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Objective. This study investigates if higher utilization of physical therapist assistants adversely affects patient outcomes in the acute rehabilitation setting for patients following a cerebrovascular accident (CVA). Methods. Participants were admitted to 1 of 5 inpatient rehabilitation facilities following a CVA from 2008 to 2010. High physical therapist assistant use was defined as [greater than or equal to]20% of the physical therapist visits being provided by the physical therapist assistant for an episode of care. Multivariable regression techniques examined differences in functional outcome, discharge location, and length of stay between high and low physical therapist assistant use groups. Propensity scoring methods supplemented findings of the regression analyses. Results. Of the 1561 participants, 496 (32%) had high physical therapist assistant involvement. Baseline participant characteristics such as age, sex, baseline motor function, and comorbidities did not differ between high and low physical therapist assistant use groups. After adjusting for patient characteristics, rehabilitation facility, and year, higher physical therapist assistant use did not adversely affect functional outcome or length of stay. Fewer conclusions can be drawn regarding discharge location, although there was no significant difference in discharge location between groups with high and low physical therapist assistant utilization. Propensity scoring methods supported the findings of the regression analyses. Conclusions. Higher physical therapist assistant involvement in the rehabilitation of patients following CVA did not adversely affect functional outcome, increase length of stay, or reduce the likelihood of discharge to home from an inpatient rehabilitation facility. Impact. The results demonstrate the value of the physical therapist assistant in the provision of physical therapy for patients with stroke in the inpatient rehabilitation setting. Higher involvement of the physical therapist assistant may provide cost savings while maintaining patient outcomes for this setting and population., Physical therapist services are provided by physical therapists as well as by physical therapist assistants, who are the only additional providers educated to implement selected physical therapist interventions. (1) As [...]

2022 SEP 24 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Data detailed on Cerebrovascular Diseases and Conditions - Stroke have been presented. [...]

2022 SEP 24 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Data detailed on Central Nervous System Diseases and Conditions - Intracranial Hemorrhages [...]

2022 SEP 17 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- New study results on stroke have been published. According to news reporting [...]

2022 AUG 27 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Investigators discuss new findings in Cerebrovascular Diseases and Conditions - Stroke. According [...]

2022 AUG 20 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- A new study on Cerebrovascular Diseases and Conditions - Stroke is now [...]

2022 AUG 13 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Fresh data on stroke are presented in a new report. According to [...]

2022 AUG 6 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Research findings on Cerebrovascular Diseases and Conditions - Stroke are discussed in [...]

2022 JUL 9 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Researchers detail new data in Surgery - Thrombectomy. According to news reporting [...]

2022 JUL 9 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Researchers detail new data in telemedicine. According to news reporting out of [...]

2022 JUN 4 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Fresh data on Cerebrovascular Diseases and Conditions - Stroke are presented in [...]

2022 MAY 28 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Investigators publish new report on stroke. According to news originating from New [...]

2022 MAY 21 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- A new study on Cerebrovascular Diseases and Conditions - Stroke is now [...]

2022 MAY 14 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Current study results on Nutritional and Metabolic Diseases and Conditions - Diabetes [...]

Background. The group-level responsiveness of the original, 30-item Stroke Rehabilitation Assessment of Movement measure (STREAM-30) is similar to that of the simplified STREAM (STREAM-15), even though the STREAM-30 has twice as many items as those of the STREAM-15. Objective. The purpose of this study was to compare the responsiveness of the STREAM-30 and STREAM-15 at both group and individual levels in patients with stroke. For the latter level, the Rasch-calibrated 27-item STREAM (STREAM-27) was used because the individual-level indexes of the STREAM-30 could not be estimated. Design. A repeated-measurements design was used. In total, 195 patients were assessed with the STREAM-30 at both admission and discharge. Methods. The Rasch scores of the STREAM-27 and STREAM-15 were estimated from the participants' responses on the STREAM-30. We calculated the paired t-test value, effect size, and standardized response mean as the indexes of group-level responsiveness. The significance of change for each participant was estimated as the individual-level responsiveness index, and the paired t test and test of marginal homogeneity were used for individual-level comparisons between the STREAM-27 and STREAM-15. Results. At the group level, the STREAM-30, STREAM-27, and STREAM-15 showed sufficient and comparable responsiveness. At the individual level, the STREAM-27 detected significantly more participants with significant improvement and fewer participants with no change or deterioration compared with the STREAM-15. Limitations. Few patients with subacute stroke showed deterioration at discharge, so the abilities of the 2 measures to detect deterioration remain inconclusive. Conclusions. The STREAM-27 detected more participants with significant recovery compared with the STREAM-15, although the group-level responsiveness of the 2 measures was the same. The STREAM-27 is recommended as an outcome measure to demonstrate the treatment effects of movement and mobility for patients with stroke., Responsiveness can be defined as the ability of a measure to detect change when it has occurred. (1-3) Outcome measures should be responsive in order to demonstrate treatment effects and [...]

Background. Restoration of walking capacity, as reflected by walking speed and walking distance, is a primary goal after stroke. Peak aerobic capacity (peak oxygen consumption [[[??]o.sub.2] peak]) is suggested to be correlated with walking capacity after stroke. Although the strength of this correlation is unclear, physical therapy programs often target walking capacity by means of aerobic training. Purpose. The purpose of this systematic review was to summarize the available evidence on the correlation between [[??]o.sub.2] peak and walking capacity. Data Sources. The databases MEDLINE, CINAHL, EMBASE, Cochrane Library, and SPORTDiscus were searched up to May 2014. Study Selection. Cross-sectional studies reporting correlation coefficients between [[??]o.sub.2]peak and walking capacity in stroke were included, along with longitudinal studies reporting these correlation coefficients at baseline. Data Extraction. The methodological quality of the studies was assessed using a checklist of 27 items for observational research. Information on study design, stroke severity and recovery, and assessments and outcome of [[??]o.sub.2]peak and walking capacity, as well as the reported correlation coefficients, were extracted. Data Synthesis. Thirteen studies involving 454 participants were included. Meta-analyses showed combined correlation coefficients ([r.sub.m]) for [[??]o.sub.2]peak and walking speed and for [[??]o.sub.2]peak and walking distance of.42 (95% credibility interval=.31, .54) and.52 (95% credibility interval=.42,.62), respectively. Limitations. The studies included in the present review had small sample sizes and low methodological quality. Clinical and methodological diversity challenged the comparability of the included studies, despite statistical homogeneity. Relevant data of 3 studies could not be retrieved. Conclusions. The strength of the correlation of [[??]o.sub.2]peak with walking speed was low and moderate for [[??]o.sub.2]peak and walking distance, respectively, indicating that other factors, besides [[??]o.sub.2]peak, determine walking capacity after stroke., Improving walking capacity is often a primary goal in rehabilitation after stroke. (1,2) In stroke, walking capacity reflects the autonomy in walking enabling daily life mobility, (3) which can be [...]

In the Freburger article, (1) the author applies a multiple linear regression to examine the relationship between utilization of physical therapy and total cost of care. However, a close look [...]

ABSTRACT Acute ischemic stroke (AIS) is a major cause of death and disability in the United States. Tissue plasminogen activator (t-PA) is an intravenously administered therapy that can prevent death [...]

In a large study of community-based stroke survivors in Canada, researchers found those meeting guideline-recommended levels of physical activity had a significantly lower risk for death from any cause, with [...]

Background and Purpose. The use of standardized outcome measures (OMs) can support clinicians' development of appropriate care plans, guide educators in curricular decisions, and enhance the methodological quality and generalizability of clinical trials. The purposes of this case report are: (1) to describe a framework and process for assessing psychometrics and clinical utility of OMs used poststroke; (2) to describe a consensus process used to develop recommendations for stroke-related OMs in clinical practice, research, and professional (entry-level) physical therapist education; (3) to present examples demonstrating how the recommendations have been utilized to date; and (4) to make suggestions for future efforts. Case Description. A task force of 7 physical therapists with diverse clinical and research expertise in stroke rehabilitation used a 3-stage, modified Delphi consensus process to develop recommendations on OM use. An evidence-based systematic review template and a 4-point rating scheme were used to make recommendations on OM use by care setting and patient acuity, for research, and for inclusion in professional education. Outcomes. An initial list of 77 OMs was developed based on input from numerous professional sources. Screening measures and duplicate measures were eliminated. Fifty-six OMs received full review. Measures spanned the constructs of body structure/function (21), activity (28), and participation (14). Fourteen measures received a rating of 'highly recommend.' Discussion. Use of highly recommended OMs may provide a common set of tools enabling comparisons across patients, interventions, settings, and studies. The use of a clearly defined, comprehensive assessment template may facilitate the pooling of data on OMs and contribute to best practice guidelines. Educational recommendations may inform curricular decisions., Recent evidence-based practice initiatives and the need for accountability in clinical practice have focused attention on the use of standardized outcome measures (OMs) in physical therapy. (1-4) Monitoring patient status [...]

Background. The lack of knowledge about the responsiveness and predictive validity of a set of Hierarchical Balance Short Forms (the HBSF) in people with stroke limits the utility of the HBSF in both clinical and research settings. Objective. The purpose of this study was to investigate the responsiveness and predictive validity of the HBSF in people receiving inpatient rehabilitation after stroke. Design. A prospective cohort study was conducted. Methods. Sixty-six participants completed both the 6-item HBSF and the 12-item Postural Assessment Scale for Stroke (PASS) after admission to the rehabilitation ward and before hospital discharge. The standardized effect size (ES) and the standardized response mean (SRM) were used to investigate the internal responsiveness of the HBSF and the PASS. Changes in the Barthel Index and the mobility subscale of the Stroke Rehabilitation Assessment of Movement were used as the external criteria for examining external responsiveness. Moreover, the admission scores on the HBSF and the PASS and the discharge scores on the Barthel Index and mobility subscale of the Stroke Rehabilitation Assessment of Movement were analyzed to investigate the predictive validity of the 2 balance measures. Results. The internal responsiveness of the HBSF was high (ES>0.9, SRM>1.6). The SRM of the HBSF was significantly larger than that of the PASS, whereas the ES of the HBSF was not significantly larger than that of the PASS. The external responsiveness and predictive validity of the HBSF were sufficient and similar to those of the PASS (external responsiveness: r [greater than or equal to] .35; predictive validity: r [greater than or equal to] .67). Limitations. The convenience sampling of people receiving inpatient rehabilitation after stroke may limit the generalization of the results. Conclusions. The HBSF has sufficient responsiveness and predictive validity in people receiving inpatient rehabilitation after stroke and is thus recommended for both clinicians and researchers., Balance impairment often occurs after a stroke (1) and can greatly affect the recovery of mobility and activities of daily living (ADL). (2) Several studies also have shown that changes [...]

Background. Community walking is limited among survivors of stroke; however, the contributing factors are not clearly understood. Objective. This study examined the association of features in the environment with frequency of community walking following stroke. Design. An observational study design was used, with frequency of community walking data collected prospectively. Method. Thirty survivors of stroke (mean age=67 years; mean months since stroke = 40), and 30 older adults without stroke (mean age=68 years) participated. Frequency of community walking (number of trips, walking-related activities [WRA], and the ratio of WRA to trips) and satisfaction were measured using self-report. The Environmental Analysis of Mobility Questionnaire (EAMQ) was used to determine frequency of encounter with versus avoidance of environmental features during community walking. Negative binomial and linear regression models were used to analyze the association of environmental features with measures of community walking. Results. Survivors of stroke reported reduced community walking and fewer encounters with and greater avoidance of features within 8 dimensions of the environment compared with a control group of adults without stroke. Following stroke, avoidance of features in some environmental dimensions was associated with frequency of community walking as measured by number of trips, number of WRA, and the ratio of WRA to trips. Environmental features explained little of the variability in community walking. Limitations. Limitations included a small sample size and limited diversity among participants. This study examined only physical features in the environment and did not include other environmental factors, such as social support, which may influence participation. Conclusions. Avoidance of features within some, but not all, environmental dimensions was associated with self-reported frequency of community walking following stroke, suggesting that some environmental features may limit community walking more than others., Mobility, defined as the ability to walk safely and independently, is integral to the performance of basic activities of daily living (BADLs) and instrumental activities of daily living 0ADLs). (1) [...]

Background. Studies have suggested that constraint-induced therapy combined with trunk restraint (CIT-TR) improves arm movement and reduces trunk compensation. Whether participants who receive CIT-TR can translate the benefits to real-life circumstances awaits further investigation. Objective. The effects of distributed CIT-TR (dCIT-TR) on motor function, daily function, quality of life (QOL), and arm-trunk control were investigated. Design. The study was a single-blind, randomized controlled trial. Setting. The study took place at 4 hospitals. Participants. Participants were 57 people who had had a stroke 6 to 55 months earlier. Intervention. Participants received a dose-matched intervention (2 hours per day, 5 days per week, for 3 weeks) of dCIT-TR, distributed constraint-induced therapy (dCIT), or control therapy. Measurements. The Action Research Arm Test (ARAT), Motor Activity Log, Frenchay Activities Index (FAI), and Stroke Impact Scale (SIS) were used to evaluate motor function, daily function, and QOL. Data for reaching kinematics were recorded. Results. Participants receiving dCIT-TR and dCIT exhibited higher overall scores on the ARAT, FAI, and hand function domain of the SIS and better quality of movement and larger amount of use (of the affected arm) on the Motor Activity Log than participants in the control group. Participants receiving dCIT-TR further demonstrated greater improvements on the ARAT grip subscale and FAI outdoor activities scale than participants receiving dCIT or participants in the control group. However, participants receiving dCIT showed greater improvements on the strength domain of the SIS after training than participants receiving dCIT-TR or participants in the control group. Limitations. Research with a larger sample size is needed. Conclusions. Participants who received dCIT-TR were able to translate gains in arm-trunk control into functional performance and QOL, specifically in grip function and outdoor activities. A long-term study to examine the recovery course for force output may be needed to evaluate people's perception of less improvement in strength after dCIT-TR., Constraint-induced therapy (CIT) (1-3) and its modified (4) and distributed (5,6) derivatives reduce movement deficits, improve movement performance, and improve real-world functional use of the hemiparetic upper extremity (UE) by [...]

Background: Acupuncture is frequently advocated as an adjunct treatment during stroke rehabilitation. The aim of this review was to assess its effectiveness in this setting. Methods: We searched 25 databases and 12 major Korean traditional medicine journals from their inception to October 2009. We included randomized controlled trials, with no language restrictions, that compared the effects of acupuncture (with or without electrical stimulation) with sham acupuncture. We assessed the methodologic quality of the trials using the Cochrane risk-of-bias criteria and the PEDro (Physiotherapy Evidence Database) scale. Results: Ten of 664 potentially relevant studies met our inclusion criteria. For acute and subacute stages after stroke, we included seven trials. A meta-analysis of the five studies that assessed functionality did not show a significant difference in favour of acupuncture, with high heterogeneity. A post-hoc sensitivity analysis of three trials with low risk of bias did not show beneficial effects of acupuncture on activities of daily living at the end of the intervention period (n = 244; standard mean difference 0.07, 95% confidence interval [CI] -0.18 to 0.32; [I.sup.2] = 0%) or after follow-up (n = 244; standard mean difference 0.10, 95% CI -0.15 to 0.35; [I.sup.2] = 0%). For the chronic stage after stroke, three trials tested effects of acupuncture on function according to the Modified Ashworth Scale; all failed to show favourable effects. Interpretation: Our meta-analyses of data from rigorous randomized sham-controlled trials did not show a positive effect of acupuncture as a treatment for functional recovery after stroke., Acupuncture is often used as an adjunct to mainstream rehabilitation after stroke. It involves the insertion of an acupuncture needle into the skin at certain points of the body. Acupuncture [...]

Background. Initial severity of upper-limb motor impairment and exercise intensity are important predictors of improved upper-limb function during stroke rehabilitation. Initial severity of motor impairment, however, is not modifiable by rehabilitation, and increased one-on-one treatment is not always feasible. Alternative methods to increase intensity and improve upper-limb function are needed. Objective. The purpose of this study was to examine caregiver involvement in upper-limb treatment as a method to improve upper-limb function. Design. This study was a secondary analysis of a multi-site randomized controlled trial for upper-limb recovery during subacute inpatient stroke rehabilitation. Methods. Data from 50 individuals with subacute stroke who were randomly assigned to the experimental group (upper-limb exercise) were used for the analysis. Outcome variables were measured at baseline and at completion of the 4-week intervention. Group comparisons between participants with caregiver support and participants without caregiver support were done using an analysis of variance. Using the Fugl-Meyer Upper-Limb Motor Impairment Scale and time spent in treatment (intensity) as covariates, a multivariate regression analysis was performed to determine the additive value of caregiver support on upper-limb function, as measured by change scores on the Chedoke Arm and Hand Activity Inventory and the Motor Activity Log. Results. Group comparisons revealed that participants with caregiver support had improved upper-limb function compared with those without caregiver support and were more likely to increase the amount of time spent doing exercise. The multiple regression analysis showed that Fugl-Meyer score, treatment intensity, and caregiver support were significant predictors of upper-limb improvement ([R.sup.2]=.240-.292). In the regression models, caregiver support accounted for 5% to 9% of upper-limb improvement. Limitations. Support was coded as a dichotomous variable, and thus the degree of support or qualitative nature of support was not captured. Conclusions. Involvement of caregivers was a determinant of improved upper-limb function over and above initial severity of motor impairment and exercise intensity. Further research is needed to determine the optimal qualitative and quantitative elements of caregiver involvement in stroke rehabilitation in order to maximize results., Upper-limb dysfunction post-stroke is prevalent, with up to 70% of individuals incurring paresis in the initial stage of recovery. (1) Use of the upper limb is vital to the completion [...]

ASTRACT Studies have demonstrated that the stress of family caregiving places caregivers at risk for developing depression, poor quality of life, and health problems. The purpose of this review was [...]

For 45 years as a physical therapist, I worked in predominantly orthopedic settings. Only during the last 8 years have I been privy to the use of low level laser [...]

Introduction A meta-analysis based on the UK Stroke Unit Trialist's Collaboration study (1997) showed an 18% reduction in mortality, a 29% reduction in death or activities of daily living (ADL) [...]

Background and Purpose. An efficient, reliable, and valid instrument for assessing motor function in patients with stroke is needed by both clinicians and researchers. To improve administration efficiency, we applied the multidimensional Rasch model to the 30-item, 3-subscale Stroke Rehabilitation Assessment of Movement (STREAM) instrument to produce a concise, reliable, and valid instrument (simplified STREAM [S-STREAM]) for measuring motor function in patients with stroke. Subjects and Methods. The STREAM (consisting of 3 subscales: upper-limb movements, lower-limb movements, and mobility) was administered to 351 subjects with first stroke occurrence and a median time after stroke of 19.5 months. The unidimensionality of each subscale of the STREAM first was verified with unidimensional Rasch analysis. Each subscale of the STREAM then was simplified by deleting redundant items on the basis of expert opinion and the results of the Rasch analysis. The Rasch reliability of the S-STREAM and the concurrent validity of the S-STREAM with the STREAM were examined with multidimensional Rasch analysis and the intraclass correlation coefficient (ICC), respectively. Results. After deleting the items that did not fit the Rasch model, we found that the 8-item upper-limb movement subscale, the 9-item lower-limb movement subscale, and the 10-item mobility subscale assessed single, unidimensional upper-limb movements, lower-limb movements, and mobility, respectively. We selected 5 items from each subscale to construct the S-STREAM and found that the reliability of each subscale of the resulting simplified instrument was high (Rasch reliability coefficients of ≥ .91). The agreement between the subscale scores (Rasch estimates) of the S-STREAM and those of the STREAM was excellent (ICC of ≥ .99, with a lower limit for the 95% confidence interval of ≥ .985), indicating good concurrent validity of the S-STREAM with the STREAM. Discussion and Conclusion. The S-STREAM demonstrates high Rasch reliability, unidimensionality, and concurrent validity with the STREAM in patients with stroke. Furthermore, the S-STREAM is efficient to administer, as it consists of only half the number of items in the original STREAM. Additional studies to examine other psychometric properties (eg, predictive validity and responsiveness) of the S-STREAM or its psychometric properties in various recovery stages after stroke are needed to further establish its utility in both clinical and research settings. Key Words: Motor function, Psychometrics, Rasch model, Stroke., Motor and mobility problems are very common after stroke. (1) For the purposes of treatment planning and outcome assessment, it is important to reliably and accurately assess motor function in [...]