQ-5D visual analog scale).RESULTS: In total, 98 people completed the trial. Compared with controls, the training group showed significant improvement in balance performance (P < 0.001), gait speed (P = 0.001), and dual-task interference (P = 0.04) following the intervention. No group differences were observed for physical activity level or any patient-reported measures.DISCUSSION AND CONCLUSIONS: Highly challenging balance training is effective at improving balance, gait, and dual-task performance when delivered at a clinically feasible dose, in a range of rehabilitation settings, without direct involvement of the research group.Video Abstract available for more insights from the authors (see the Video, Supplementary Digital Content 1, available at: http://links.lww.com/JNPT/A299).
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- Moren, Carina, et al.
(författare)
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The Effects of Physical Activity on Prescription in Persons With Transient Ischemic Attack : A Randomized Controlled Study
- 2016
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Ingår i: Journal of neurologic physical therapy. - 1557-0576 .- 1557-0584. ; 40:3, s. 176-183
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose: Transient ischemic attack (TIA) is a strong predictor of stroke, and physical inactivity is one risk factor for TIA/stroke. Physical activity on Prescription (PaP) can increase physical activity, but the effect of PaP after TIA has not been described. Our goal was to objectively measure the effect of PaP on physical activity and physical capacity, as well as self-rated health at 3 and 6 months after TIA. Methods: The primary outcome was moderate to vigorous intensities of physical activity objectively assessed by accelerometry. Secondary outcomes were steps per day assessed by accelerometry, physical capacity assessed by the 6-minute walk test, and self-rated health assessed by EQ-5D VAS. Results: Eighty-eight individuals with TIA were randomized to an intervention group (n = 44) that received conventional treatment and PaP or to a control group (n = 44) that received conventional treatment alone. There was a 30% dropout among the participants at 6 months. No significant differences between groups were found in physical activity at 3 and 6 months. At 6 months, participants in the intervention group were significantly more likely to have improved their physical capacity than the control group. There was no significant difference between groups in self-rated health. Discussion and Conclusions: PaP did not increase physical activity after TIA; however, there was an increase in physical capacity. The nonsignificant results for physical activity may be the result of a relatively high baseline physical activity level. The results may also indicate that prior studies suggesting that PaP increases physical activity overestimated effects because of the self-reported nature of the previous outcomes.
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- Nilsson, Maria H., et al.
(författare)
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Predictive Factors of Fall-Related Activity Avoidance in People With Parkinson Disease-A Longitudinal Study With a 3-Year Follow-up
- 2020
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Ingår i: Journal of Neurologic Physical Therapy. - 1557-0584. ; 44:3, s. 188-194
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Knowledge of predictive factors can foster the development of preventive approaches. This study examined how prevalence and severity of fall-related activity avoidance evolve over a 3-year period in people with Parkinson disease (PD). A specific aim was to identify predictive factors of fall-related activity avoidance (ie, modified Survey of Activities and Fear of Falling in the Elderly [mSAFFE] scores) after 3 years. METHODS: The sample included 151 people with PD (mean [SD] age: 68 [8.8] years). The mSAFFE score was the dependent variable in multivariable linear regression analyses, with 17 potential predictors. On the basis of a collinearity check, 2 models studying various risk factors were developed. Model 1 included concerns about falling and model 2 walking difficulties. RESULTS: After 3 years, more participants reported fall-related activity avoidance, that is, 34% versus 50% (P < 0.001). Regression model 1 explained 63% of the variance. The strongest predictive factor was concerns about falling (standardized regression coefficient, β = 0.589), followed by pain (β = 0.161), unsteadiness while turning (β = 0.137), and age (β = 0.136). These variables remained significant when adjusting for mSAFFE baseline scores.In model 2 (explained 50% of the variance), the strongest predictive factor was perceived walking difficulties (β = 0.392), followed by age (β = 0.238), unsteadiness while turning (β = 0.198), and pain (β = 0.184). Unlike the other factors, walking difficulties were not significant when adjusting for mSAFFE baseline scores. DISCUSSION AND CONCLUSIONS: Fall-related activity avoidance increased over time in people with PD. If fall-related activity avoidance is to be targeted, this study suggests that interventions should address concerns about falling, pain, unsteadiness while turning, and walking difficulties.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A310).
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- Vive, Sara, et al.
(författare)
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Enriched, Task-Specific Therapy in the Chronic Phase After Stroke: An Exploratory Study.
- 2020
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Ingår i: Journal of neurologic physical therapy : JNPT. - 1557-0584. ; 44:2, s. 145-155
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Tidskriftsartikel (refereegranskat)abstract
- There is a need to translate promising basic research about environmental enrichment to clinical stroke settings. The aim of this study was to assess the effectiveness of enriched, task-specific therapy in individuals with chronic stroke.This is an exploratory study with a within-subject, repeated-measures design. The intervention was preceded by a baseline period to determine the stability of the outcome measures. Forty-one participants were enrolled at a mean of 36 months poststroke. The 3-week intervention combined physical therapy with social and cognitive stimulation inherent to environmental enrichment. The primary outcome was motor recovery measured by Modified Motor Assessment Scale (M-MAS). Secondary outcomes included balance, walking, distance walked in 6 minutes, grip strength, dexterity, and multiple dimensions of health. Assessments were made at baseline, immediately before and after the intervention, and at 3 and 6 months.The baseline measures were stable. The 39 participants (95%) who completed the intervention had increases of 2.3 points in the M-MAS UAS and 5 points on the Berg Balance Scale (both P < 0.001; SRM >0.90), an improvement of comfortable and fast gait speed of 0.13 and 0.23 m/s, respectively. (P < 0.001; SRM = 0.88), an increased distance walked over 6 minutes (24.2 m; P < 0.001; SRM = 0.64), and significant improvements in multiple dimensions of health. The improvements were sustained at 6 months.Enriched, task-specific therapy may provide durable benefits across a wide spectrum of motor deficits and impairments after stroke. Although the results must be interpreted cautiously, the findings have implications for enriching strategies in stroke rehabilitation.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A304).
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