Group task-specific circuit training for patients discharged home after stroke may be as effective as individualised physiotherapy in improving mobility

Abstract

Does task oriented circuit training improve mobility in patients with stroke compared with individualised physiotherapy? Randomised, controlled trial with concealed allocation and blinded outcome assessment. Nine outpatient rehabilitation centres in the Netherlands. Patients with a stroke who had been discharged home and who could walk 10 m without assistance were included. Cognitive deficits and inability to communicate were key exclusion criteria. Randomisation of 250 participants allocated 126 to task oriented circuit training and 124 to individualised physiotherapy. The task oriented circuit training group trained for 90 min twice-weekly for 12 weeks supervised by physiotherapists and sports trainers as they completed 8 mobility-related stations in groups of 2 to 8 participants. Individualised outpatient physiotherapy was designed to improve balance, physical conditioning, and walking. The primary outcome was the mobility domain of the stroke impact scale measured at 12 weeks and 24 weeks. The domain includes 9 questions about a patient's perceived mobility competence and is scored from 0 to 100 with higher scores indicating better mobility. Secondary outcome measures included other domains of the stroke impact scale, the Nottingham extended ADL scale, the falls efficacy scale, the hospital anxiety and depression scale, comfortable walking speed, 6-minute walk distance, and a stairs test. 242 participants completed the study. There were no differences in the mobility domain of the stroke impact scale between the groups at 12 weeks (mean difference (MD) -0.05 units, 95% CI -1.4 to 1.3 units) or 24 weeks (MD -0.6, 95% CI -1.8 to 0.5). Comfortable walking speed (MD 0.09 m/s, 95% CI 0.04 to 0.13), 6-minute walk distance (MD 20 m, 95% CI 35.3 to 34.7), and stairs test (MD -1.6s, 95% CI -2.9 to -0.3) improved a little more in the circuit training group than the control group at 12 weeks. The memory and thinking domain of the stroke impact scale (MD -1.6 units, 95% CI -3.0 to -0.2), and the leisure domain of the Nottingham extended ADL scale (MD -0.74, 95% CI -1.47 to -0.01) improved a little more in the control group than the circuit training group at 12 weeks. The groups did not differ significantly on the remaining secondary outcomes at 12 weeks or 24 weeks. In patients with mild to moderate stroke who have been discharged home, task oriented circuit training completed in small groups was as effective as individual physiotherapy in improving mobility and may be a more efficient way of delivering therapy.