The Effect of Additional Core Stability Exercises on Improving Dynamic Sitting Balance, Trunk Control and Functional Rehabilitation for Subacute Stroke Patients: A Randomized Controlled Trial
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Brain Injury, Vascular
- Sponsor
- Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau
- Enrollment
- 87
- Locations
- 1
- Primary Endpoint
- Stepping
- Status
- Terminated
- Last Updated
- 2 years ago
Overview
Brief Summary
This study assess the effectiveness of core stability exercises performed in subacute phase of stroke. Half of participants will receive conventional physiotherapy, while the other half will receive core stability exercises and core stability exercises plus transcutaneous electrical nerve stimulation (TENS).
Detailed Description
Background: The majority of subjects who have suffered a first-time stroke have balance disability in the subacute phase. Trunk impairment, restricted balance, and impaired postural control in patients with stroke are correlated with increasing risk of falls and impaired mobility. This creates disability and dependency in their activities of daily living. The core is central to almost all kinetic chains in the body. Several studies and a systematic review have shown that implementing core stability exercises may be a viable strategy for improving trunk performance and dynamic sitting balance, standing balance, and gait in post-stroke patients. Main objective: To compare the efficacy of conventional physiotherapy versus an approach based on a Core Stability Exercises (CSEs) program, in terms of dynamic balance, gait and functional rehabilitation at the end of the intervention (5 weeks) and in the long term (sustained effect over time at 3 and 6 months), in sub-acute post-stroke patients. A secondary objective will be to develop and evaluate the feasibility and efficacy of a specific mobile application (app) to reinforce the adherence to unsupervised home-based CSEs by the own patient in the long term. Methodology: Multicentre blinded-assessor randomized controlled (parallel group) trial. Study duration per patient will be 29 weeks (intervention period: 5 weeks, followed by 24 weeks follow-up). The study will consist in two parts: 1) A main study (CORE Trial) where physiotherapy modalities will be compared (main comparisons), and 2) an ancillary substudy (CORE-App Study) where the effect of a mobile application (app) will be evaluated (secondary comparison). Expected results: The study will provide useful information on the short and long term effects of a physiotherapy rehabilitation program based on core stability exercises, as well as the potential use of a mobile app to reinforce long term adherence to unsupervised home-based physiotherapy.
Investigators
Eligibility Criteria
Inclusion Criteria
- •First ever stroke same and less than 30 days (diagnostic criteria according to the World Health Organization definition; corresponding to ICD-9 code 434) weather cortical or subcortical, and ischemic or haemorrhagic.
- •Unilateral localization of the stroke verified by computed tomography (CT).
- •More or equal than18 years.
- •Ability to understand and execute simple instructions.
- •Spanish Version of Trunk Impairment Scale.2.0 less than10 points.
- •National institute of Health Stroke Scale (NIHSS) score \> 4 points.
Exclusion Criteria
- •Rankin scale more or equal than 2 points before stroke.
- •Orthopaedic and other neurological disorders that hamper sitting balance.
- •Relevant psychiatric disorders that may prevent from following instructions.
- •Other treatments that could influence the effects of the interventions.
- •Contraindication to physical activity (e.g., heart failure).
- •Using cardiac pacemakers.
- •Moderate to severe cognitive impairments as indicated by Minimental test score \< 24 points.
- •Patients with haemorrhagic stroke that have undergone surgery.
Outcomes
Primary Outcomes
Stepping
Time Frame: Change from Baseline at week 5
Brunel Balance Assessment (BBA) (section 3 stepping). Section 3 consists of 6 levels (number 7 to 12) each of which increase the demand on balance ability, ranging from assisted balance to moving within the base of support, and changes of the base of support. At each level, the patient receives a score (1 point) for his/her efforts. Total score ranges from a minimum of 0 to a maximum of 6. This gives an indication on whether the patient is improving within a level, even if he/she is not able to progress to the next level. The score also reflects how well the individual is functioning within this section. Higher values represent a better outcome.
Dynamic sitting balance and trunk control
Time Frame: Change from Baseline at week 5
Trunk Impairment Scale Spanish-version TIS 2.0 (S-TIS 2.0), consisting of a dynamic balance subscale (with 10 items) and a coordination subscale (with 6 items). Total score ranges from a minimum of 0 to a maximum of 16. Each item will be performed 3 times and the highest score counts. The tests are verbally explained to the patient and can be demonstrated if needed. The highest possible total score for the S-TIS 2.0 (16 points) indicates a good dynamic sitting balance and correct trunk control and sitting coordination. On the contrary, if the patient cannot maintain a sitting position for 10 seconds without back and arm support, with hands on thighs, feet in contact with the ground and knees bent at 90° (starting position), the total scale-score is 0 points.
Secondary Outcomes
- Sitting balance(Change from Baseline at week 5)
- Gait speed(week 5)
- Standing balance(Change from Baseline at week 5)
- Risk of falling(Change from Baseline at week 5)
- Postural control(Change from Baseline at week 5)
- Activities of daily living(Change from Baseline at week 5)
- Spasticity(Change from Baseline at week 5)
- Rate of falls(week 5)
- Health-related quality of life: EQ-5D-5L(week 5)