A multimodal training with visual biofeedback in subacute stroke survivors: a randomized controlled trial.
Journal
European journal of physical and rehabilitation medicine
ISSN: 1973-9095
Titre abrégé: Eur J Phys Rehabil Med
Pays: Italy
ID NLM: 101465662
Informations de publication
Date de publication:
Feb 2020
Feb 2020
Historique:
pubmed:
27
9
2019
medline:
20
8
2020
entrez:
27
9
2019
Statut:
ppublish
Résumé
Early interventions maximizing patient's involvement are essential to promote gait restoration and motor recovery after stroke. The aim of this study is to evaluate the effects of a multimodal biofeedback training involving cycling augmented by functional electrical stimulation (FES) and balance exercises on walking ability and motor recovery. Randomized controlled trial (NCT02439515). Inpatient rehabilitation facility. Subacute stroke survivors (less than 6 months from the first event) aged up to 90 years old. Sixty-eight participants were randomly allocated to an experimental group, performing 15 sessions of biofeedback FES-cycling training followed by 15 sessions of biofeedback balance training (20 minutes each) in addition to usual care (70 minutes), and a control group performing 30 sessions (90 minutes) of usual care. Participants were evaluated before training, after 15 sessions, after 30 sessions, and at 6-month follow-up through: gait speed (primary outcome), spatiotemporal gait parameters, Six-Minute Walking Test, Functional Independence Measure, Motricity Index, Trunk Control Test, Berg Balance Scale, and Fall Efficacy Scale. Both groups significantly improved over time, but no group and interaction effects were found for any outcomes. The 73% of the experimental group achieved a clinically meaningful change in gait speed compared to the 38% of the control group (P=0.048). These percentages were even more unbalanced for patients with a moderate to severe gait impairment at baseline (91% versus 36%; P=0.008). The multimodal biofeedback training was not statistically superior to usual care, showing only a positive trend in favor of the experimental group on locomotion recovery. Patients initially not able to walk might be the best candidates for such a training. The multimodal biofeedback training is a task-specific, repetitive and intensive training requiring a minimal supervision, which might result in a lower staff to patient ratio if organized in group sessions. Therefore, it can represent a good alternative for early stroke rehabilitation.
Sections du résumé
BACKGROUND
BACKGROUND
Early interventions maximizing patient's involvement are essential to promote gait restoration and motor recovery after stroke.
AIM
OBJECTIVE
The aim of this study is to evaluate the effects of a multimodal biofeedback training involving cycling augmented by functional electrical stimulation (FES) and balance exercises on walking ability and motor recovery.
DESIGN
METHODS
Randomized controlled trial (NCT02439515).
SETTING
METHODS
Inpatient rehabilitation facility.
POPULATION
METHODS
Subacute stroke survivors (less than 6 months from the first event) aged up to 90 years old.
METHODS
METHODS
Sixty-eight participants were randomly allocated to an experimental group, performing 15 sessions of biofeedback FES-cycling training followed by 15 sessions of biofeedback balance training (20 minutes each) in addition to usual care (70 minutes), and a control group performing 30 sessions (90 minutes) of usual care. Participants were evaluated before training, after 15 sessions, after 30 sessions, and at 6-month follow-up through: gait speed (primary outcome), spatiotemporal gait parameters, Six-Minute Walking Test, Functional Independence Measure, Motricity Index, Trunk Control Test, Berg Balance Scale, and Fall Efficacy Scale.
RESULTS
RESULTS
Both groups significantly improved over time, but no group and interaction effects were found for any outcomes. The 73% of the experimental group achieved a clinically meaningful change in gait speed compared to the 38% of the control group (P=0.048). These percentages were even more unbalanced for patients with a moderate to severe gait impairment at baseline (91% versus 36%; P=0.008).
CONCLUSIONS
CONCLUSIONS
The multimodal biofeedback training was not statistically superior to usual care, showing only a positive trend in favor of the experimental group on locomotion recovery. Patients initially not able to walk might be the best candidates for such a training.
CLINICAL REHABILITATION IMPACT
CONCLUSIONS
The multimodal biofeedback training is a task-specific, repetitive and intensive training requiring a minimal supervision, which might result in a lower staff to patient ratio if organized in group sessions. Therefore, it can represent a good alternative for early stroke rehabilitation.
Identifiants
pubmed: 31556542
pii: S1973-9087.19.05847-7
doi: 10.23736/S1973-9087.19.05847-7
doi:
Banques de données
ClinicalTrials.gov
['NCT02439515']
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM