Training Dual-task Balance and Walking in Community-dwelling Older Adults With Chronic Stroke: a Randomized Controlled Trial
试验速览
- 阶段
- 不适用
- 入组人数
- 84
- 试验地点
- 1
- 主要终点
- Timed-up-and-go test with and without dual-task
研究概览
简要总结
Background Functional community ambulation not only requires a critical level of postural control and walking skills, but also the ability to engage in cognitive tasks while walking (i.e., dual-task walking) and adapt to the constantly-changing environmental contexts. There is evidence showed that dual-task balance and gait performance is significantly impaired after stroke. Increasing evidence also suggests that dual-task balance and gait performance is useful for predicting falls among individuals with stroke. Considering the high clinical relevance of dual-task balance and gait performance, it is essential that stroke rehabilitation adequately addresses dual-task deficits. Developing specific dual-task balance and gait training to enhance dual-task performance is thus necessary to promote community ambulation and reintegration.
Study Aim The aim of this Introduction Many individuals after stroke continue to cope with residual physical impairments after discharge from hospital. One of the major problems encountered by people after stroke is community reintegration. Functional community ambulation not only requires a critical level of postural control and walking skills, but also the ability to engage in cognitive tasks while walking (i.e., dual-task walking) and adapt to the constantly-changing environmental contexts. There has been an increasing awareness of the importance of dual-task gait performance in community-dwelling individuals with stroke in the past few years.
There is evidence showed that dual-task balance and gait performance is significantly impaired after stroke. Increasing evidence also suggests that dual-task balance and gait performance is useful for predicting falls among individuals with stroke. Considering the high clinical relevance of dual-task balance and gait performance, it is essential that stroke rehabilitation adequately addresses dual-task deficits. Developing specific dual-task balance and gait training to enhance dual-task performance is thus necessary to promote community ambulation and reintegration.
Study Aim This will be a single-blinded randomized controlled trial (RCT).The aim of this study is to examine the efficacy of a dual-task exercise program on cognitive-motor interference in balance and walking tasks, balance self-efficacy, participation in everyday activities, community reintegration and incidence of falls among individuals with chronic stroke.
详细描述
Introduction Many individuals after stroke continue to cope with residual physical impairments after discharge from hospital. One of the major problems encountered by people after stroke is community reintegration. Functional community ambulation not only requires a critical level of postural control and walking skills, but also the ability to engage in cognitive tasks while walking (i.e., dual-task walking) and adapt to the constantly-changing environmental contexts. There has been an increasing awareness of the importance of dual-task gait performance in community-dwelling individuals with stroke in the past few years.
There is evidence showed that dual-task balance and gait performance is significantly impaired after stroke. Increasing evidence also suggests that dual-task balance and gait performance is useful for predicting falls among individuals with stroke. Considering the high clinical relevance of dual-task balance and gait performance, it is essential that stroke rehabilitation adequately addresses dual-task deficits. Developing specific dual-task balance and gait training to enhance dual-task performance is thus necessary to promote community ambulation and reintegration.
Study Aim The aim of this study is to examine the efficacy of a dual-task exercise program on cognitive-motor interference in balance and walking tasks, balance self-efficacy, participation in everyday activities, community reintegration and incidence of falls among individuals with chronic stroke.
Study design
This will be a single-blinded randomized controlled trial (RCT). After baseline evaluation, subjects will be randomly allocated to one of the three groups: (1) dual-task training group, (2) single-task training group, (3) strengthening and flexibility exercise group (controls), using a 1:1:1 randomization sequence.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 50 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •diagnosis of a stroke
- •more than 6 months of stroke onset
- •aged 50 years or above
- •community-dwelling
- •medically stable
- •score ≥21 on the Montreal Cognitive Assessment (MoCA)
- •score ≤ 25 on the Mini Balance Evaluation Systems Test (Mini-BESTest)
- •able to ambulate without physical assistance of another person as determined during the 10-meter walk test
- •ability to follow 3-step commands
排除标准
- •having neurological conditions other than stroke
- •not community-dwelling prior to the stroke event
- •significant receptive and expressive aphasia
- •severe and uncorrected hearing or visual deficits
- •serious musculoskeletal disorders (e.g. amputation)
- •serious cardiovascular conditions affecting the ability to participate in exercise training
- •pain experienced at rest or movement
- •other serious illnesses that preclude participation
研究组 & 干预措施
Dual-task training group
Participants in this group will receive dual-task balance and gait training for half hour and relaxation exercise for another half hour in each session. There will be 3 sessions per week for 8 weeks.
干预措施: Dual-task training group (Behavioral)
Single-task training group
This group of subjects will participate in single-task gait and balance activities for half hour and single-task cognitive training in sitting position for another half hour in each session. There will be 3 sessions per week for 8 weeks.
干预措施: Single-task training group (Behavioral)
Flexibility and strength training group
The subjects in this group will engage in flexibility exercises and upper limb strengthening exercises for one hour in each session. There will be 3 sessions per week for 8 weeks.
干预措施: Flexibility and strength training group (Behavioral)
结局指标
主要结局
Timed-up-and-go test with and without dual-task
时间窗: week 16
A walking test
Timed-up-and-go test with and without dual-task
时间窗: week 0
A walking test
Timed-up-and-go test with and without dual-task
时间窗: week 8
A walking test
次要结局
- Motricity Index(week 16)
- Chedoke Arm and Hand Activity Inventory(week 16)
- Frenchay Activities Index(week 16)
- Tinetti Assessment Tool (Gait)(week 16)
- 10-meter walk test with and without dual-task(week 16)
- Sensory organization test with and without dual-task(week 16)
- Obstacle crossing with and without dual-task(week 16)
- Mini-Balance Evaluations Systems Test(week 16)
- Activities-specific balance confidence scale(week 16)
- Stroke Specific Quality of Life Scale(week 16)
- Incidence of fall(week 0-6 months after training)
- Global Rating of Change score(week 16)
- Upper limb muscle strength(week 16)
- 10-meter walk test with and without dual-task(week 0)
- 10-meter walk test with and without dual-task(week 8)
- Sensory organization test with and without dual-task(week 0)
- Sensory organization test with and without dual-task(week 8)
- Obstacle crossing with and without dual-task(week 0)
- Obstacle crossing with and without dual-task(week 8)
- Mini-Balance Evaluations Systems Test(week 0)
- Mini-Balance Evaluations Systems Test(week 8)
- Activities-specific balance confidence scale(week 0)
- Activities-specific balance confidence scale(week 8)
- Stroke Specific Quality of Life Scale(week 0)
- Stroke Specific Quality of Life Scale(week 8)
- Motricity Index(week 0)
- Motricity Index(week 8)
- Chedoke Arm and Hand Activity Inventory(week 0)
- Chedoke Arm and Hand Activity Inventory(week 8)
- Frenchay Activities Index(week 0)
- Frenchay Activities Index(week 8)
- Tinetti Assessment Tool (Gait)(week 0)
- Tinetti Assessment Tool (Gait)(week 8)
- Global Rating of Change score(week 8)
- Upper limb muscle strength(week 0)
- Upper limb muscle strength(week 8)
研究者
Marco Yiu-Chung Pang
Professor
The Hong Kong Polytechnic University