Abstract
Objective: This study compared two modes of physiotherapy service over 12 months in community-dwelling people with stroke, either following a train—wait train paradigm by providing bouts of intense physiotherapy, or a continuous less intense programme.
Design: Randomized trial.
Setting: Community-dwelling people with stroke.
Interventions: Fifty patients, first-time stroke, discharged home, following inpatient rehabilitation, allocated to two groups, A and B. Over 12 months, Group A (n = 25) received three two-month blocks of therapy at home, each block contained four 30 to 45 minute sessions per week, totalling 96 sessions. Group B (n = 25) continuously received two 30 to 45 minute sessions per week, totalling 104 sessions.
Main outcome measures: Primary Rivermead Mobility Index (0—15), secondary upper- and lower-limb motor functions, Activities of Daily Living competence, tone and number of falls.
Results: Both groups were comparable at onset, the mean age in Group A (B) was 62.4 (61.9) years. A and B patients equally improved functions over time, between group differences did not occur. The initial (terminal) Rivermead Mobility Index was 9.4 ± 2.8 (12.2 ± 2.1) in Group A, and 8.5 ± 3.5 (11.2 ± 2.7) in Group B. More Group B patients fell seriously (7 versus 1).
Conclusions: The intermittent high-intensity and continuous low-intensity therapy protocols were equally effective, the sheer intensity seems more important than the time-mode of application. The relatively young patients functionally improved in the first year after stroke, the reduced risk of serious falls in the intermittent high-intensity group should be validated.
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