609414
research-article2015
CRE0010.1177/0269215515609414Clinical RehabilitationCabanas-Valdés et al.
CLINICAL REHABILITATION
Article
The effect of additional core stability exercises on improving dynamic sitting balance and trunk control for subacute stroke patients: a randomized controlled trial
Clinical Rehabilitation 2016, Vol. 30(10) 1024–1033 © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0269215515609414 cre.sagepub.com
Rosa Cabanas-Valdés1, Caritat Bagur-Calafat1, Montserrat Girabent-Farrés2, Fernanda Mª Caballero-Gómez3, Montserrat Hernández-Valiño4 and Gerard Urrútia Cuchí5
Abstract Objective: To examine the effect of core stability exercises on trunk control, dynamic sitting and standing balance, gait, and activities of daily living in subacute stroke patients. Design: A randomized controlled trial. Setting: Inpatient rehabilitation hospital in two centres. Subjects: Eighty patients (mean of 23.25 (±16.7) days post-stroke) were randomly assigned to an experimental group and a control group. Interventions: Both groups underwent conventional therapy for five days/week for five weeks and the experimental group performed core stability exercises for 15 min/day. The patients were assessed before and after intervention. Main measures: The Trunk Impairment Scale (Spanish-Version) and Function in Sitting Test were used to measure the primary outcome of dynamic sitting balance. Secondary outcome measures were standing balance and gait as evaluated via Berg Balance Scale, Tinetti Test, Brunel Balance Assessment, Postural Assessment Scale for Stroke (Spanish-Version), and activities of daily living using Barthel Index. 1Department
of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC) Barcelona, Catalonia, Spain 2Department of Physiotherapy (Biostatistics Unit), Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Catalonia, Spain 3Physical Medicine and Rehabilitation, Parc Taulí Sabadell Hospital Universitari, Sabadell, Catalonia, Spain 4Department of Physiotherapy, Parc Sanitari Pere Virgili, Barcelona, Catalonia, Spain
5Centro
Cochrane Iberoamericano, Institut d’Investigació Biomèdica Sant Pau, CIBERESP, Barcelona, Catalonia, Spain
Corresponding author: Rosa Cabanas-Valdés, Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC) Josep Trueta street, E-08195 Sant Cugat del Vallés Barcelona, Catalonia, Spain. Email: [email protected]
1025
Cabanas-Valdés et al.
Results: The experimental group showed statistically significant differences for all of the total scale scores (P3 on the modified Rankin scale,10 a Barthel Index11 score ⩾75, and a Spanish Version of Trunk Impairment Scale 2.012,13 score ⩾10. Other exclusion criteria included orthopaedic or neurological impairments that could influence sitting balance, inability to understand instructions as assessed by a Mini Mental State Examination score ⩽ 24, apraxia, and hemineglect.
1026 Information on patients’ age, days post-stroke, stroke severity as assessed by National Institutes of Health Stroke Scale, and the side and location of the lesion was collected from medical records. Participants were asked to sign an informed consent before participating. The ethical committee from Parc Taulí Sabadell Hospital Universitari gave approval. The study was carried out as per the standards set by the Declaration of Helsinki. The number of patients required for this study was calculated taking into consideration the score variable “dynamic sitting balance subscale” on the Spanish Version of Trunk Impairment Scale 2.0. A standard deviation of 2.3 was assumed in both groups based on our results in the validation study for this scale performed prior to the trial. We also assumed a type I error of 5% and a twotailed t-test with 80% power. We estimated that 37 patients would need to be included in each study arm in order to detect a 1.5-point improvement, yielding a total of 74 patients. To offset any possible dropouts estimated at
research-article2015
CRE0010.1177/0269215515609414Clinical RehabilitationCabanas-Valdés et al.
CLINICAL REHABILITATION
Article
The effect of additional core stability exercises on improving dynamic sitting balance and trunk control for subacute stroke patients: a randomized controlled trial
Clinical Rehabilitation 2016, Vol. 30(10) 1024–1033 © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0269215515609414 cre.sagepub.com
Rosa Cabanas-Valdés1, Caritat Bagur-Calafat1, Montserrat Girabent-Farrés2, Fernanda Mª Caballero-Gómez3, Montserrat Hernández-Valiño4 and Gerard Urrútia Cuchí5
Abstract Objective: To examine the effect of core stability exercises on trunk control, dynamic sitting and standing balance, gait, and activities of daily living in subacute stroke patients. Design: A randomized controlled trial. Setting: Inpatient rehabilitation hospital in two centres. Subjects: Eighty patients (mean of 23.25 (±16.7) days post-stroke) were randomly assigned to an experimental group and a control group. Interventions: Both groups underwent conventional therapy for five days/week for five weeks and the experimental group performed core stability exercises for 15 min/day. The patients were assessed before and after intervention. Main measures: The Trunk Impairment Scale (Spanish-Version) and Function in Sitting Test were used to measure the primary outcome of dynamic sitting balance. Secondary outcome measures were standing balance and gait as evaluated via Berg Balance Scale, Tinetti Test, Brunel Balance Assessment, Postural Assessment Scale for Stroke (Spanish-Version), and activities of daily living using Barthel Index. 1Department
of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC) Barcelona, Catalonia, Spain 2Department of Physiotherapy (Biostatistics Unit), Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Catalonia, Spain 3Physical Medicine and Rehabilitation, Parc Taulí Sabadell Hospital Universitari, Sabadell, Catalonia, Spain 4Department of Physiotherapy, Parc Sanitari Pere Virgili, Barcelona, Catalonia, Spain
5Centro
Cochrane Iberoamericano, Institut d’Investigació Biomèdica Sant Pau, CIBERESP, Barcelona, Catalonia, Spain
Corresponding author: Rosa Cabanas-Valdés, Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC) Josep Trueta street, E-08195 Sant Cugat del Vallés Barcelona, Catalonia, Spain. Email: [email protected]
1025
Cabanas-Valdés et al.
Results: The experimental group showed statistically significant differences for all of the total scale scores (P3 on the modified Rankin scale,10 a Barthel Index11 score ⩾75, and a Spanish Version of Trunk Impairment Scale 2.012,13 score ⩾10. Other exclusion criteria included orthopaedic or neurological impairments that could influence sitting balance, inability to understand instructions as assessed by a Mini Mental State Examination score ⩽ 24, apraxia, and hemineglect.
1026 Information on patients’ age, days post-stroke, stroke severity as assessed by National Institutes of Health Stroke Scale, and the side and location of the lesion was collected from medical records. Participants were asked to sign an informed consent before participating. The ethical committee from Parc Taulí Sabadell Hospital Universitari gave approval. The study was carried out as per the standards set by the Declaration of Helsinki. The number of patients required for this study was calculated taking into consideration the score variable “dynamic sitting balance subscale” on the Spanish Version of Trunk Impairment Scale 2.0. A standard deviation of 2.3 was assumed in both groups based on our results in the validation study for this scale performed prior to the trial. We also assumed a type I error of 5% and a twotailed t-test with 80% power. We estimated that 37 patients would need to be included in each study arm in order to detect a 1.5-point improvement, yielding a total of 74 patients. To offset any possible dropouts estimated at
