Physical fitness training for stroke patients (Review) - Update Software

Cooke 2010
Methods Design: phase I multicenter trial; 4 centres; mixed training plus usual care versus usual care -
during usual care - i.e. functional strength training (FST) plus conventional physiotherapy
(CPT) versus conventional physiotherapy alone and versus conventional physiotherapy
plus conventional physiotherapy (CPT + CPT)
Randomisation: computer-generated random allocation in blocks of 9 per trial centre (stratified
allocation by baseline scores for visual spatial neglect)
Allocation concealment: sequentially numbered sealed opaque envelopes
Blinding: assessor blinded to group allocation
Intention-to-treat: attempt to measure participants at outcome and follow-up even if they
withdraw but analyses were not performed according to intention-to-treat principle
Measurements: at the end of intervention (6 weeks) and 12 weeks later (follow-up)
Withdrawals: at outcome 10 (9%) had withdrawn. 7 participants were lost at outcome
in the control CPT group (3 unwell, 3 withdrew, 1 moved abroad) and 3 in the CPT +
CPT group (2 unwell, 1 sectioned). At follow-up, a further 18 participants had withdrawn
(26%). 14 participants were lost in the CPT group (5 unwell, 4 withdrew, 1 moved abroad,
2 housebound, 2 died); 7 in the CPT + CPT group (5 unwell, 1 sectioned, 1 withdrew);
and 7 in the CPT + FST group (5 unwell, 2 withdrew)
Participants Randomised: total 109 participants. 38 participants were randomised to CPT, 35 to CPT
+ CPT, and 36 to FST + CPT (only the results from the CPT and the CPT + FST groups
were included in this review)
Intervention: FST + CPT = 36 participants: 22 males (61%) and 14 females (39%); mean
age: 71.17 (SD 10.6); 33.86 (SD 16.50) days after stroke
Control: CPT = 38 participants: 21 males (55%) and 17 females (45%); mean age: 66.37
(SD 13.7); 36.76 (SD 22.41) days after stroke
Inclusion criteria: inpatients between 1 and 13 weeks after anterior circulation stroke (ischaemic
and haemorrhagic); independently mobile; some voluntary contraction in the
lower affected limb; no orthopaedic surgery or trauma affecting the lower limb in the last
8 weeks; no previous history of neurological diseases; able to follow a 1-stage command
Exclusion criteria: not reported
Interventions Intervention: FST/mixed training plus CPT. FST consisted of increasing the amount
of bodyweight the patients needed to move; increasing movements resistance; reducing
amount of bodyweight support during treadmill training. Frequency of intervention: 1
hour for 4 days/week for 6 weeks
Control: CPT included soft issue mobilisation, facilitation of muscle activity, facilitation
of co-ordinated multi-joint movement; tactile and proprioceptive input, resistive exercise,
and functional retraining. Frequency of intervention: 1 hour for 4 days/week for 6 weeks
Setting: hospital
Outcomes Included outcomes: walking speed; health related quality of life measures (e.g. EuroQuol)
Other outcomes: gait parameters; paretic knee torque force analysis; modified RMI
Notes Trial authors stated ’strength training’ but intervention was actually mixed training
Risk of bias
Bias Authors’ judgement Support for judgement
Physical fitness training for stroke patients (Review)
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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