Effect of innovative vs. usual care physical therapy in subacute rehabilitation after stroke. A multicenter randomized controlled trial.
Marianne Sivertsen, Ellen Christin Arntzen, Karl Bjørnar Alstadhaug and 1 others
PMID 36407967WHAT IT FOUND
Adding trunk-focused exercises to usual stroke physiotherapy did not improve trunk control or physical activity more than usual care alone.
Both groups improved in balance and walking. Usual care showed better quality of life scores, possibly due to longer treatment duration.
Key findings
01Group allocation did not significantly predict 12-week scores for the primary outcomes of trunk control or physical activity.
02Both groups showed significant within-group improvements in trunk control, balance, and gait speed.
03The usual care group had significantly better health-related quality of life scores at 12 weeks compared to the intervention group.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study was underpowered, recruiting 60 participants when 74 were required for 80% power. There was substantial attrition in the intervention group (10 lost to follow-up/excluded), reducing the analysed sample to 25 vs 30. Baseline imbalances existed: the intervention group was older, had higher stroke severity, and lower premorbid function. The intervention group received significantly fewer weeks of physiotherapy (average 7.94) than the usual care group (average 10.36), which may confound the quality of life results. Implementation fidelity was potentially compromised by reliance on only 1-2 trained therapists per site and pandemic-related disruptions.
Declared interests
Funded by the Northern Norway Regional Health Authority. The funders played no role in the design, conduct, or reporting of the study.
The easy way to misread this
Do not conclude that I-CoreDIST is ineffective compared to usual care without noting that the usual care group received more weeks of therapy on average. The better quality of life scores in the usual care group may reflect this dose difference rather than the method itself.