A randomized controlled trial of Cognitive Sensory Motor Training Therapy on the recovery of arm function in acute stroke patients

2012 ◽  
Vol 26 (12) ◽  
pp. 1096-1104 ◽  
Author(s):  
Ratanapat Chanubol ◽  
Parit Wongphaet ◽  
Napapit Chavanich ◽  
Cordula Werner ◽  
Stefan Hesse ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Acute Stroke ◽  
Controlled Trial ◽  
Motor Training ◽  
Stroke Patients ◽  
Randomized Controlled ◽  
Sensory Motor ◽  
Arm Function ◽  
Training Therapy

Abstract NS4: Challenges and Lessons Learned in an Ongoing Randomized Controlled Trial to Test the Effectiveness of a Multicomponent Intervention in Improving Delirium Outcomes in Acute Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Karen L Rice ◽  
Marsha Bennett ◽  
Linley Berger ◽  
Bethany Jennings ◽  
Erin Barry ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Acute Stroke ◽  
Controlled Trial ◽  
Lessons Learned ◽  
Intervention Fidelity ◽  
Stroke Patients ◽  
Randomized Controlled ◽  
Multicomponent Intervention ◽  
Study Staff ◽  
Therapeutic Activities

Delirium in acute stroke has higher morbidity and mortality than those without delirium. This two-group randomized controlled trial (RCT) tests if a multicomponent intervention improves delirium outcomes in stroke patients at a comprehensive stroke center. This presentation describes the challenges in managing a RCT in acute stroke. Scientific rigor requires coordinating staff, enrolling adequate sample size, assuring intervention fidelity, and fostering data integrity. A sample of 282 subjects is required for 80% power (α=0.05) to determine a 10% reduction in incident delirium. Eligibility includes acute stroke, aged ≥ 50 years, no aphasia or delirium on admit. Subjects randomized to Usual Care (UC) or Delirium Care (DC). Both groups receive standardized Stroke Care. DC subjects receive a multicomponent intervention: 1) pharmacist recommendations using Anticholinergic Drug scale scores; and 2) therapeutic activities. NIHSS, Montreal Cognitive Assessment (MoCA), Confusion Assessment Method (CAM), and mRS are used to determine primary (delirium) and secondary endpoints (LOS, neurological deficit, functional status). A total of 513 patients screened over 289 consecutive days required unbudgeted staff. The 310 excluded [aphasia (94), baseline delirium (36), critically ill (92), LOS <2 days (69), other causes (19)] unexpectedly impacted enrollment. Of eligible, 66% (133/203) consented; UC (n=65), DC (n=68). Hospital volunteers engaged DC subjects in therapeutic activities twice daily, including holidays. Two pharmacists independently made recommendations for each group. Outcome data were validated at daily rounds. Stroke-related cognitive dysfunction required more time than norm to complete the MoCA. Both the CAM and team consensus was used to confirm delirium. Lessons learned: 1) study staff attending rounds was key to enrollment, intervention fidelity, and data integrity; 2) securing a pool of on-call volunteers to sustain therapeutic activities was required; and 3) additional and unanticipated resources were needed. In conclusion, successful conduct of a RCT in acute stroke patients requires a dedicated well-trained study staff 7 days a week, including holidays.

scholarly journals Effects of mental imagery on lower limb function in sub-acute stage of stroke patients; a randomized controlled trial

2021 ◽  
Vol 3 (1) ◽  
pp. 21-23
Author(s):  
Wajiha Shahid ◽  
Maryam Shabbir ◽  
Anam Naz ◽  
Naveed Arshad ◽  
Umair Ahmed
Keyword(s):  
Randomized Controlled Trial ◽  
Conservative Treatment ◽  
Acute Stroke ◽  
Mental Imagery ◽  
Neural Circuit ◽  
Controlled Trial ◽  
Acute Stage ◽  
Stroke Patients ◽  
Randomized Controlled ◽  
Muscle Testing

Introduction: Stroke is the most common type of cerebrovascular injury caused by sudden decrease in blood supply that can lead to weaknesses and other associated problems. Many treatment options are available for stroke with promising results. This trial was designed to explore the role of mental imagery (visual) in the sub-acute stage, considering the stroke patient, especially in evaluating its effects on the lower extremities. Material & Methods: An experimental randomized controlled trial was performed from July to August 2018 in physiotherapy departments of National Hospital and Aadil Hospital Defence Lahore. A total of 80 patients having sub-acute stroke with strong perceptions having a score of 25 or more in the Mini Mental Score Exam and a 3 +/5 manual muscle testing grade system in the lower extremity were taken using non-probability consecutive sampling procedure. All the patients were divided into 2 groups randomly. Conservative treatment including strengthening and balance training were given to one group and conservative treatment with addition of visual imagery to the second group. Independent t-test was used to assess significant differences between the two groups. Results: Comparison of Berg Balance Scale at pre-intervention between the experimental group and the controlled group was not significant, 13.76 ± 2.85 vs 13.84 ± 3.26 (p=0.927), respectively. After intervention the effects of treatment were significant in both groups, 18.64 ± 2.33 vs 17.80 ± 2.94(p=0.007), respectively. Comparison of Time Up and Go test at pre-intervention between groups was not significant, 6.28 ± 1.86 vs 6.68 ± 0.99(p=0.347), respectively. The intervention effects after treatment in both groups were significant, 1.84 ± 1.28 vs 3.56 ± 1.26 (p=0.001), respectively. Conclusion: It is concluded that mental imagery along with conservative treatment plays a vital role in construction of neural circuit in sub-acute stroke patients.

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