Early targeted trunk training to improve mobility outcomes post stroke
Research type
Research Study
Full title
Does early targeted trunk training improve mobility outcome at 6 months for patients who are unable to sit unsupported at admission? A mixed method feasibility study.
IRAS ID
172028
Contact name
Isaac Sorinola
Contact email
Sponsor organisation
King's College London
Duration of Study in the UK
1 years, 6 months, 2 days
Research summary
Many people after stroke report considerable difficulty with moving about within their home environment and this continues to be an area of concern for many years. Apart from the disabling consequences for individuals, reduced mobility results in increased burden on carers. Therefore, improving mobility outcomes will be beneficial to both individuals and their carers.
Previous research has shown that stroke results to significant trunk impairments and this impedes overall functional outcomes, including mobility. Indeed, evidence suggests that individuals with poor trunk function, such as the inability to sit unsupported early after stroke have a high likelihood of poor mobility at six months. Despite this, physiotherapy that specifically targets trunk performance is often neglected during early rehabilitation. It is well recognised that augmenting therapy input, such as additional lower limb therapy, early after stroke leads to improved functional outcomes. Therefore given that trunk function is a good predictor of mobility outcome, directing augmented therapy at the trunk early after stroke could also improve mobility outcomes. Recent research utilising specific trunk training in individuals with mixed trunk function ability shows some improvements in mobility. However, it is not clear what the response will be in those patients with significant trunk impairments who are most at risk of long term mobility problems.
We would like to determine if early additional trunk training could improve mobility in those with more severe trunk problems. In order to achieve this, we must first establish whether it is possible to conduct a clinical trial that can answer this question. Therefore, we aim to carry out a study to determine the feasibility and acceptability of delivering additional trunk training during early rehabilitation after stroke. This will inform the evaluation of possibility of a future clinical trial to explore efficacy and cost-effectiveness of this intervention.
Summary of study results:
Many people after stroke report considerable difficulties with moving about within their home and outside environments and this continues to be an area of concern for many years. Given that trunk function is a good predictor of mobility outcomes, directing more therapy at the trunk early after stroke could improve rehabilitation outcomes. The aim of this study was to investigate the possibility of providing additional trunk training (ATT) during early post stroke rehabilitation and to determine if the ATT was acceptable to people with severe trunk weakness, their carers and physiotherapists. Twenty-one (21) adults with inability to sit independently for 30 seconds after the third day of stroke and who were well enough to participate were recruited from 5 NHS hospitals. They were given ATT in addition to usual stroke rehabilitation during in-hospital rehabilitation.
We found that 1 in 5 stroke patients admitted had severe trunk weakness. While only a quarter of these individuals were suitable, the majority of them were willing to join the study.
Delivering ATT was challenging due primarily to the limited capacity of the physiotherapists to deliver the additional intervention and patient related issues such as excessive fatigue.
Nevertheless, two-thirds of participants in the study completed more than a quarter of the planned dose of ATT. Large improvements were seen in individuals' use of the trunk, their mobility and quality of life after ATT, similar to findings in people with less severe trunk weakness in previous studies.
The participants, their carers, and physiotherapists found ATT to be beneficial and acceptable as an intervention. They also reported the assessment outcomes were appropriate and not burdensome. Physiotherapists expressed that they would be unwilling to withhold ATT intervention, if their patient was in a control group as they considered it to be beneficial. Participants also felt that they would be unhappy if they were randomised to a control group.
This study has shown that ATT is an acceptable intervention and that participants are willing and able to be recruited. However, there is a need to modify the recruitment criteria to ensure that more individuals who have severe trunk weakness can be included in a future trial. Secondly, the willingness of people to be randomly allocated to different groups in a clinical trial needs to be carefully considered. Thirdly, the clinical outcomes are encouraging that large effects may be achieved.REC name
East of England - Essex Research Ethics Committee
REC reference
15/EE/0317
Date of REC Opinion
13 Nov 2015
REC opinion
Further Information Favourable Opinion