Jaana Paltamaa

Effectiveness of constraint-induced movement therapy on activity and participation after stroke: a systematic review and meta-analysis of randomized controlled trials

Objective: To examine the effect of constraint-induced movement therapy and modified constraint-induced movement therapy on activity and participation of patients with stroke (i.e. the effect of different treatment durations and frequency) by reviewing the results of randomized controlled trials. Data sources: A systematic literature search was conducted in MEDLINE, CINAHL, EMBASE, PEDro, OTSeeker, CENTRAL and by manual search. Review methods: Randomized controlled trials for patients over 18 years old with stroke and published in Finnish, Swedish, English or German were included. Studies were collected up to the first week in May 2011. The evidence was high, moderate, low or no evidence according to the quality of randomized controlled trial and the results of meta-analyses. Results: Search resulted in 30 papers reporting constraint-induced movement therapy, including 27 randomized controlled trials published between 2001 and 2011. Constraint-induced movement therapy practice for 60–72 hours over two weeks produced better mobility (i.e. ability to carry, move and handle objects) with high evidence compared to control treatment. Constraint-induced movement therapy for 20–56 hours over two weeks, 30 hours over three weeks and 15–30 hours over 10 weeks improved mobility of the affected upper extremity. However, with self-care as an outcome measure, only 30 hours of constraint-induced movement therapy practice over three weeks demonstrated an improvement. Conclusion: Constraint-induced movement therapy and modified constraint-induced movement therapy proved to be effective on affected hand mobility and to some extent self-care on the World Health Organization’s International Classification of Functioning, Disability and Health activity and participation component, but further studies are needed to find out the optimal treatment protocols for constraint-induced movement therapy.

Measuring Deterioration in International Classification of Functioning Domains of People With Multiple Sclerosis Who Are Ambulatory

Background and Purpose: Measures to detect important effects related to physical therapy interventions must be able to detect an important change. The purpose of this study was to select the most responsive physical functioning measures for multiple sclerosis (MS) using the International Classification of Functioning, Disability and Health (ICF) as a framework. Subjects: The participants were 120 people with MS who were ambulatory from a population-based sample. Methods: Physical functioning was assessed by quantitative clinical measures of activities (n=5) and body functions (n=7) and by self-reported performance in self-care, mobility, and domestic life domains in the activities and participation component of the ICF at baseline and 2 years later. A participants perception of change and a change in Expanded Disability Status Scale (EDSS) scores were used as external criteria in the analysis of the receiver operating characteristic curve and the minimally important change score. The minimal detectable change was calculated as distribution-based responsiveness. Results: According to the external criteria, 51% of the participants showed deterioration as measured by their own perceptions compared with the 26% of the participants who showed deterioration as rated by the clinician. Regardless of the external criterion applied, the measures most responsive to deterioration were self-reported scores in self-care, mobility, and domestic life; distance walked and change in heart rate during a 6-minute walk test; 10-m walk test speeds, stride length, and cadence; repetitive squatting; and Box and Block Test scores. Discussion and Conclusion: The results show the relative responsiveness of different measures in the subsample who deteriorated and provide data that can facilitate the interpretation of score changes in people with MS who are ambulatory for future studies and in clinical practice.

Evidence for the effectiveness of walking training on walking and self-care after stroke. A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE To examine the effect of randomized controlled trials of walking training on walking and self-care in patients with stroke. DATA SOURCES MEDLINE, CINAHL, Embase, PEDro, OTSeeker, Central, and manual search to the end of August 2012. STUDY SELECTION English, Finnish, Swedish, or German language walking training randomized controlled trials for patients over 18 years of age with stroke. DATA SYNTHESIS The meta-analyses included 38 randomized controlled trials from 44 reports. There was high evidence that in the subacute stage of stroke, specific walking training resulted in improved walking speed and distance compared with traditional walking training of the same intensity. In the chronic stage, walking training resulted in increased walking speed and walking distance compared with no/placebo treatment, and increased walking speed compared with overall physio-therapy. On average, 24 training sessions for 7 weeks were needed. CONCLUSION Walking training improves walking capacity and, to some extent, self-care in different stages of stroke, but the training frequency should be fairly high.

Progressive resistance training in Parkinson's disease: a systematic review and meta-analysis

Objectives To investigate if there is evidence on effectiveness of progressive resistance training in rehabilitation of Parkinson disease. Design Systematic review and meta-analysis. Data sources: Central, Medline, Embase, Cinahl, Web of Science, Pedro until May 2014. Randomised controlled or controlled clinical trials. The methodological quality of studies was assessed according to the Cochrane Collaborations domain-based evaluation framework. Data synthesis: random effects meta-analysis with test for heterogeneity using the I² and pooled estimate as the raw mean difference. Participants Adults with primary/idiopathic Parkinsons disease of any severity, excluding other concurrent neurological condition. Interventions Progressive resistance training defined as training consisting of a small number of repetitions until fatigue, allowing sufficient rest between exercises for recovery, and increasing the resistance as the ability to generate force improves. Comparison Progressive resistance training versus no treatment, placebo or other treatment in randomised controlled or controlled clinical trials. Primary and secondary outcome measures Any outcome. Results Of 516 records, 12 were considered relevant. Nine of them had low risk of bias. All studies were randomised controlled trials conducted on small samples with none or 1 month follow-up after the end of intervention. Of them, six were included in quantitative analysis. Pooled effect sizes of meta-analyses on fast and comfortable walking speed, the 6 min walking test, Timed Up and Go test and maximal oxygen consumption were below the level of minimal clinical significance. Conclusions There is so far no evidence on the superiority of progressive resistance training compared with other physical training to support the use of this technique in rehabilitation of Parkinsons disease. Systematic review registration number PROSPERO 2014:CRD42014009844.

Effectiveness of technology-based distance physical rehabilitation interventions on physical activity and walking in multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials.

Abstract Objective: To determine the effectiveness of technology-based distance physical rehabilitation interventions in multiple sclerosis (MS) on physical activity and walking. Data sources: A systematic literature search was conducted in seven databases from January 2000 to September 2016. Randomized controlled trials of technology-based distance physical rehabilitation interventions on physical activity and walking outcome measures were included. Methods: Methodological quality of the studies was determined and a meta-analysis was performed. In addition, a subanalysis of technologies and an additional analysis comparing to no treatment were conducted. Results: The meta-analysis consisted of 11 studies. The methodological quality was good (8/13). The Internet, telephone, exergaming, and pedometers were the technologies enabling distance physical rehabilitation. Technology-based distance physical rehabilitation had a large effect on physical activity (standard mean difference (SMD) 0.59; 95% confidence interval (95% CI) 0.38 to 0.79; p < 0.00001) compared to control group with usual care, minimal treatment, and no treatment. A large effect was also observed on physical activity (SMD 0.59; 95% CI 0.34 to 0.83; p < 0.00001) when compared to no treatment alone. There were no differences in walking and the subanalysis of technologies. Conclusions: Technology-based distance physical rehabilitation increased physical activity among persons with MS, but further research on walking in MS is needed. Implications for Rehabilitation Technology-based distance physical rehabilitation interventions increase physical activity among persons with MS. This study was unable to identify if the technologies (Internet, telephone, or combinations) lead to differing effects on physical activity or walking in the distance physical rehabilitation interventions in MS. Further research on the effectiveness of technology-based distance physical rehabilitation interventions on walking in MS is needed.

A study of the psychometric properties of 12-item World Health Organization Disability Assessment Schedule 2.0 in a large population of people with chronic musculoskeletal pain

Objective: To assess the validity of the Finnish translation of the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0). Design: Cross-sectional cohort survey study. Setting: Physical and Rehabilitation Medicine outpatient university clinic. Subjects: The 501 consecutive patients with chronic musculoskeletal pain. Main measures: Exploratory factor analysis and a graded response model using item response theory analysis were used to assess the constructs and discrimination ability of WHODAS 2.0. Results: The exploratory factor analysis revealed two retained factors with eigenvalues 5.15 and 1.04. Discrimination ability of all items was high or perfect, varying from 1.2 to 2.5. The difficulty levels of seven out of 12 items were shifted towards the elevated disability level. As a result, the entire test characteristic curve showed a shift towards higher levels of disability, placing it at the point of disability level of +1 (where 0 indicates the average level of disability within the sample). Conclusions: The present data indicate that the Finnish translation of the 12-item WHODAS 2.0 is a valid instrument for measuring restrictions of activity and participation among patients with chronic musculoskeletal pain.

Reliability of the Dynamic Gait Index (Finnish version) in individuals with neurological disorders

Purpose: To produce a Finnish version of the Dynamic Gait Index (DGI) and establish its reliability in people with neurological disorders affecting balance. Method: A consecutive sample of 33 participants in inter-rater and 30 participants in intra-rater sample were tested. The DGI was administered in two testing sessions 1–2 h apart. Reliability was assessed with the intra-class correlation coefficient (ICC), Bland–Altman 95% limits of agreement, coefficient of reproducibility (CR), and standard error of the mean (SEM). Results: The instructions from the original DGI were preserved during the translation process with no need for cultural adaptations. The relative reliability of the total scores proved to be high in inter-rater (ICC = 0.90) and intra-rater (ICC = 0.91) testing. The relative reliability between single items varied from poor to high in inter-rater (r = 0.57–0.96) and intra-rater (r = 0.20–0.97) testing. Absolute reliability of the total score was high, and in single items, it varied similarly to relative reliability. The SEM was 1.2 points in inter-rater and 0.8 points in intra-rater testing. Conclusions: The Finnish version of DGI was produced and found to be a reliable tool for clinical testing of balance in neurological patients with balance disorder. Implications for Rehabilitation The Dynamic Gait Index (DGI) is a promising test for the fall-risk evaluation, since it is a standardized tool for evaluating the quality of dynamic balance during walking and an individual’s ability to modify walking in different kinds of situations and dual tasks. In this study, the Finnish version of the DGI was produced and the total score was reliable. Thus, the Finnish DGI can be recommended for clinical testing in individuals with neurological diseases involving balance disorder.