Modified Rivermead Mobility Index Research Articles

RTMS for Poststroke Pusher Syndrome: A Randomized, Patient-Blinded Controlled Clinical Trial

Background Patients with poststroke pusher syndrome (PS) require longer duration of rehabilitation and more supplemental care after discharge. Effective treatment of PS remains a challenge. The role of repetitive transcranial magnetic stimulation (rTMS) for PS has not been examined. Objective Assess the efficacy of rTMS for patients with poststroke PS in reducing pushing behavior, enhancing motor recovery and improving mobility. Methods A randomized, patient- and assessor-blinded sham-controlled trial with intention-to-treat analysis was conducted. Thirty-four eligible patients with poststroke PS were randomly allocated to receive either rTMS or sham rTMS for 2 weeks. Pushing behavior on the Burke lateropulsion scale and scale for contraversive pushing, motor function on Fugl-Meyer assessment scale-motor domain (FMA-m) and mobility on modified Rivermead mobility index were measured at baseline, 1 and 2 weeks after intervention. Repeated-measures analysis of covariance was used for data analysis. Results There was no significant interaction between intervention and time on Burke lateropulsion scale (F = 2.747, P = .076), scale for contraversive pushing (F = 1.583, P = .214), or change of modified Rivermead mobility index (F = 1.183, P = .297). However, a significant interaction between intervention and time was observed for FMA-m (F = 5.464, P = .019). Post hoc comparisons of FMA-m show better improvement in rTMS group with mean differences of 12.7 (95% CI −7.3 to 32.7) and 15.7 (95% CI −4.6 to 36.0) at post-treatment week 1 and week 2 respectively. Conclusions rTMS did not demonstrate significant efficacy in improving pushing behavior and mobility in patients with PS. However, rTMS might have potential effect in enhancing motor function for patients with PS. Registration: The study was registered in the Chinese Clinical Trial Registry (registration No. ChiCTR2200058015 at http://www.chictr.org.cn/searchprojen.aspx) on March 26, 2022.

CSP2023: 259 - The Modified Rivermead Mobility Index: Is there inter-rater reliability between registered and un-registered physiotherapists?

CSP2023: 259 - The Modified Rivermead Mobility Index: Is there inter-rater reliability between registered and un-registered physiotherapists?

A Case Study of Combined Korean Medicine Treatment of Paraplegia Diagnosed as Spinal Cord Infarction

Spinal cord infarction is one of the rare strokes with no clear signs of serious nerve damage or after-effects. This study reports on the effectiveness of a combined treatment of Korean medicine and acupuncture on bilateral paraplegia, dysuria, and constipation in a patient with sudden-onset spinal cord infarction. An 84-year-old male patient was diagnosed with spinal cord infarction in August 2022. After diagnosis by whole spine MRI, he received treatment for two months at another hospital, but the improvement was insignificant. He then received Korean medicine treatment, and during this period, his lower extremity manual muscle test grade improved from 3 to 4 and his modified Rivermead mobility index score increased by 13 points, compared with hospitalization. Dysuria improved with acupuncture, and constipation improved with herbal medicine treatment. A combination of herbal medicine and acupuncture can be used to treat paraplegia, dysuria, and constipation caused by spinal cord infarction.

Activity-Based Therapy for Mobility, Function and Quality of Life after Spinal Cord Injuries-A Mixed-Methods Case Series.

(1) Background: Despite inconclusive evidence on the benefits of activity-based therapies (ABTs) in people with spinal cord injuries, implementation has occurred in clinics worldwide in response to consumers' requests. We explored the clinical changes and participants' perceptions from engaging in an ABT program in the community. (2) Methods: This mixed-methods study involved a pragmatic observational multiple-baseline design and an evaluation of participants' perceptions. Fifteen participants were included. Outcome measures were balance in sitting using the Seated Reach Distance test, mobility using the Modified Rivermead Mobility Index and quality of life using the Quality of Life Index SCI version pre- and post-participation in an ABT community-based program. Linear mixed models and logistic regressions were used to analyse the effects of intervention. Semi-structured interviews explored participants' perceptions using inductive thematic analysis. (3) Results: There was an increase of 9% in the standardised reach distance (95% CI 2-16) for sitting balance, 1.33 points (95% CI: 0.81-1.85) in mobility and 1.9 points (0.17-2.1) in quality of life. Two themes emerged from the interviews: (1) reduced impact of disability and an increased sense of life as before, and (2) the program was superior to usual rehabilitation. No adverse events related to the intervention were observed. (4) Conclusion: ABT delivered in the community improved clinical outcomes in people with a chronic SCI. High levels of satisfaction with the program were reported.

Proactive outcome monitoring and standardisation of physiotherapy stroke rehabilitation- A retrospective functional outcomes analysis of Accelerated Stroke Ambulation Programme (ASAP).

A clinical quality improvement programme named Accelerated Stroke Ambulation Programme (ASAP) was piloted in Physiotherapy Department of Tai Po Hospital from 1st October 2019 to 30th September 2020 and executed as a standard practice afterwards. The goal of ASAP was to facilitate early maximal walking ability of stroke patients in early rehabilitation phase. ASAP featured (1) proactive outcome monitoring and standardised process compliance monitoring by a patient database - Stroke Registry; (2) standardised mobility prediction by Reference Modified Rivermead Mobility Index (MRMI) Gain and (3) standardised intervention database - Stroke Treatment Library. To investigate the effectiveness of ASAP in an inpatient rehabilitation setting for stroke patients in terms of functional outcomes. The design was a retrospective comparative study to analyse the difference in functional outcomes of Pre-ASAP Group (1st October 2018 - 30th September 2019) and Post-ASAP Group (1st October 2020-30th September 2021). The primary outcome measures were MRMI, Berg's Balance Scale (BBS), Modified Barthel Index (MBI), MRMI Gain, BBS Gain, MBI Gain, MRMI Efficiency, BBS Efficiency and MBI Efficiency. There 348 subjects in Pre-ASAP Group and 281 subjects in Post-ASAP Group. Both groups had highly significant within-group improvement in MRMI, BBS and MBI (). The MRMI Gain of Pre-ASAP Group and Post-ASAP Group was 6.32 and 7.42, respectively; and the difference was significant (). The BBS Gain of Pre-ASAP Group and Post-ASAP Group was 8.17 and 9.70, respectively; and the difference was in margin of significance (). The MBI Gain of Pre-ASAP Group and Post-ASAP Group was 10.69 and 11.96, respectively; but the difference was non-significant (). The MRMI Efficiency, BBS Efficiency and MBI Efficiency of Post-ASAP Group were higher than Pre-ASAP Group but the difference was non-significant. The results of this study reflected that stroke rehabilitation programme with proactive outcome monitoring, standardised process compliance monitoring, standardised mobility prediction and standardised intervention database was practical in real clinical practice with better functional outcomes than traditional physiotherapy practice which were dominated by personal preference and experience of therapists. Proactive outcome monitoring, standardised process compliance monitoring, standardised mobility prediction and standardised intervention database may enhance the effectiveness in terms of functional outcomes of stroke rehabilitation programme.

Efficiency of High-Intensity Gait Training in the Rehabilitation of Post-Stroke Patients

Aim: Research of the effectiveness of high-intensity gait training in the rehabilitation of middle-aged patients in different periods after a stroke. Materials and Methods: Middle-aged post-stroke patients took part in the research. They performed either a comprehensive rehabilitation program with the addition of high-intensity gait training or only high-intensity gait training. All patients underwent an assessment of their functioning before and after rehabilitation programs. The following tests were used for assessment: the Berg Balance Scale, the Modified Rivermead Mobility Index, the Functional Ambulation Classification, the 10-meter walk test, and “Get Up and Go” test. The results were processed using statistical methods. Results: The application of high-intensity gait training has demonstrated high efficiency in middle-aged post-stroke patients. Adding the method of high-intensity gait training to comprehensive rehabilitation programs demonstrated significantly higher efficiency than the use of only high-intensity gait training. At the same time, in post-stroke patients, in the early recovery period, the improvement in functioning was better than in the late recovery period. Conclusions: Adding the method HIGT to the comprehensive rehabilitation of middle-age post-stroke patients leads to a significant improvement in their functioning, especially in the early recovery period.

Predictors of ambulatory recovery and walking proficiency in community-dwelling stroke survivors: a cross-sectional study

BackgroundAlthough the major goal of rehabilitation is to return a stroke survivor (SSv) to as close to their pre-stroke functioning, limitation in ambulatory recovery and walking proficiency is the major impediment. Despite the importance of walking to the outcomes in stroke, factors predicting its recovery remain unclear. This study therefore was aimed at exploring the predictors of ambulatory recovery and walking proficiency in community-dwelling SSv.MethodsThis study involved 164 (83females) SSv from four tertiary health institutions in Nigeria. Ambulatory level and status was assessed using Functional Ambulatory Classification, motor function using the Fugl-Myer Assessment scale (lower limb), and ambulatory/waking endurance using the 6-min walk test. Ambulatory capability was assessed using the Lower Extremity Functional Scale, ambulatory self-confidence using the Ambulatory Self-Confidence Questionnaire, and functional ambulatory profile using the Modified Emory Functional Ambulation Profile. Mobility was assessed using the Modified Rivermead Mobility Index, functional mobility using Time Up and Go, balance using the Berg Balance Scale, and cognitive function using the modified Mini-Mental State Examination. Spatial indexes were assessed using the Footprint method and temporal variables using a stopwatch and gait speed on a 10-m walkway. Data was analyzed using multiple regression analysis at p ≤ 0.05.ResultsParticipants (mean age = 54.3±11.36 years) have had stroke for 12.9 ± 17.39 months and spent 9.82 ± 13.19 months in hospital admissions. More (65.2%) had ischemic stroke with 54.3% of them having left hemispheric stroke. The predictors of ambulatory onset in SSv were stroke duration and length of stay in hospital admission contributing 40.3% (β = 0.403) and 17.6% (β = 0.176) respectively to the variance. Mobility (β = 0.249, p < 0.001), gait speed (β = 0.185, p = 0.012), paretic double-limb support time (β = 0.155, p = 0.03), balance (β = 0.334, p < 0.001), and cognition (β = 0.155, p = 0.01) were predictors of ambulatory self-confidence contributing 59.5% to the variance. Balance (β = 0.363, p < 0.001) and mobility (β = 0.155, p = 0.015) were predictors of ambulatory capability contributing 52.9% to the variance. Balance (β = −0.489, p < 0.001), paretic double-limb support time (β = 0.223, p = 0.003), gait speed (β = −0.181, p = 0.022), and paretic swing phase duration (β = 0.177, p = 0.01) were predictors of functional ambulatory profile (p < 0.05) contributing 52.9% to the variance. Gait speed (β = −0.648, p < 0.001) and step length (β = −0.157, p = 0.003) were predictors of walking endurance contributing 76.5% to the variance.ConclusionAmbulatory recovery and walking proficiency depend on the interplay among duration of stroke and length of hospitalization on the one hand and balance performance, cognitive function, and the spatiotemporal integrity of the affected limb on the other hand.

RTMS for poststroke pusher syndrome: study protocol for a randomised, patient-blinded controlled clinical trial

IntroductionPoststroke pusher syndrome (PS) prevalence is high. Patients with PS require longer rehabilitation with prolonged length of stay. Effective treatment of PS remains a challenge for rehabilitation professionals. Repetitive transcranial...

Effect of Oral Tranexamic Acid on the Blood Transfusion Rate and the Incidence of Deep Vein Thromboembolism in Patients after TKA.

Purpose To explore the effect of oral tranexamic acid treatment on the blood transfusion rate and the incidence of deep vein thromboembolism after total knee arthroplasty (TKA). Methods 90 patients undergoing TKA admitted to First People's Hospital of Changshu City from January 2019 to January 2020 were selected and randomized into the control group and the experimental group accordingly (45 cases in each group). The control group intravenously received 20 mL/kg tranexamic acid before the incision was closed. The experimental group was given 1 g of tranexamic acid orally before anesthesia, 6 h and 12 h after the operation. Results The experimental group witnessed better perioperative indexes in relation to the control group. The experimental group displayed better postoperative coagulation function indexes as compared to the control group (P < 0.05). Remarkably lower postoperative vascular endothelial function indexes in the experimental group than in the control group were observed. The experimental group experienced a markedly lower incidence of deep vein thromboembolism in comparison with the control group (P < 0.05). The postoperative knee society score (KSS) score of the experimental group was significantly higher than that of the control group. A significantly higher postoperative modified rivermead mobility index (MRMI) score was yielded in the experimental group in contrast to the control group (P < 0.05). The experimental group obtained lower numerical rating scale (NRS) scores at T2 and T3 as compared to the control group. Conclusion Oral tranexamic acid is a suitable alternative for patients undergoing TKA in terms of reducing the blood transfusion rate, relieving pain, and accelerating the recovery of the patient's limbs.

Construction of the Mobility to Participation Assessment Scale for Stroke (MPASS) and Testing Its Validity and Reliability in Persons With Stroke in Thailand.

ObjectivesThis study was conducted to develop the Mobility to Participation Assessment Scale for Stroke (MPASS) and assess its content validity, internal consistency, inter-rater and intra-rater reliability, and convergent validity in people with stroke living in the community.MethodsThe MPASS was developed using published data on mobility-related activity and participation timing in elderly individuals, and then reviewed by community physical therapists. Content validity was established by reaching a consensus of experienced physical therapists in a focus group. The MPASS was scored for 32 participants with stroke (mean age 61.75±4.92 years) by 3 individual testers. Reliability was examined using the intraclass correlation coefficient (ICC), internal consistency using the Cronbach alpha coefficient (α), and convergent validity using the Pearson correlation coefficient (r) to compare the MPASS to the Modified Rivermead Mobility Index as a referent test of mobility.ResultsThe MPASS consists of 8 items, and its scoring system provides information on the ability of people with stroke to reach a movement level enabling them to live in society, including interactions with other people and safe living in the community. The inter-rater and intra-rater reliability were excellent (ICC, 0.948; 95% confidence interval [CI], 0.893 to 0.982 and ICC, 0.967; 95% CI, 0.933 to 0.989, respectively). Internal consistency was good (α=0.877). The convergent validity was moderate (r=0.646; p<0.001).ConclusionsThe newly developed MPASS showed acceptable construct validity and high reliability. The MPASS is suitable for use in people with stroke, especially those who have been discharged and live in the community with the ability to initiate sitting.

Translation and validation of stroke impact scale-16 in Urdu for Pakistan.

To translate and validate the Urdu version of stroke impact scale-16 for Pakistani society. The prospective cohort study was conducted from February 2018 to February 2020 after approval from the ethics review board of The University of Lahore, Lahore, Pakistan, and copmprised patients with mild to moderate stroke who were recruited from five public and two private hospitals of the Punjab province. Established guidelines were followed to translate the Stroke Impact Scale-16. The patients were concurrently evaluated on Barthel Index, Stroke Rehabilitation Assessment of Movement, Modified Rivermead Mobility Index, Modified Rankin Scale, Short Form 36 Health Survey Questionnaire and the Hospital Anxiety and Depression Scale to assess the validity of Stroke Impact Scale-16, and spearmen correlation coefficient was used to determine the correlation among the scales. Analysis of variance was employed to determine the discriminant validity. Intraclass correlation coefficient, weighted kappa, Cronbach's alpha and item-total correlation were calculated to establish the stability and consistency of Stroke Impact Scale-16. Data was analysed using SPSS 25. Of the 90 patients, 50(55.5%) were females and 40(45.5%) were males. The subjects were aged 50-80 years. The correlation of Stroke Impact Scale-16 was strong with the established tools and ranged from 0.78 to 0.91. The discriminant validity was also significant (p<.001) across all Modified Rankin Scale levels. The Intraclass correlation coefficient was 0.94 and Cronbach's alpha was 0.91 for test-retest reliability and internal consistency, respectively. All corrected item-total correlation values exceeded the priori minimum standard (>0.40) and ranged from 0.51 to 0.68. The weighted kappa for item reliability also achieved priori criteria (>0.40) and ranged from 0.53 to 0.88. With slight modifications, the Urdu version of Stroke Impact Scale-16 was found to have satisfactory psychometric properties and can be used in clinical and research settings for stroke survivors in Pakistan.

Spatiotemporal Gait Parameters and Walking Characteristics in Community-Dwelling Ambulatory Stroke Survivors

Background: Gait dysfunction is a major sequalae of stroke which negatively affect stroke survivors’walking and community re-integration. Understanding the impairments that determine their communityfunctioning willassist in development of effective treatment strategies for them to overcome theirdisability.Aim: The aim of the study was to explore thespatiotemporal gait parameters and walking characteristicsin community-dwelling ambulatory stroke survivors and determined howthey differ across time ofcommencement of ambulation and duration of ambulation post-stroke.Method: This study involved 164 (83males) community-dwelling ambulatory stroke survivors inKano, Nigeria. The spatiotemporal gait parameters wereassessed along 12-meter distance walkingpath. Spatiotemporal symmetry was computed from the spatiotemporal parameters. Lower limb motorimpairment, lower extremity function, and functional ambulation were assessed using Fugyl-Meyerassessment scale, Lower Extremity Functional scale, and Modified Emory functional ambulatoryprofile respectively. Their physical mobility was assessed using Modified Rivermead mobility index,walking confidence using ambulatory self-confidence questionnaire while Berg balance scale was usedto measure balance. Functional mobility and walking endurance was assessed using the Time up andgo test and 6-minute walk test respectively.Walking status was assessed with functional ambulatorycategory.Results: The participants were aged30years and abovewith 61% above 50years. Most (59.8%)participants commenced ambulation within 1-month of stroke with 65.9% being independent infunctional ambulation. Their spatiotemporal, mobility and balance parameters as well as spatiotemporalsymmetry characteristics were severely affected and are significantly inversely related to their times ofcommencement of ambulation post-stroke.Conclusion: Spatiotemporal gait parameters, mobility parametersand balance performances areseverely abnormal in community-dwelling stroke survivors and negatively impact on their walkingability and community functioning.

Influence of comorbidities on functional outcomes in patients with surgically treated fragility hip fractures: a retrospective cohort study

BackgroundThe incidence and number of fragility hip fractures are gradually increasing, resulting in a wide consumption of medical resources. Various factors affecting functional recovery in patients with fragility hip fractures are known, and comorbid diseases are one of them. The purpose of this study is to determine the effect of comorbidities on functional outcomes in patients surgically treated for fragility hip fractures, thereby contributing to the efficient distribution of medical resources.MethodsThis was a retrospective cohort study performed in the three tertiary rehabilitation facilities. A total of 211 patients (50 men and 161 women; average age 81.6 ± 6.7 years) who had undergone surgery for fragility hip fractures were followed up from immediately after transfer to the Department of Rehabilitation Medicine to 6 months postoperatively. Comorbidities referred to a summary of the following conditions: hypertension, diabetes mellitus, chronic liver disease, dementia, cerebrovascular accident, and osteoporosis. Functional outcomes included Koval’s grade, Functional Ambulatory Category (FAC), Functional Independence Measure (FIM)-locomotion, Modified Rivermead Mobility Index, Berg Balance Scale (BBS), 4-Meter Walking speed Test (4MWT), the Korean version of the Mini-Mental State Examination(K-MMSE), Geriatric Depression Scale (GDS), EuroQol Five-Dimension (EQ-5D) questionnaire, the Korean version of the Modified Barthel Index (K-MBI), the Korean version of the Instrumental Activities of Daily Living (K-IADL), and Korean version of Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight scale (K-FRAIL). For all tests, each patient was assessed immediately after transfer and 6 months post-surgery.ResultsMultivariate linear regression analyses adjusted for age, sex, the initial variable of the functional outcomes, and comorbidities revealed that dementia had a significant negative impact on Koval’s grade and K-FRAIL 6 months postoperatively. Diabetes mellitus had a significant negative impact on the FAC, GDS, EQ-5D, K-IADL, and K-FRAIL 6 months postoperatively. Patients with osteoporosis showed a significant negative outcome of FIM-locomotion 6 months postoperatively. A cerebrovascular accident revealed a significant negative impact on the BBS 6 months postoperatively. In addition, hypertension led to significantly less favorable outcomes of the K-FRAIL 6 months postoperatively.ConclusionsThis study confirmed that comorbidities, particularly dementia and diabetes mellitus, significantly influence functional outcomes 6 months after fragility hip fracture surgeries.

Effectiveness of a Home-Based Fragility Fracture Integrated Rehabilitation Management (FIRM) Program in Patients Surgically Treated for Hip Fractures.

Background: The purpose of this study was to investigate the effectiveness of a home-based fragility fracture integrated rehabilitation management (H-FIRM) program following an inpatient FIRM (I-FIRM) program in patients surgically treated for hip fracture. Methods: This nonrandomized controlled trial included 32 patients who underwent hip surgery for a fragility hip fracture. The patients were divided into two groups: a prospective intervention group (n = 16) and a historical control group (n = 16). The intervention group performed a nine-week H-FIRM program combined with the I-FIRM program. The historical control group performed the I-FIRM program only. Functional outcomes included Koval’s grade, Functional Ambulatory Category (FAC), Functional Independence Measure (FIM) locomotion, Modified Rivermead Mobility Index (MRMI), 4 m walking speed test (4MWT), and the Korean version of Modified Barthel Index (K-MBI). All functional outcomes were assessed one week (before I-FIRM), three weeks (before I-FIRM), and three months (after H-FIRM) after surgery. Results: Both groups showed significant and clinically meaningful improvements in functional outcomes over time. Compared with the control group, the intervention group showed clinically meaningful improvements in Koval’s grade, FAC, FIM locomotion, MRMI, 4MWT, and K-MBI from baseline to three months. Conclusion: H-FIRM may be an effective intervention for improving functional outcomes in older people after fragility hip fractures.

Effects of Trunk Control Training on Dynamic Sitting Balance and Trunk Function in Hemiplegia Patients after Acute Stroke

To investigate the effect of trunk control training on trunk function, balance, mobility and functional independence in hemiplegia patients after acute stroke, and to compare the therapeutic effects with conventional stroke rehabilitation. The study was designed as a randomized controlled trial. The subjects and evaluators were blinded and the therapist was unblinded. Subjects were randomly assigned to either the experimental group or the control group using a computer-generated random number table, the experimental group ( n=15) received30 min of high-intensity trunk control training plus 15 min of low-intensity conventional stroke rehabilitation (45 min, once1 d for 5 d). The control group ( n=15) received only 45 min low-intensity conventional stroke rehabilitation, once 1 d for 5 d. Trunk function was the primary outcome, which was evaluated by the Trunk Impairment Scale (TIS). The secondary outcome included balance, mobility and functional independence, which were assessed by the Brunel Balance Assessment (BBA), the Modified Rivermead Mobility Index (MRMI) and the modified Barthel Index (MBI). Subjects were assessed before and after the intervention. After 5 d of treatment, the scores of TIS general table, TIS static sitting balance sub table, TIS coordination sub table, BBA, MRMI and MBI were increased, but there was no statistically significant difference between the two groups (all P>0.05). The trunk control training group improved dynamic sitting balance more significantly, the score of TIS dynamic sitting balance sub table increased more than that in the control group, with a statistically significant difference ( P<0.05). The results of this study indicate that trunk control training has improved trunk function, balance, mobility, and activities of daily living in hemiplegia patients after acute stroke, and trunk control training improves dynamic sitting balance more effectively than conventional stroke rehabilitation.

Effects of kinesiology taping on trunk function, balance, and mobility in stroke patients: a pilot feasibility study.

[Purpose] This study aimed to explore whether trunk kinesiology taping (KT) can improve trunk function, mobility, and balance in post-stroke patients with hemiparesis. [Participants and Methods] We conducted a single-group pre-post design pilot feasibility study. Thirteen individuals with post-stroke hemiplegia were recruited for this study. All patients received therapeutic trunk KT on the skin, representing the direction of fibres of the trunk muscles underneath. We used the Trunk Impairment Scale (TIS) and Trunk Control Test (TCT) to measure trunk function, Fugl-Meyer assessment (FMA) for balance, limits of stability (LOS) to evaluate balance, and the modified Rivermead mobility index (MRMI) to assess mobility in post-stroke patients. All measures were assessed before and immediately after the intervention. [Results] No adverse effects were found and all patients completed the trial. Compared to the baseline, TIS scores were significantly increased after KT, whereas no changes in TCT score were detected. The directional control of LOS was significantly improved, while no significant changes were seen in the other parameters of LOS, FMA-balance, and MRMI scores. [Conclusion] The results of this investigation show that trunk KT has immediate effects that improve certain trunk functional and balance parameters in stroke patients.

Comparing the Impact of an Implicit Learning Approach With Standard Care on Recovery of Mobility Following Stroke: Protocol for a Pilot Cluster Randomized Controlled Trial.

BackgroundAlthough implicit and explicit learning approaches have been well investigated in healthy populations, there is less evidence regarding the relative benefits of each approach in clinical practice. Studies in stroke typically investigate single elements of an implicit learning approach (ILA; eg, reduced quantity feedback or an external focus of attention) within controlled environments. These studies predominantly evaluate performance, with few measuring this over time (ie, learning). The relevance and transferability of current research evidence into stroke rehabilitation is therefore limited.ObjectiveThe objective of this study was to compare the ILA with standard care in the acute phase following stroke, to generate data and insights to inform the design of a definitive trial, and to understand patient and therapist perceptions of the ILA.MethodsThis is a multicenter, assessor-blind, cluster randomized controlled pilot trial with nested qualitative evaluation. Stroke units (clusters) will be randomized to either ILA (intervention) or standard care (control) arms. Therapy teams at the intervention sites will be trained in the ILA and provided with an intervention manual. Those at the control sites will have minimal input from the research team, other than for data collection. Consent will be provided at the individual participant level. Once enrolled, participants will receive rehabilitation that focuses on lower limb recovery, using the designated approach. Measures will be taken at baseline, every 2 weeks until the point of discharge from hospital, and at 3 months post stroke onset. Measures include the Fugl Meyer Assessment (motor leg subsection), modified Rivermead Mobility Index, Swedish Postural Adjustment in Stroke Scale, and achievement of mobility milestones. Fidelity of the treatment approach will be monitored using observational video analysis. Focus groups and interviews will be used to gain insight into the perceptions of trial participants and clinical teams.ResultsThe first site opened to recruitment in February 2019. The opening of a further 5 sites will be staggered throughout 2019. Results are expected in early 2021.ConclusionsThe findings from this mixed methods pilot study will be used to inform the design of a definitive study, comparing the ILA with standard care in acute stroke rehabilitation.Trial RegistrationClinicalTrials.gov NCT03792126; https://clinicaltrials.gov/ct2/show/NCT03792126International Registered Report Identifier (IRRID)DERR1-10.2196/14222

Walking velocity and modified rivermead mobility index as discriminatory measures for functional ambulation classification of chronic stroke patients

Background:The cut-off values of walking velocity and classification of functional mobility both have a role in clinical settings for assessing the walking function of stroke patients and setting rehabilitation goals and treatment plans.Objective:The present study investigated whether the cut-off values of the modified Rivermead Mobility Index (mRMI) and walking velocity accurately differentiated the walking ability of stroke patients according to the modified Functional Ambulation Category (mFAC).Methods:Eighty two chronic stroke patients were included in the study. The comfortable/maximum walking velocities and mRMI were used to measure the mobility outcomes of these patients. To compare the walking velocities and mRMI scores for each mFAC point, one-way analysis of variance and the post-hoc test using Scheffe’s method were performed. The patients were categorized according to gait ability into either or mFAC VI group. The cut-off values for mRMI and walking velocities were calculated using a receiver-operating characteristic curve. The odds ratios of logistic regression analysis (Wald Forward) were analyzed to examine whether the cut-off values of walking velocity and mRMI can be utilized to differentiate functional walking levels.Results:Except for mFACs III and IV, maximum walking velocity differed between mFAC IV and mFAC V , between mFAC V and mFAC VI , and between mFAC VI and mFAC VII . The cut-off value of mRMI is and the area under the curve is 0.87, respectively; the cut-off value for comfortable walking velocity is m/s and the area under the curve is 0.92, respectively; also, the cut-off value for maximum walking velocity is m/s and the area under the curve is 0.97, respectively. In the logistic regression analysis, the maximum walking velocity m/s, and mRMI scores, are able to distinguish from mFAC VI.Conclusion:The cut-off values of maximum walking velocity and mRMI are recommended as useful outcome measures for assessing ambulation levels in chronic stroke patients during rehabilitation.

Activity-Based Therapy in a Community Setting for Independence, Mobility, and Sitting Balance for People With Spinal Cord Injuries.

Introduction:Activity-based therapy (ABT) aims to activate the neuromuscular system below the level of the spinal cord lesion and promote recovery of motor tasks through spinal reorganisation, motor learning and changes to muscles and sensory system. We investigated the effects of a multimodal ABT program on mobility, independence and sitting balance in individuals with spinal cord injury (SCI).Methods:Retrospective clinical data from 91 adults who independently enrolled in four community-based ABT centres in Australia were analysed. The multimodal ABT program was delivered for 3 to 12 months, one to four times per week. Assessments were undertaken every 3 months and included the Modified Rivermead Mobility Index (MRMI), Spinal Cord Independence Measure (SCIM) and seated reach distance (SRD). A linear mixed model analysis was used to determine time-based and other predictors of change.Results:There was a significant improvement after 12 months for all outcome measures, with a mean change score of 4 points in the SCIM (95% confidence interval [CI]: 2.7-5.3, d = 0.19), 2 points in the MRMI (95% CI: 1-2.3, d = 0.19) and 0.2 in the SRD (95% CI: 0.1-2.2, d = 0.52). Greater improvements occurred in the first 3 months of intervention. There were no interaction effects between time and the neurological level of injury, American Spinal Injury Association Impairment Scale classification, or duration post-injury for most outcomes.Conclusions:A community-based ABT exercise program for people with SCI can lead to small improvements in mobility, independence and balance in sitting, with greater improvements occurring early during intervention.

Stratification of stroke rehabilitation: Five-year profiles of functional outcomes.

Background:Stroke rehabilitation in inpatient setting requires high intensity of manpower and resources. Early stratification of patients with stroke could facilitate early discharge plan and reduce avoidable length of stay (LOS) in hospital. Stratification of patients with stroke in clinical setting is usually based on functional scores which are quite time-consuming and require a special training to complete the full score.Objective:The objective of the study was to explore whether Modified Functional Ambulation Category (MFAC) can serve as a stratification tool of patients with stroke in inpatient rehabilitation.Methods:This was a retrospective, descriptive study of the demographic, functional outcomes of patients with stroke in an inpatient rehabilitation center. A total of 2,722 patients completed a stroke rehabilitation program from 2011 to 2015 were recruited. The patients were divided into seven groups according to their admission MFAC. The between-group difference in LOS, functional outcomes at admission and discharge including Modified Rivermead Mobility Index (MRMI) and Modified Barthel Index (MBI) as well as MRMI gain, MRMI efficiency, MBI gain, and MBI efficiency were analyzed.Results:Subjects with admission categories of MFAC 2 and 3 had a highly significant () MRMI gain (6.2 and 6.6, respectively) and subjects with admission categories of MFAC 3 to 5 had highly significant () MRMI efficiency (0.34, 0.40, and 0.39, respectively). The subjects with admission categories of MFAC 2 to 5 had a highly significant () MBI gain (9.7, 10.2, 9.3, and 7.0, respectively) and the subjects with admission categories of MFAC 4 to 5 had a highly significant () MBI efficiency (0.70 and 0.72, respectively). The subjects with admission categories of MFAC 1 and 2 had a highly significant () LOS (27.7 and 26.6, respectively). MFAC profile was also established to represent the distribution of discharge MFAC of subjects according to their admission MFAC. The chance of subjects with admission categories of MFAC 1 and MFAC 2 progress to any kind of walker (MFAC 2) is 12.7% and 58.2%, respectively. The chance of subjects with admission MFAC 3, MFAC 4 and MFAC 5 progress to independent walker (MFAC 5) is 6.7%, 14.8%, and 50.3%, respectively. Both admission MFAC and admission MBI had strong correlations with discharge MFAC (, and , , respectively), discharge MRMI (, and , , respectively) and discharge MBI (, and , , respectively).Conclusion:This study showed that patients on admission with moderate disability in term of MFAC had the greatest mobility gain and basic activities of daily living (ADL) gain from inpatient stroke rehabilitation. Admission MFAC could be a stratification tool of patients with stroke in inpatient rehabilitation.