Effects of Neuropilates on Functional Outcomes in Chronic Stroke: A Randomized Clinical Trial
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Participants
2.3. Intervention
2.4. Measures
2.4.1. General Medical Information
2.4.2. Functional Outcomes
- Functional Independence Measure (FIM) [12] was used to assess functional independence of activities of daily living, and it was the main outcome. It comprises 18 items regarding motor and cognitive daily performance. The score ranges from 1 to 7, with a higher score indicating a higher level of functional independence. Administration was carried out through task observation (eating, grooming, bathing, dressing—upper body, dressing—lower body, toileting, transfers between bed, chair, and wheelchair, toilet, tub/shower, walk and stairs) and an interview (bladder management, bowel management, auditory comprehension, verbal expression, social memory). The minimal clinically important difference values for the FIM in patients post-stroke are 22, 17 and 3 for the total FIM, motor FIM and cognitive FIM, respectively [13].
- Functional Reach Test (FRT) [14] was used to measure the maximum distance an individual can move their gravity towards the limits of their support area (i.e., static balance). In a relaxed standing posture, with the feet at hip height, the person is instructed to do a shoulder flexion up to 90 degrees and to keep the hand extended. The person must go forward as much as they can, and the examiner then records the final distance in centimeters. Two preliminary practice trials were administered to each participant preceding the performance of three FRT trials. The final score was determined by calculating the mean score derived from the three trials.
- Timed ‘Up and Go’ (TUG) [15] was used to measure overall balance and gait speed. The person is asked to get up from a chair, walk 3 m, turn, return to the chair and sit down. The final score is recorded in seconds, with a higher score indicative of a diminished balance.
2.4.3. Upper Limb Performance Outcomes
- Nine Hole Peg Test (NHPT) [16] was used to assess manual dexterity as it is considered a gold-standard test for this outcome. Each participant was asked to place nine pegs on a board with 9 holes and to remove them again, as quickly as possible. The final score is recorded in seconds, with a higher score being indicative of a diminished manual dexterity. Each hand was scored separately.
- Box and Block Test (BBT) [17] was used to assess overall upper limb gross motor performance. It is composed of a wooden box divided in two compartments by a partition, one of which contains 150 wooden blocks. Each participant was asked to move, one by one, as many wooden blocks as possible from one compartment to the other within 60 s. Scores were based on the number of blocks transferred, with higher scores being indicative of a better upper limb performance. Each arm was scored separately.
- Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) [18] was used to assess daily activity and participation according to the 9 domains described in the International Classification of Upper Limb Functioning, Disability, and Health.
2.4.4. Secondary Outcomes
2.5. Statiscal Analysis
3. Results
3.1. Attrition Rate
3.2. Baseline Characteristics of Participants
3.3. Effects of the Intervention
Primary Outcomes
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | Control Group n = 15 Mean (SD)/N (%) | Experimental Group n = 15 Mean (SD)/N (%) | p Value |
---|---|---|---|
Age | 55.7 (16.8) | 58.5 (11.1) | 0.732 |
Sex | 0.713 | ||
Male | 8 (53.3) | 9 (60.0) | |
Female | 7 (47.7) | 6 (40.0) | |
Months since diagnosis | 50.1 (33.4) | 34.5 (18.0) | 0.128 |
Stroke | 0.409 | ||
Hemorrhagic | 10 (66.7) | 12 (80.0) | |
Ischemic | 5 (33.3) | 3 (20.0) | |
Hand dominance | 0.624 | ||
Right | 12 (80.0) | 13 (86.7) | |
Left | 3 (20.0) | 2 (13.3) | |
Impaired upper limb | 0.143 | ||
Right | 9 (60.0) | 5 (33.3) | |
Left | 6 (40.0) | 10 (66.7) | |
Occupational Therapy intervention weekly hours | 1.9 (0.3) | 1.6 (0.5) | 0.034 * |
Physical Therapy intervention weekly hours | 1.7 (0.5) | 1.8 (0.4) | 0.679 |
FIM a | 68.0 (6.4) | 74.5 (7.7) | 0.018 * |
FRT b | 2.6 (1.8) | 2.7 (2.0) | 0.847 |
TUG c | 110.3 (49.6) | 93.4 (26.4) | 0.254 |
NHPT d (right) | 111.9 (48.1) | 77.0 (31.7) | 0.027 * |
NHPT d (left) | 90.1 (40.4) | 96.2 (30.8) | 0.645 |
BBT e (right) | 29.9 (31.0) | 51.3 (31.3) | 0.068 |
BBT e (left) | 41.6 (29.5) | 28.7 (26.2) | 0.214 |
DASH disability | 85.3 (8.7) | 86.1 (7.6) | 0.790 |
DASH occupation | 94.1 (7.5) | 91.1 (8.7) | 0.320 |
Experimental Group | |||||
---|---|---|---|---|---|
Outcomes | Pre-Intervention Score (M [SD]) | Post-Intervention Score (M [SD]) | p Value | Follow-Up Score (M [SD]) | p Value |
FIM a | 74.5 (7.7) | 82.1 (6.7) | <0.001 * | 82.3 (6.8) | <0.001 * |
FRT b | 2.7 (2.0) | 5.7 (2.6) | <0.001 * | 5.5 (2.6) | <0.001 * |
TUG c | 93.4 (26.4) | 91.0 (26.4) | 0.008 * | 87.3 (24.2) | <0.001 * |
NHPT d (right) | 77.0 (31.7) | 67.5 (20.9) | 0.007 * | 63.2 (18.6) | 0.002 * |
NHPT d (left) | 96.2 (30.8) | 82.3 (21.7) | <0.001 * | 80.8 (22.4) | <0.001 * |
BBT e (right) | 51.5 (31.3) | 56.4 (31.3) | <0.001 * | 58.6 (32.6) | 0.427 |
BBT e (left) | 28.7 (26.2) | 35.7 (27.1) | <0.001 * | 50.1 (54.9) | 0.134 |
DASH disability | 86.1 (7.6) | 82.3 (7.9) | <0.001 * | 81.7 (7.6) | <0.001 * |
DASH occupation | 91.1 (8.7) | 86.1 (8.5) | <0.001 * | 85.5 (9.1) | <0.001 * |
Control group | |||||
Outcomes | Pre-intervention Score (M [SD]) | Post-intervention score (M [SD]) | p Value | Follow-up score (M [SD]) | p Value |
FIM a | 68.0 (6.4) | 70.2 (6.5) | 0.002 * | 70.5 (6.5) | 0.002 * |
FRT b | 2.6 (1.8) | 2.8 (1.7) | 0.098 | 2.6 (1.8) | 0.974 |
TUG c | 110.3 (49.6) | 108.6 (47.8) | 0.080 | 106.1 (49.6) | 0.064 |
NHPT d (right) | 111.9 (48.1) | 109.4 (47.3) | <0.001 * | 109.1 (47.5) | 0.007 * |
NHPT d (left) | 90.1 (40.4) | 89.5 (41.4) | 0.173 | 89.0 (42.3) | 0.289 |
BBT e (right) | 29.9 (31.0) | 30.8 (31.6) | 0.097 | 35.2 (32.8) | 0.583 |
BBT e (left) | 41.6 (29.5) | 42.7 (30.1) | 0.048 * | 43.0 (30.6) | 0.022 * |
DASH disability | 85.3 (8.7) | 84.5 (8.6) | 0.138 | 84.5 (8.7) | 0.200 |
DASH occupation | 94.1 (7.5) | 93.1 (7.2) | 0.161 | 93.0 (7.3) | 0.136 |
Post-Intervention | Follow-Up | |||||
---|---|---|---|---|---|---|
Outcomes | Inter-Group Difference | [95% CI] | p Value | Inter-Group Difference | [95% CI] | p Value |
FIM a | 11.9 | [7.0, 16.9] | <0.001 * | 11.7 | [6.8, 16.7] | <0.001 * |
FRT b | 2.9 | [1.2, 4.5] | 0.001 * | 2.9 | [1.2, 4.6] | 0.001 * |
TUG c | −17.6 | [−46.4, 11.3] | 0.222 | −18.9 | [−48.1, 10.3] | 0.196 |
NHPT d (right) | −41.9 | [−69.8, −13.9] | 0.005 * | −45.9 | [−73.6, −18.2] | 0.003 * |
NHPT d (left) | −7.2 | [−32.3, 17.9] | 0.557 | −8.2 | [−33.9, 17.5] | 0.513 |
BBT e (right) | 25.6 | [2.1, 49.1] | 0.034 * | 23.4 | [−1.1, 47.9] | 0.060 |
BBT e (left) | −7.0 | [−28.4, 14.4] | 0.509 | 7.1 | [−26.2, 40.3] | 0.667 |
DASH disability | −2.2 | [−8.4, 4.0] | 0.471 | −2.8 | [−8.9, 3.3] | 0.355 |
DASH occupation | −6.9 | [−12.8, −1.0] | 0.023 * | −7.5 | [−13.7, −1.4] | 0.018 * |
Post-Intervention | Follow-Up | |||
---|---|---|---|---|
Outcomes | p Value | Effect Size (η2) | p Value | Effect Size (η2) |
FIM a | <0.001 * | 0.461 | <0.001 * | 0.435 |
FRT b | 0.016 * | 0.197 | 0.014 * | 0.203 |
TUG c | 0.663 | 0.007 | 0.767 | 0.003 |
NHPT d (right) | 0.013 * | 0.207 | 0.005 * | 0.253 |
NHPT d (left) | 0.571 | 0.012 | 0.538 | 0.014 |
BBT e (right) | 0.126 | 0.085 | 0.024 * | 0.174 |
BBT e (left) | 0.835 | 0.002 | 0.894 | 0.001 |
DASH disability | 0.867 | 0.001 | 0.958 | <0.001 |
DASH occupation | 0.189 | 0.063 | 0.152 | 0.074 |
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García-Bravo, C.; Delgado-Lobete, L.; Montes-Montes, R.; Rodríguez-Pérez, M.P.; Trugeda-Pedrajo, N.; Fernández-Gómez, G.; García-Bravo, S. Effects of Neuropilates on Functional Outcomes in Chronic Stroke: A Randomized Clinical Trial. Healthcare 2024, 12, 850. https://doi.org/10.3390/healthcare12080850
García-Bravo C, Delgado-Lobete L, Montes-Montes R, Rodríguez-Pérez MP, Trugeda-Pedrajo N, Fernández-Gómez G, García-Bravo S. Effects of Neuropilates on Functional Outcomes in Chronic Stroke: A Randomized Clinical Trial. Healthcare. 2024; 12(8):850. https://doi.org/10.3390/healthcare12080850
Chicago/Turabian StyleGarcía-Bravo, Cristina, Laura Delgado-Lobete, Rebeca Montes-Montes, Mª Pilar Rodríguez-Pérez, Nuria Trugeda-Pedrajo, Gemma Fernández-Gómez, and Sara García-Bravo. 2024. "Effects of Neuropilates on Functional Outcomes in Chronic Stroke: A Randomized Clinical Trial" Healthcare 12, no. 8: 850. https://doi.org/10.3390/healthcare12080850
APA StyleGarcía-Bravo, C., Delgado-Lobete, L., Montes-Montes, R., Rodríguez-Pérez, M. P., Trugeda-Pedrajo, N., Fernández-Gómez, G., & García-Bravo, S. (2024). Effects of Neuropilates on Functional Outcomes in Chronic Stroke: A Randomized Clinical Trial. Healthcare, 12(8), 850. https://doi.org/10.3390/healthcare12080850