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Comparison of an intermittent high-intensity versus continuous low-intensity physiotherapy service over 12 months in community-dwelling people with stroke: a randomized trial [with consumer summary] |
Hesse S, Welz A, Werner C, Quentin B, Wissel J |
Clinical Rehabilitation 2011 Feb;25(2):146-156 |
clinical trial |
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
OBJECTIVE: This study compared two modes of physiotherapy service over 12 months in community-dwelling people with stroke, either following a train-wait train paradigm by providing bouts of intense physiotherapy, or a continuous less intense programme. DESIGN: Randomized trial. SETTING: Community-dwelling people with stroke. INTERVENTIONS: Fifty patients, first-time stroke, discharged home, following inpatient rehabilitation, allocated to two groups, A and B. Over 12 months, group A (n = 25) received three two-month blocks of therapy at home, each block contained four 30 to 45 minute sessions per week, totalling 96 sessions. Group B (n = 25) continuously received two 30 to 45 minute sessions per week, totalling 104 sessions. MAIN OUTCOME MEASURES: Primary Rivermead Mobility Index (0 to 15), secondary upper- and lower-limb motor functions, Activities of Daily Living competence, tone and number of falls. RESULTS: Both groups were comparable at onset, the mean age in group A (B) was 62.4 (61.9) years. A and B patients equally improved functions over time, between group differences did not occur. The initial (terminal) Rivermead Mobility Index was 9.4 +/- 2.8 (12.2 +/- 2.1) in group A, and 8.5 +/- 3.5 (11.2 +/- 2.7) in group B. More group B patients fell seriously (7 versus 1). CONCLUSIONS: The intermittent high-intensity and continuous low-intensity therapy protocols were equally effective, the sheer intensity seems more important than the time-mode of application. The relatively young patients functionally improved in the first year after stroke, the reduced risk of serious falls in the intermittent high-intensity group should be validated.
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