Elsevier

The Lancet

Volume 359, Issue 9302, 19 January 2002, Pages 199-203
The Lancet

Articles
Physiotherapy for patients with mobility problems more than 1 year after stroke: a randomised controlled trial

https://doi.org/10.1016/S0140-6736(02)07443-3Get rights and content

Summary

Background

Community physiotherapy is often prescribed for stroke patients with long-term mobility problems. We aimed to assess the effectiveness of this treatment in patients who had mobility problems 1 year after stroke.

Methods

We screened 359 patients older than 50 years for a single-masked, randomised controlled trial to assess the effects of community physiotherapy. Assessments were made at baseline, 3, 6, and 9 months in 170 eligible patients assigned treatment or no intervention. The primary outcome measure was mobility measured by the Rivermead mobility index. Secondary outcome measures were gait speed, number of falls, daily activity (Barthel index scores), social activity (Frenchay activities index), hospital anxiety and depression scale, and emotional stress of carers (general health questionnaire 28). Analyses were by intention to treat.

Findings

Follow-up was available for 146 patients (86%). Changes in scores on the Rivermead mobility index (score range 0–15) differed significantly between treatment and control groups at 3 months (p=0·018), but only by a median of 1 point (95% CI 0–1), with an interpolated value of 0·55 (0·08–1·04). Gait speed was 2·6 m/min (0·30–4·95) higher in the treatment group at 3 months. Neither treatment effect persisted at 6-months' and 9-months' follow-up. Treatment had no effect on patients' daily activity, social activity, anxiety, depression, and number of falls, or on emotional stress of carers.

Interpretation

Community physiotherapy treatment for patients with mobility problems 1 year after stroke leads to significant, but clinically small, improvements in mobility and gait speed that are not sustained after treatment ends.

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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