ArticlesPhysiotherapy for patients with mobility problems more than 1 year after stroke: a randomised controlled trial
Introduction
Patients who have had a stroke often have long-term difficulties with walking and other daily activities such as getting out of a chair and climbing stairs.1 Falls are a frequent and potentially serious consequence of stroke.2 Patients who have deteriorating mobility or who have had falls are often referred for physiotherapy treatment by family practitioners and other agencies, such as social services.3 However, the benefit of community physiotherapy for patients with long-term mobility problems after a stroke is inconclusive. Wade and colleagues4 reported a small but temporary improvement in walking speed for patients who had mobility problems 1 year or longer after stroke. However, the study4 was underpowered and was not done within an established community physiotherapy service. In our single-masked, randomised, controlled trial we aimed to assess the effectiveness of routine community physiotherapy for patients with mobility difficulties 1 year after onset of a stroke.
Section snippets
Patients
We identified patients from hospital and community therapy stroke registers. Eligible patients were those who were older than 50 years, had had a stroke at least 1 year previously, and who had associated persisting mobility problems. We defined a mobility problem as: use of a mobility aid (other than a walking stick); a fall in the previous 3 months; unable to manage stairs, slopes, or uneven surfaces independently; or a slower gait speed over 10 m than expected for age group.5 We excluded
Results
We identified 359 potential trial participants who had had their last stroke between January, 1995, and October, 1997. We excluded 177 patients: 72 did not have mobility problems, 48 had mobility problems from other causes, 20 had an abbreviated mental test score of less than 7, 19 had had recent or current physiotherapy, 11 were immobile, four had had another stroke, two had been misdiagnosed, and one was eligible but not recruited in error. Of the remaining 182 patients, ten refused consent
Discussion
Our results show that routine physiotherapy causes a small and transitory improvement in the mobility of patients with persisting difficulties 1 year after stroke. Social activity, mood, carer stress, and the number of times patients fell were not affected by treatment. The improvement in patients' mobility at 3 months, although significant, was too small to be clinically important and was not sustained. Patients who had fallen in the 3 months before the study and patients who had very poor
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