Effect of a therapeutic intervention for the hemiplegic upper limb in the acute phase after stroke: a single-blind, randomized, controlled multicenter trial. A study on additional early physiotherapy after stroke and factors affecting functional recovery Physiotherapy for patients with mobility problems more than 1 year after stroke: a randomised controlled trial Is dosage of physiotherapy a critical factor in deciding patterns of recovery from stroke: a pragmatic randomized controlled trial. Does an early increased-intensity interdisciplinary upper limb therapy programme following acute stroke improve outcome? Effectiveness of an intensive outpatient rehabilitation program for postacute stroke patients. The significance of intensity of rehabilitation of stroke--a controlled trial. Early and Repetitive Stimulation of the Arm Can Substantially Improve the Long-Term Outcome After Stroke: A 5-Year Follow-up Study of a Randomized Trial Enhanced physical therapy for arm function after stroke: a one year follow up study. Enhanced physical therapy improves recovery of arm function after stroke. A randomised controlled trial. Randomized, controlled trial to evaluate increased intensity of physiotherapy treatment of arm function after stroke. Domiciliary occupational therapy for patients with stroke discharged from hospital: randomised controlled trial Additional task-related practice improves mobility and upper limb function early after stroke: a randomised controlled trial. Remedial therapy after stroke: a randomised controlled trial. A randomized controlled comparison of upper-extremity rehabilitation strategies in acute stroke: A pilot study of immediate and long-term outcomes. Effect of severity of arm impairment on response to additional physiotherapy early after stroke A randomized trial on the efficacy
of intensive rehabilitation in the acute phase of ischemic
stroke The Role of Technology in Task-Oriented Training in Persons with Subacute Stroke: A Randomized Controlled Trial A randomized controlled trial of enhanced Social Service occupational therapy for stroke patients Occupational therapy for stroke patients not admitted to hospital: a randomised controlled trial Follow-up services for stroke survivors after hospital discharge-a randomized control study Does an extended stroke unit service with early supported discharge have any effect on balance or walking speed? Physiotherapy intervention late after stroke and mobility. Can augmented physiotherapy input enhance recovery of mobility after stroke? A randomized controlled trial Gait outcomes after additional backward walking training in patients with stroke: a randomized controlled trial Intensive Early Physiotherapy Combined with Dexamphetamine Treatment in Severe Stroke: A Randomized, Controlled Pilot Study PEDro. A database of randomized trials and systematic reviews in physiotherapy. What’s New in Stroke Rehabilitation Task-specific physical therapy for optimization of gait recovery in acute stroke patients.
BACKGROUND AND PURPOSE Arm function recovery is notoriously poor in stroke patients . The effect of treatment modalities , particularly those directed at improving upper limb function , has been studied primarily in chronic stroke patients . The purpose of this study was to investigate the effect of a specific therapeutic intervention on arm function in the acute phase after stroke . METHODS In a single-blind , r and omized , controlled multicenter trial , 100 consecutive patients were allocated to either an experimental group that received an additional treatment of sensorimotor stimulation or to a control group . The intervention was applied for 6 weeks . Patients were evaluated for level of impairment ( Brunnström-Fugl-Meyer test ) and disability ( Action Research Arm test , Barthel Index ) before , midway , and after the intervention period and at follow-up 6 and 12 months after stroke . RESULTS Patients in the experimental group performed better on the Brunnström-Fugl-Meyer test than those in the control group throughout the study period , but differences were significant only at follow-up . Results on the Action Research Arm test and Barthel Index revealed no effect at the level of disability . The effect of the therapy was attributed to the repetitive stimulation of muscle activity . The treatment was most effective in patients with a severe motor deficit and hemianopia or hemi-inattention . No adverse effects due to the intervention were found . CONCLUSIONS Adding a specific intervention during the acute phase after stroke improved motor recovery , which was apparent 1 year later . These results emphasize the potential beneficial effect of therapeutic interventions for the arm Objective : To investigate whether additional early physiotherapy after stroke improved functional recovery in stroke patients . Design : A prospect i ve , r and omized , controlled study . Setting : One stroke ward and an acute stroke unit in a large teaching hospital , southern China . Subjects : Patients with first-onset stroke consecutively admitted to the stroke centre . Interventions : One group ( n = 78 ) received additional early physiotherapy ( AEP ) for 45 minutes , five days a week for four weeks starting within the first week since stroke onset ; the routine therapy ( RT ) group ( n = 78 ) received no professional rehabilitation therapy . Main outcome measures : Glasgow Coma Scale , Mini-Mental State Examination , Fugl-Meyer Assessment of Motor Recovery , Clinical Neurological Deficit Scale and Modified Barthel Index ( MBI ) . Results : Patients from the AEP group had a high drop-out rate ( n = 28 ) , but those remaining made relatively better functional recovery at 30 days than those from the RT group if measured by MBI . Multiple linear regression analysis revealed that cognitive disturbance , aphasia , double incontinence , site of lesion and sensory impairment might affect functional recovery after stroke . Conclusions : Additional early physiotherapy might improve independence of patients after stroke but failed to show benefit in other aspects in our study . Cognitive disturbance , aphasia , double incontinence , site of lesion as well as sensory impairment might affect functional outcome after stroke BACKGROUND Community physiotherapy is often prescribed for stroke patients with long-term mobility problems . We aim ed to assess the effectiveness of this treatment in patients who had mobility problems 1 year after stroke . METHODS We screened 359 patients older than 50 years for a single-masked , r and omised controlled trial to assess the effects of community physiotherapy . Assessment s were made at baseline , 3 , 6 , and 9 months in 170 eligible patients assigned treatment or no intervention . The primary outcome measure was mobility measured by the Rivermead mobility index . Secondary outcome measures were gait speed , number of falls , daily activity ( Barthel index scores ) , social activity ( Frenchay activities index ) , hospital anxiety and depression scale , and emotional stress of carers ( general health question naire 28 ) . Analyses were by intention to treat . FINDINGS Follow-up was available for 146 patients ( 86 % ) . Changes in scores on the Rivermead mobility index ( score range 0 - 15 ) differed significantly between treatment and control groups at 3 months ( p=0.018 ) , but only by a median of 1 point ( 95 % CI 0 - 1 ) , with an interpolated value of 0.55 ( 0.08 - 1.04 ) . Gait speed was 2.6 m/min ( 0.30 - 4.95 ) higher in the treatment group at 3 months . Neither treatment effect persisted at 6-months ' and 9-months ' follow-up . Treatment had no effect on patients ' daily activity , social activity , anxiety , depression , and number of falls , or on emotional stress of carers . INTERPRETATION Community physiotherapy treatment for patients with mobility problems 1 year after stroke leads to significant , but clinical ly small , improvements in mobility and gait speed that are not sustained after treatment ends BACKGROUND AND PURPOSE The best treatment and management of stroke patients has been shown to be in stroke units by multidisciplinary rehabilitation teams . Since the composition of stroke units differs it is important to know the extent to which the different components contribute to this results . Physiotherapy is one component of most rehabilitation teams and recent systematic review s have shown that patients with stroke receiving more physiotherapy  achieve more recovery from disability . However , information about the actual amounts of physiotherapy needed to achieve this result is not known . METHOD A pragmatic , r and omized , single-blind , controlled trial comparing recovery from disability in subjects receiving the current st and ard amount of 30 minutes ' physiotherapy with those receiving double that amount ( 60 minutes ) . The study included measures of physical performance and function , psychological aspects of anxiety and depression , and perceived control over recovery . RESULTS Some 114 subjects were recruited to the study ; full six-week data are available for 104 subjects and six-month data for 93 subjects . Comparison of initial to six-week difference scores in the control and intervention groups of the whole sample did not show a significant difference . Scrutiny of the recovery curves of the whole sample showed that , in half the sample , three distinct patterns of recovery were demonstrated . CONCLUSION These results suggest that doubling the physiotherapy time available for patients in a stroke unit will not provide a measurable benefit for all patients . The subgroup analysis of patterns of recovery must be regarded as speculative , but provides the basis for hypotheses about those likely to respond well to more intensive therapy Objective : To determine whether an early increased-intensity upper limb therapy programme following acute stroke improves outcome . Design : A r and omized controlled trial . Setting : A stroke unit which provides acute care and rehabilitation for all stroke admissions . Subjects : One hundred and twenty-three patients who had had a stroke causing upper limb impairment within the previous 10 days . Intervention : The intervention group received stroke unit care plus enhanced upper limb rehabilitation provided jointly by a physiotherapist and occupational therapist , commencing within 10 days of stroke , and available up to 30 minutes/day , five days/week for six weeks . The control group received stroke unit care . Main outcome measures : The primary outcome measure was the Action Research Arm Test ( ARAT ) three months after stroke . Secondary outcome measures : Motricity Index ; Frenchay Arm Test ; upper limb pain ; Barthel ADL Index ; Nottingham E-ADL Scale ; and costs to health and social services at three and six months after stroke . Results : There were no differences in outcomes between the intervention and control groups three and six months after stroke . During the intervention period the intervention group received a median of 29 minutes of enhanced upper limb therapy per working day as in patients . The total amount of inpatient physiotherapy and occupational therapy received by the intervention group was a median of 52 minutes per working day during the intervention period and 38 minutes per working day for the control group ( p = 0.001 ) . There were no differences in service costs . Conclusions : An early increased-intensity interdisciplinary upper limb therapy programme jointly provided by a physiotherapist and occupational therapist did not improve outcome after stroke . The actual difference in the amount of therapy received by intervention and control groups was less than planned due to a competitive therapy bias The effectiveness of ongoing rehabilitation services for postacute stroke survivors is poorly documented . We design ed a r and omized control , single-blinded study to demonstrate the effectiveness of intensive outpatient therapy . The treatment intervention consisted of 1 hr each of physical and occupational therapy , four times per week , for 12 wk ; therapy focused on neuromuscular facilitation and functional tasks . All subjects were screened before the therapies and after 3 mo and 9 mo . Forty-nine stroke survivors , who were at least l yr ( mean , 2.9 yr ) poststroke , were r and omized with two treated patients to each control ( no treatment supplied ) . All patients had received inpatient rehabilitation at the time of their acute stroke , but no patient had any ongoing therapy  within the last 6 mo . The outcome measures included the Functional Independence Measure ( FIM ) , Brunnstrom stages of motor recovery , timed mobility tasks , and the Jebson h and evaluation . We also evaluated the level of depression , self-esteem , and socialization . The treated patients demonstrated an improvement of 6.6 points over the 3 mo of therapy compared with only 1.5 points in the control group in the FIM motor score transformed using Rasch analysis . The change from time 0 to 3 mo was significant in the treated group but not in the controls . Treated patients maintained their gains at the 9-mo follow-up , and controls lost ground . The treated group improved in terms of socialization and self-esteem as evidence d by a lower Sickness Impact Profile , whereas the controls tended to get worse . There was a trend toward less depression , but this did not reach a P = 0.05 level of significance . This study demonstrates that significant functional gains can still be attained in the postacute stroke survivor , despite prior inpatient rehabilitation services Of the 373 stroke patients 95 were admitted to the feasibility study of stroke rehabilitation . The patients were divided into two groups , an intensive and a normal treatment group . In this study , the functional recovery of stroke , measured by ADL and motor function was significantly better in the intensive treatment group . There was no difference in institutionalization or incidence of death between the groups . The gain of ADL and motor function was greatest during the first three months after stroke in the intensive treatment group . The conclusion is that intensified physiotherapy seems to improve the functional recovery of stroke patients Background and Purpose — Several studies have investigated the effect of therapeutic interventions for the arm in the acute phase after stroke , with follow-ups at a maximum of 12 months . The aim of this study was to examine the effect of repetitive sensorimotor training of the arm at 5 years after stroke . Subjects and Methods — One hundred consecutive stroke patients were r and omly allocated either to an experimental group that received daily additional sensorimotor stimulation of the arm or to a control group . The intervention period was 6 weeks . Assessment s of the patients were made before , midway , and after intervention , and at 6 and 12 months after stroke . In this study , 62 patients were reassessed at 5 years after stroke . The Brunnström-Fugl-Meyer ( BFM ) test , Action Research Arm ( ARA ) test , and Barthel index ( BI ) were used as the primary outcome measures . Results — At the 5-year follow-up , there was a statistically significant difference for both the BFM and ARA tests in favor of the experimental group . The mean differences in improvement between the groups from the initial evaluation to the 5-year assessment corresponded to 17 points on the BFM and 17.4 on the ARA . No effect was found for the BI . The treatment was most effective in patients with a severe initial motor deficit . Conclusions — Adding a specific intervention for the arm during the acute phase after a stroke result ed in a clinical ly meaningful and long-lasting effect on motor function . The effect can be attributed to early , repetitive , and targeted stimulation Ninety seven patients with stroke who had participated in a r and omised trial of conventional physical therapy nu an enhanced therapy for arm function were followed up at one year . Despite the emphasis of the enhanced therapy approach on continued use of the arm in everyday life , the advantage seen for some patients with enhanced therapy at six months after stroke had diminished to a non-significant trend by one year . This was due to some late improvement in the conventional therapy group whereas the enhanced therapy group remained static or fell back slightly . It is recommended that trials should be conducted comparing very intensive therapy for the arm with controls without treatment . This would provide a model of the effects of therapy on intrinsic neural recovery that would be relevant to all areas of neurological rehabilitation Previous research on stroke rehabilitation has not established whether increase in physical therapy lead to better intrinsic recovery from hemiplegia . A detailed study was carried out of recovery of arm function after acute stroke , and compares orthodox physiotherapy with an enhanced therapy regime which increased the amount of treatment as well as using behavioural methods to encourage motor learning . In a single-blind r and omised trial , 132 consecutive stroke patients were assigned to orthodox or enhanced therapy groups . At six months after stroke the enhanced therapy group showed a small but statistically significant advantage in recovery of strength , range and speed of movement . This effect seemed concentrated amongst those who had a milder initial impairment . More work is needed to discover the reasons for this improved recovery , and whether further development of this therapeutic approach might offer clinical ly significant gains for some patients BACKGROUND AND PURPOSE Many patients have impaired arm function after stroke , for which they receive physiotherapy . The aim of the study was to determine whether increasing the amount of physiotherapy early after stroke improved the recovery of arm function and to compare the effects of this therapy when administered by a qualified therapist or a trained , supervised assistant . The physiotherapy followed a typical British approach , which is Bobath derived . Ten hours of additional therapy were given over a 5-week period . METHODS The study design was a single-blind , r and omized , controlled trial . Stroke patients were recruited from those admitted to the hospital in the 5 weeks after stroke . They were r and omly allocated to routine physiotherapy , additional treatment by a qualified physiotherapist , or additional treatment by a physiotherapy assistant . Outcome was assessed after 5 weeks of treatment and at 3 and 6 months after stroke on measures of arm function and of independence in activities of daily living . RESULTS There were 282 patients recruited to the study . The median initial Barthel score was 6.5 , and the median age of the patients was 73 years . The median initial Rivermead Motor Assessment Arm score was 1 . There were no significant differences between the groups at r and omization or on any of the outcome measures . Only half of the patients allocated to the 2 additional-therapy groups completed the program . CONCLUSIONS This increase in the amount of physiotherapy for arm impairment with a typical British approach given early after stroke did not significantly improve the recovery of arm function in the patients studied . A number of other studies of interventions aim ed at rehabilitation of arm function have reported positive results . Such findings may have been due to the content of these interventions , to the greater intensity of the interventions , or to the selection of patients to whom the treatments were applied Abstract Objective : To establish if a brief programme of domiciliary occupational therapy could improve the recovery of  patients with stroke discharged from hospital . Design : Single blind r and omised controlled trial . Setting : Two hospital sites within a UK teaching hospital . Subjects : 138 patients with stroke with a definite plan for discharge home from hospital . Intervention : Six week domiciliary occupational therapy or routine follow up . Main outcome measures : Nottingham extended activities of daily living score and “ global outcome ” ( deterioration according to the Barthel activities of daily living index , or death ) . Results : By eight weeks the mean Nottingham extended activities of daily living score in the intervention group was 4.8 points ( 95 % confidence interval −0.5 to 10.0 , P=0.08 ) greater than that of the control group . Overall , 16 ( 24 % ) intervention patients had a poor global outcome compared with 30 ( 42 % ) control patients ( odds ratio 0.43 , 0.21 to 0.89 , P=0.02 ) . These patterns persisted at six months but were not statistically significant . Patients in the intervention group were more likely to report satisfaction with a range of aspects of services . Conclusion : The functional outcome and satisfaction of patients with stroke can be improved by a brief occupational therapy programme carried out in the patient 's home immediately after discharge . Major benefits may not , however , be sustained The purpose of this study was to investigate whether additional practice of either upper limb or mobility tasks improved functional outcome during inpatient stroke rehabilitation . This prospect i ve , r and omised , single blind clinical trial recruited 30 stroke subjects into either an Upper Limb or a Mobility Group . All subjects received their usual rehabilitation and an additional session of task-related practice using a circuit class format . Independent assessors , blinded to group allocation , tested all subjects . Outcome measures used were three items of the Jebsen Taylor H and Function Test ( JTHFT ) , two  arm items  of the Motor Assessment Scale ( MAS ) , and three mobility measures , the Timed Up and Go Test ( TUGT ) , Step Test , and Six Minute Walk Test ( 6MWT ) . Both groups improved significantly between pre- and post-tests on all of the mobility measures , however only the Upper Limb Group made a significant improvement on the JTHFT and MAS upper arm items . Following four weeks training , the Mobility Group had better locomotor ability than the Upper Limb Group ( between-group differences in the 6MWT of 116.4 m , 95 % CI 31.4 to 201.3 m , Step Test 2.6 repetitions , 95 % CI -1.0 to 6.2 repetitions , and TUGT -7.6 sec , 95 % CI -15.5 to 0.2 sec ) . The JTHFT dexterity scores in the Upper Limb Group were 6.5 sec ( 95 % CI -7.4 to 20.4 sec ) faster than the Mobility Group . Our findings support the use of additional task-related practice during inpatient stroke rehabilitation . The circuit class format was a practical and effective means to provide supervised additional practice that led to significant and meaningful functional gains Of 1094 patients with a confirmed stroke admitted to Northwick Park , a district general hospital , 364 ( 33 % ) died while in hospital , 215 ( 20 % ) were fully recovered when discharged , and 329 ( 30 % ) were too frail or too ill from diseases other than stroke to be considered for active rehabilitation . Only 121 ( 11 % ) were suitable for intensive treatment .  They and 12 patients referred direct to out patients were allocated at r and om to one of three different courses of rehabilitation . Intensive was compared with conventional rehabilitation and with a third regimen which included no routine rehabilitation , but under which patients were encouraged to continue with exercises taught while in hospital and were regularly seen at home by a health visitor .  Progress at three months and 12 months was measured by an index of activities of daily living . Improvement was greatest in those receiving intensive treatment , intermediate in those receiving conventional treatment , and least in those receiving no routine treatment .  Decreasing intensity of treatment was associated with a significant increase in the proportions of patients who deteriorated and in the extent to which they deteriorated . Probably only a few stroke patients , mostly men , are suitable for  intensive outpatient rehabilitation  , but for those patients the treatment is effective and realistic OBJECTIVE To evaluate the immediate and long-term effects of 2 upper-extremity rehabilitation approaches for stroke compared with st and ard care in participants stratified by stroke severity . DESIGN Nonblinded , r and omized controlled trial ( baseline , postintervention , 9mo ) design . SETTING Inpatient rehabilitation hospital and outpatient clinic . PARTICIPANTS Sixty-four patients with recent stroke admitted for inpatient rehabilitation were r and omized within severity strata ( Orpington Prognostic Scale ) into 1 of 3 intervention groups . Forty-four patients completed the 9-month follow-up . INTERVENTIONS St and ard care ( SC ) , functional task practice ( FT ) , and strength training ( ST ) . The FT and ST groups received 20 additional hours of upper-extremity therapy beyond st and ard care distributed over a 4- to 6-week period . MAIN OUTCOME MEASURES Performance measures of impairment ( Fugl-Meyer Assessment ) , strength ( isometric torque ) , and function ( Functional Test of the Hemiparetic Upper Extremity [ FTHUE ] ) . RESULTS Compared with SC participants , those in the FT and ST groups had significantly greater increases in Fugl-Meyer motor scores ( P=.04 ) and isometric torque ( P=.02 ) posttreatment . Treatment benefit was primarily in the less severe participants , where improvement in FT and ST group Fugl-Meyer motor scores more than doubled that of the SC group . Similar results were found for the FTHEU and isometric torque . During the long term , at 9 months , the less severe FT group continued to make gains in isometric muscle torque , significantly exceeding those of the ST group ( P<.05 ) . CONCLUSIONS Task specificity and stroke severity are important factors for rehabilitation of arm use in acute stroke . Twenty hours of upper extremity-specific therapy over 4 to 6 weeks significantly affected functional outcomes . The immediate benefits of a functional task approach were similar to those of a resistance-strength approach , however , the former was more beneficial in the long-term Objective : To investigate effect of initial severity of arm impairment on response to additional physiotherapy for the arm after stroke . Design : In this controlled trial , patients were r and omized into one of three groups :  routine physiotherapy ( RPT ) patients received no additional physiotherapy ; qualified physiotherapy ( QPT ) patients received additional treatment from a qualified physiotherapist ; assistant physiotherapy ( APT ) patients received additional treatment from a trained supervised assistant . Comparisons between the whole groups found no significant differences and have been reported elsewhere . In a post hoc analysis , the groups were subdivided according to severity of initial arm impairment . The subgroups were then compared . Setting : A general hospital with acute and rehabilitation facilities for stroke patients . Subjects : Patients ( n= 282 ) between one and five weeks after stroke . Interventions : Ten hours additional physiotherapy were given over a five-week period . The treatment approach reflected current usual British practice . ‘ Blind ’ outcome assessment was performed after intervention , and at three and six months after stroke . Main outcome measures : Rivermead Motor Assessment Arm Scale , Action Research Arm Test . Results : In more severe patients , no benefits of additional treatment were detected . In less severe patients , significant benefits were found in those who completed treatment with the trained assistant . However , a considerable number of patients did not complete the additional treatment . The content of treatment differed between the QPT and APT groups . Treatment of less severe APT patients emphasized repetitive supervised practice of movements and functional tasks . No significant effects of additional treatment were found in terms of shoulder pain or spasticity . Conclusions : Regardless of whether additional physiotherapy was given or not , patients with severe arm impairment improved very little in arm function . Enabling adaptation to loss of arm function may be an appropriate rehabilitation strategy for some patients . Trends in the data confirm findings of some previous studies that intensive treatment for patients with some motor recovery of the upper limb is effective . Following patient assessment and treatment planning by a qualified physiotherapist , it may be appropriate for guidance of repetitive practice of motor and functional tasks to be delegated to trained and closely supervised assistant staff Abstract .Sixty patients admitted to hospital for hemispherical ischemic stroke causing severe disabilities were enrolled in the study . The patients were divided in two groups : A and B. The patients in group A were given intensive rehabilitative treatment ; those in group B were given ordinary rehabilitative treatment . Both treatments lasted 14 days . At the end of that period , the patients of both groups were sent to the same rehabilitation center to continue treatment , using the same methods for all . The patients were evaluated by means of the modified N. I. H. Stroke Scale and the Barthel-Index on the day of enrolment , on the 14th and 180th day . The results obtained from intensive treatment were no better than those obtained from ordinary treatment . This study shows that there is no point in adopting an intensive rehabilitative treatment for an ischemic stroke in its acute phase : a more expensive and time-consuming effort does not in any way lead to a better outcome This trial compares the effects of task-oriented physical therapy ( PT ) provided with and without the use of rehabilitation technology on locomotor recovery in 63 persons with subacute stroke . Participants in the experimental ( EXP ) group used a treadmill , a Kinetron isokinetic exerciser , and a limb-load monitor , whereas those in the control ( CTL ) group did not while engaging in PT 1 h per day , 5 days per week for 2 months . Locomotor recovery was assessed by clinical ( gait speed , Fugl Meyer motor leg and arm subscores , the Balance Scale , the Timed Up and Go , and the Barthel ambulation subscore ) and laboratory outcomes ( gait kinematics and kinetics ) pre- and posttherapy and 3 months later . Within groups , gait speed ( P < 0.01 ) and all secondary measures improved posttherapy ( P < 0.01 - 0.05 ) , and improvements in clinical measures were maintained at follow-up , but there was no difference between groups ( P > 0.05 ) . When the groups were pooled , the increase in gait speed was associated ( r = 0.52 , P = 0.003 ) with an increase in ankle power generation of the affected leg . The results demonstrate that the efficacy of the task-oriented approach is not dependent on rehabilitation technology Objective : To determine whether stroke patients referred to the Social Service occupational therapy service  would benefit from an enhanced service compared to the usual service . Design : R and omized controlled study allocating patients to the enhanced service or the usual service . Subjects : Stroke patients discharged home from hospital and referred to Social Service occupational therapy department . Outcome measures : The sections and total score from the Nottingham Extended Activities of Daily Living Scale ( EADL ) , the Barthel Index , the General Health Question naire ( GHQ ) and the number of pieces of equipment provided were analysed . Results : One hundred and eleven stroke patients were recruited to this study . Fifty-three were r and omly allocated to the enhanced service and 58 to the usual service . Patients receiving the enhanced service were seen more quickly after referral , for longer , and received significantly more visits ( p < 0.01 ) than those receiving the usual service . Three months after entry to the study the enhanced service group had better EADL ( p < 0.01 ) than the usual service group . This benefit remained significant in only the mobility section of the EADL at six months . Carers of the stroke patients in the enhanced group had lower GHQ scores ( p < 0.05 ) than those in the usual group at six months . Conclusions : This trial supports the use of domiciliary occupational therapy for stroke patients after discharge from hospital in terms of improvements in functional outcomes in the short term , but the long-term benefits remain unclear BACKGROUND Patients who have a stroke are not always admitted to hospital , and 22 - 60 % remain in the community , frequently without coordinated rehabilitation . We aim ed to assess the efficacy of an occupational therapy intervention for patients with stroke who were not admitted to hospital . METHODS In this single-blind r and omised controlled trial , consecutive stroke patients on a UK community register in Nottingham and Derbyshire were allocated r and omly to up to 5 months of occupational therapy at home or to no intervention ( control group ) 1 month after their stroke . The aim of the occupational therapy was to encourage independence in personal and instrumental activities of daily living . Patients were assessed on outcome measures at baseline ( before r and omisation ) and at 6 months . The primary outcome measure was the score on the extended activities of daily living ( EADL ) scale at 6 months . Other outcome measures included the Barthel index , the general health question naire 28 , the carer strain index , and the London h and icap scale . All assessment s were done by an independent assessor who was unaware of treatment allocation . The analysis included only data from completed question naires . FINDINGS 185 patients were included : 94 in the occupational therapy group and 91 in the control group . 22 patients were not assessed at 6 months . At follow-up , patients who had occupational therapy had significantly higher median scores than the controls on : the EADL scale ( 16 vs 12 , p<0.01 , estimated difference 3 [ 95 % CI 1 to 4 ] ) ; the Barthel index ( 20 vs 18 , p<0.01 , difference 1 , [ 0 - 1 ] ) ; the carer strain index ( 1 vs 3 , p<0.05 , difference 1 [ 0 to 2 ] ) ; and the London h and icap scale ( 76 vs 65 , p<0.05 , difference 7 , [ 0.3 to 13.5 ] ) . There were no significant differences on the general health question naire between the patient or carer . INTERPRETATION Occupational therapy significantly reduced disability and h and icap in patients with stroke who were not admitted to hospital Objective : To evaluate whether follow-up services for stroke survivors could improve functional outcome and reduce readmission rate . In this paper results of functional outcome are reported . Design : R and omized controlled trial allocating patients to one of three different types of aftercare : ( 1 ) follow-up home visits by a physician , ( 2 ) physiotherapist instruction in the patient 's home , or ( 3 ) st and ard aftercare . Subjects : Stroke patients with persisting impairment and disability who , after completing inpatient rehabilitation , were discharged to their homes . Outcome measures : Six months after discharge , functional outcome was assessed with Functional Quality of Movement , Barthel Index , Frenchay Activity Index and Index of Extended Activites of Daily Living . Results : One-hundred and fifty-five stroke patients were included in the study . Fifty-four received follow-up home visits by a physician , 53 were given instructions by a physiotherapist in their home and 48 received st and ard aftercare only . No statistically signi ca nt differences in functional outcome six months after discharge were demonstrated between the three groups . However , all measurements showed a tendency towards higher scores indicating better function in both interventions groups compared with the control group . Conclusion : Follow-up services after stroke may be a way of improving functional outcome . The results of the present study should be evaluated in future trials . More research in this eld is needed , especially studies of how to support stroke survivors to resume social and leisure activities OBJECTIVE To evaluate the effect of an extended stroke unit service with early supported discharge on balance and walking speed , and to explore the association between initial leg paresis , initial movement ability and balance one year after stroke . DESIGN A r and omized controlled trial comparing early supported discharge with ordinary stroke unit service . PATIENTS A total of 62 eligible patients after stroke . METHODS The outcome measures were Berg Balance Scale and walking speed at 1 , 6 , 26 and 52 weeks after stroke . RESULTS We found no significant differences between the 2 groups during follow-up . There was a significant improvement on Berg Balance Scale ( p=0.013 ) and walking speed ( p=0.022 ) in the early supported discharge group , but not in the ordinary service group , from 1 to 6 weeks ' follow-up . All patients with initial severe leg paresis suffered from poor balance one year after the stroke . The odds ratio for poor balance was 42.1 ( 95 % confidence interval ; 3.5 - 513.9 ) among patients with no initial walking ability . CONCLUSION These results do not conclusively indicate that early supported discharge has an effect on balance . A strong association was found between initial severe leg paresis , initial inability to walk and poor balance after one year OBJECTIVE --To determine whether the intervention of a physiotherapist improved mobility in patients seen more than one year after stroke . DESIGN --R and omised crossover trial comparing two groups offered intervention by a physiotherapist , one immediately after entry into the trial and the other after a delay of three months . The intervention consisted of identifying problems and offering advice and help to solve the problems . SETTING -- Patients ' homes in Oxfordshire . SUBJECTS-- Patients who had reduced mobility due to a stroke more than one year before entry ; 60 were recruited from a community stroke register and 34 in other ways . MAIN OUTCOME MEASURES --St and ard measures of mobility including gait speed , functional ambulation categories , the Nottingham extended activities of daily living index , and individual items from the Barthel activities of daily living index and the Frenchay activities index . Measures of manual dexterity , depression , and anxiety were used as controls . RESULTS --94 patients entered the trial and 49 were r and omised to immediate and 45 to delayed physiotherapy ; 89 were compared at the crossover point . At r and omisation the two groups were comparable . At three months the group given early therapy showed an improvement in gait speed whereas the untreated group had declined ( differences of -3.9 v 6.4 s to walk 10 m ; p less than 0.01 ) ; between three and six months the group given delayed therapy showed improvement and the previously treated group declined ( differences of 6.5 v -3.9 s to walk 10 m ; p less than 0.01 ) . A 9 % ( 95 % confidence interval 0 % to 18 % ) decrease in time taken to walk 10 m was associated with treatment and a 12 % ( 2 % to 19 % ) increase when patients were untreated . Other measures did not change significantly . CONCLUSION --Intervention of an experienced physiotherapist late after stroke specifically improves mobility , albeit by a small amount , but the effects do not seem to be maintained , perhaps because there is an underlying decline in mobility in these patients . Gait speed offers a simple and sensitive measure of outcome Objective : To discover if the provision of additional  inpatient physiotherapy after stroke speeds the recovery of mobility . Design : A multisite single-blind r and omized controlled trial ( RCT ) comparing the effects of augmented physiotherapy input with normal input on the recovery of mobility after stroke . Setting : Three rehabilitation hospitals in North Glasgow , Scotl and . Subjects : Patients admitted to hospital with a clinical diagnosis of stroke , who were able to tolerate and benefit from mobility rehabilitation .  Intervention : We aim ed to provide double the amount of physiotherapy to the augmented group . Main measures : Primary outcomes were mobility milestones ( ability to st and , step and walk ) , Rivermead Mobility Index ( RMI ) and walking speed . Results : Seventy patients were recruited . The augmented therapy group received more direct contact with a physiotherapist ( 62 versus 35 minutes per weekday ) and were more active ( 8.0 % versus 4.8 % time st and ing or walking ) than normal therapy controls . The augmented group tended to achieve independent walking earlier ( hazard ratio 1.48 , 95 % confidence interval 0.90–2.43 ; p=0.12 ) and had higher Rivermead Mobility Index scores at three months ( mean difference 1.6 ; 0.1 to 3.3 ; p=0.068 ) but these differences did not reach statistical significance . There was no significant difference in any other outcome . Conclusions : A modest augmented physiotherapy programme result ed in patients having more direct physiotherapy time and being more active . The inability to show statistically significant changes in outcome measures could indicate either that this intervention is ineffective or that our study could not detect modest changes Objective : To examine the effectiveness of additional backward walking training on gait outcome of patients post stroke . Design : R and omized controlled trial . Setting : Medical centre . Subjects : Twenty-five subjects with stroke , who were lower extremity Brunnstrom motor recovery stage at 3 or 4 and were able to walk 11 m with or without a walking aid or orthosis , r and omly allocated to two groups , control ( n = 12 ) and experimental ( n = 13 ) . Interventions : Subjects in both groups participated in 40 min of conventional training programme three times a week for three weeks . Subjects in experimental group received additional 30 min of backward walking training for three weeks at a frequency of three times per week . Main measures : Gait was measured using the Stride Analyzer . Gait parameters of interest were walking speed , cadence , stride length , gait cycle and symmetry index . Measures were made at baseline before commencement of training ( pre-training ) and at the end of the three-week training period ( post-training ) . Results : After a three-week training period , subjects in experimental group showed more improvement than those in control group for walking speed ( change score : 8.609 ± 6.95 versus 3.659 ± 2.92 , p-value = 0.032 ) , stride length ( change score : 0.0909 ± 0.076 versus 0.00649 ± 0.078 , p-value = 0.006 ) , and symmetry index ( change score : 44.079 ± 53.29 versus 5.309 ± 13.91 , p-value = 0.018 ) . Conclusions : This study demonstrated that asymmetric gait pattern in patients post stroke could be improved from receiving additional backward walking therapy Background : The most severely disabled stroke patients are often excluded from studies evaluating effects of physiotherapy . This study intended to investigate the effect of an increased intensity of physiotherapy in combination with dexamphetamine the first week after ischemic stroke in patients with an impaired level of consciousness and severe motor dysfunction . Methods : Thirty patients were enrolled within 96 h after onset of symptoms . Patients were r and omized to 30–45 min of physiotherapy twice daily or to maximally 15 min per day for 5 days . All patients received dexamphetamine to achieve alertness . Functional outcome measures were assessed at baseline , the day after treatment discontinuation , and 3 and 12 months after stroke onset . Residence of living was registered at long-term follow-ups . Results : No statistically significant differences were seen between groups in the outcomes measured at any time point . However , both groups improved over time in all outcomes at 3 and 12 months ( p < 0.05 ) , except for sensory functions at 3 months and motor functions at 12 months . The number of patients needed to treat ( NNT ) to achieve the desired improvement in Lindmark motor score was 8 , with the 95 % CI being NNT(harm ) 10 to NNT(beneficial ) 3 . The fraction of patients who died was the same in both treatment groups , 47 % ( 95 % CI 28–65 % ) . Conclusions : An increased intensity of physiotherapy in combination with dexamphetamine during the first week after stroke onset did not affect short- or long-term outcome in this limited sample of patients with severe stroke This paper describes PEDro , the Physiotherapy Evidence Data base . PEDro is a web-based data base of r and omized controlled trials and systematic review s in physiotherapy . It can be accessed free of charge at http://ptwww.cchs.usyd.edu.au/pedro . The data base contains bibliographic details and abstract s of most English- language r and omized trials and systematic review s in physiotherapy , and of many trials and review s in other language s. Trials on the data base are rated on the basis of their method ological quality so that users of the data base can quickly identify trials of high quality . Trials and systematic review s are extensively indexed to facilitate search ing . PEDro provides an important information re source to support evidence -based clinical practice Stroke rehabilitation has been revolutionized in the last decade through a combination of new imaging techniques looking at brain recovery and clinical trials into what is working in stroke rehabilitation . The fear that rehabilitation was a long way from being rooted in science1 has been overcome by an increasing underst and ing of neuronal recovery processes and their modulation by various physical and pharmacological interventions . More than 300 r and omized controlled trials provide a sound foundation for evidence -based practice in stroke rehabilitation , supplementing and often confirming decades of clinical experience . This growing body of knowledge has been enriched by several studies in 2003 . Advances in basic sciences and clinical research are beginning to merge and show that the human brain is capable of significant recovery after stroke , provided that the appropriate treatments and stimuli are applied in adequate amounts and at the right time . What is particularly exciting is the introduction s of new technologies such as robotic enhancement of therapies and virtual reality to further enhance that recovery . Stroke rehabilitation is therapy intensive and one of the unresolved debates has been around the issues of quality and quantity . Evidence is building that intensity of therapy is important . This is particularly true for language recovery . Bhogal et al2 identified 8 r and omized controlled trials ( RCTs ) , which compared the intensity of speech and language therapy ( SLT ) delivered by a trained therapist versus a non-therapist or a non-SLT control . Four of the studies were positive and these studies provided a mean of 8.8 hours of therapy per week for 11.2 weeks when compared with the 4 negative trials that provide approximately 2 hours of therapy per week for a total of 22.9 weeks . On average , positive RCTs provided 98.4 hours of therapy over half the time that the negative RCTs provided 43.6 hours . Intensive therapy A r and omized controlled pilot trial was conducted to estimate the effects of early , intensive , gait-focused physical therapy on ambulatory ability in acute , stroke patients . Twenty-seven patients with middle cerebral artery infa rct of thromboembolic origin confirmed by computed axial tomography scan were stratified and r and omly assigned to the experimental group , to a control group that received early , intensive and conventional therapy , or to a group receiving routine conventional therapy that started later and was not intense . Assessment s at entry , six weeks , and three and six months by independent evaluators permitted comparisons with reference to clinical measures of motor performance , balance , and functional capacity , and laboratory measures of gait movements . Group results at six weeks demonstrated that gait velocity was similar in the two conventional groups thereby eliminating the timing of the interventions as an important factor . At that point , gait velocity was faster in the experimental group . The difference translated into a moderate effect size of 0.58 . The time dedicated to gait training but not to total therapy time was correlated ( rs = 0.63 ) to gait velocity . This effect disappeared at three and six months after stroke . These pilot results justify planning a large trial to test the effectiveness of a therapeutic protocol that focuses on early and intense gait therapy in an effort to facilitate early ambulation following stroke
Abstract This article focuses on the impact of increased duration of exercise therapy on  functional recovery after stroke .