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Aerobic exercise and consecutive task-specific training (AExaCTT) for upper limb recovery after stroke: a randomized controlled pilot study
Valkenborghs SR, van Vliet P, Nilsson M, Zalewska K, Visser MM, Erickson KI, Callister R
Physiotherapy Research International 2019 Jul;24(3):e1775
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 examined the feasibility of a parallel-group assessor-blinded randomized controlled trial investigating whether task-specific training preceded by aerobic exercise (AEX plus TST) improves upper limb function more than task-specific training (TST) alone. METHODS: People with upper limb motor dysfunction after stroke were allocated to TST or AEX plus TST. Both groups were prescribed 60 hr of TST over 10 weeks (3 x 1-hr sessions with a therapist per week and 3 x 1 hr of home-based self-practice per week). The AEX and TST group performed 30 minutes of aerobic exercise immediately prior to the 1 hr of TST with the therapist. Recruitment, adherence, retention, participant acceptability, and adverse events were recorded. Clinical measures were performed prerandomization at baseline, on completion of the intervention, and at 1- and 6-month follow-up. RESULTS: Fifty-nine persons after stroke were screened, 42 met the eligibility criteria, and 20 (11 male; mean (SD) age 55.4 (16.0) years; time since stroke 71.7 (91.2) months) were recruited over 17 months. The mean Wolf Motor Function Test Functional Ability Score at baseline was 27.4 (max 75) and the mean Action Research Arm Test score was 11.2 (max 57). Nine were randomized to AEX plus TST and 11 to TST. There were no adverse events, but there was one drop out. Retention at 1- and 6-month follow-up was 80% and 85%, respectively. Attendance was 93% (6) for the AEX plus TST group, and 89% (9) for the TST group. AEX plus TST was perceived as acceptable (100%) and beneficial (87.5%). Exertional fatigue (visual analogue scale) prior to TST was worse in the AEX plus TST group (3.5 (0.7) out of 10) than the TST group (1.7 (1.4) out of 10). The TST group performed 31% more repetitions per session than the AEX plus TST group. CONCLUSION: A subsequent Phase III study is feasible, but modifications to eligibility criteria, outcome measures, and intervention delivery are recommended.

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