A Long-Term Follow-Up Programme for Maintenance of Motor Function after Stroke: Protocol of the life after Stroke-The LAST Study

Torunn Askim, Birgitta Langhammer, Hege Ihle-Hansen, Jon Magnussen, Torgeir Engstad, Bent Indredavik, Torunn Askim, Birgitta Langhammer, Hege Ihle-Hansen, Jon Magnussen, Torgeir Engstad, Bent Indredavik

Abstract

Background. There are no evidence-based strategies that have been shown to be superior in maintaining motor function for months to years after the stroke. The LAST study therefore intends to assess the effect of a long-term follow-up program for stroke patients compared to standard care on function, disability and health. Design. This is a prospective, multi-site randomised controlled trial, with blinded assessment 18 months after inclusion. A total of 390 patients will be recruited and randomised to a control group, receiving usual care, or to an intervention group 10 to 16 weeks after onset of stroke. Patients will be stratified according to stroke severity, age above 80, and recruitment site. The intervention group will receive monthly coaching on physical activity by a physiotherapist for 18 consecutive months after inclusion. Outcomes. The primary outcome is motor function (Motor Assessment Scale) 18 months after inclusion. Secondary outcomes are: dependency, balance, endurance, health-related quality of life, fatigue, anxiety and depression, cognitive function, burden on caregivers, and health costs. Adverse events and compliance to the intervention will be registered consecutively during follow-up.

Figures

Figure 1
Figure 1
Study design.

References

    1. Stroke Unit Trialists’ Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database of Systematic Reviews. 2007;(4)CD000197
    1. Seenan P, Long M, Langhorne P. Stroke units in their natural habitat: systematic review of observational Studies. Stroke. 2007;38(6):1886–1892.
    1. Langhorne P, Taylor G, Murray G, et al. Early supported discharge services for stroke patients: a meta-analysis of individual patients’ data. The Lancet. 2005;365(9458):501–506.
    1. Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. The Lancet. 2011;377(9778):1693–1702.
    1. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. The Lancet. 2006;367(9524):1747–1757.
    1. Furie KL, Kasner SE, Adams RJ, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke. 2011;42(1):227–276.
    1. Aktivitetshåndboken. Fysisk aktivitet i forebygging og behandling. .
    1. Rand D, Eng JJ, Tang PF, Jeng JS, Hung C. How active are people with stroke? Use of accelerometers to assess physical activity. Stroke. 2009;40(1):163–168.
    1. Zalewski KR, Dvorak L. Barriers to physical activity between adults with stroke and their care partners. Topics in Stroke Rehabilitation. 2011;18(supplement 1):666–675.
    1. Langhammer B, Lindmark B, Stanghelle JK. Stroke patients and long-term training: is it worthwhile? A randomized comparison of two different training strategies after rehabilitation. Clinical Rehabilitation. 2007;21(6):495–510.
    1. Askim T, Mørkved S, Engen A, Roos K, Aas T, Indredavik B. Effects of a community-based intensive motor training program combined with early supported discharge after treatment in a comprehensive stroke unit: a randomized, controlled trial. Stroke. 2010;41(8):1697–1703.
    1. Langhammer B, Stanghelle JK, Lindmark B. Exercise and health-related quality of life during the first year following acute stroke. A randomized controlled trial. Brain Injury. 2008;22(2):135–145.
    1. Boysen G, Krarup LH, Zeng X, et al. ExStroke pilot trial of the effect of repeated instructions to improve physical activity after ischaemic stroke: a multinational randomised controlled clinical trial. British Medical Journal. 2009;339b2810
    1. Lund A, Michelet M, Sandvik L, Wyller T, Sveen U. A lifestyle intervention as supplement to a physical activity programme in rehabilitation after stroke: a randomized controlled trial. Clinical Rehabilitation. 2012;26(6):502–512.
    1. Olsen JM, Nesbitt BJ. Health coaching to improve healthy lifestyle behaviors: an integrative review. American Journal of Health Promotion. 2010;25(1):e1–e12.
    1. Waaler H. Scenario 2030: Sykdomsutvikling for eldre fram til 2030. Oslo, Norway: Statens helsetilsyn; 1999.
    1. Early Supported Discharge Trialists. Services for reducing duration of hospital care for acute stroke patients. Cochrane Database of Systematic Reviews. 2007;(2)CD000443
    1. Banks G, Bernhardt J, Churilov L, Cumming TB. Exercise preferences are different after stroke. Stroke Research and Treatment. 2012;2012:9 pages.890946
    1. Rockwood K, Stolee P, Fox RA. Use of goal attainment scaling in measuring clinically important change in the frail elderly. Journal of Clinical Epidemiology. 1993;46(10):1113–1118.
    1. Carr JH, Shepherd RB, Nordholm L, Lynne D. Investigation of a new motor assessment scale for stroke patients. Physical Therapy. 1985;65(2):175–180.
    1. French B, Thomas LH, Leathley MJ, et al. Repetitive task training for improving functional ability after stroke. Cochrane Database of Systematic Reviews. 2007;(4)CD006073
    1. Kjendahl A, Jahnsen R, Aamodt G. Motor assessment scale, oversettelse til norsk og inter-rater reliabilitet. Fysioterapeuten. 2005;(5):14–18.
    1. Wolfe CDA, Taub NA, Woodrow EJ, Burney PGJ. Assessment of scales of disability and handicap for stroke patients. Stroke. 1991;22(10):1242–1244.
    1. Alzayer L, Beninato M, Portney LG. The accuracy of individual berg balance scale items compared with the total berg score for classifying people with chronic stroke according to fall history. Journal of Neurologic Physical Therapy. 2009;33(3):136–143.
    1. Mathias S, Nayak USL, Isaacs B. Balance in elderly patients: the “get-up and go” test. Archives of Physical Medicine and Rehabilitation. 1986;67(6):387–389.
    1. Bohannon RW. Comfortable and maximum walking speed of adults aged 20–79 years: reference values and determinants. Age and Ageing. 1997;26(1):15–19.
    1. Guyatt GH, Sullivan MJ, Thompson PJ, Fallen EL, Pugsley SO, Taylor DW, et al. The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Canadian Medical Association Journal. 1985;132(8):919–923.
    1. Duncan PW, Wallace D, Lai SM, Johnson D, Embretson S, Laster LJ. The stroke impact scale version 2.0: evaluation of reliability, validity, and sensitivity to change. Stroke. 1999;30(10):2131–2140.
    1. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Annals of Medicine. 2001;33(5):337–343.
    1. Lerdal A, Kottorp A, Gay C, Aouizerat BE, Portillo CJ, Lee KA. A 7-item version of the fatigue severity scale has better psychometric properties among HIV-infected adults: an application of a Rasch model. Quality of Life Research. 2011;20(9):1447–1456.
    1. The HUNT study—a longitudinal population health study in Norway. HUNT3-Q1—all participants age 20 and older, men and women, 2012, .
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica. 1983;67(6):361–370.
    1. Folstein MF, Folstein SE, McHugh PR. ‘Mini mental state’. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research. 1975;12(3):189–198.
    1. Tombaugh TN. Trail making test A and B: normative data stratified by age and education. Archives of Clinical Neuropsychology. 2004;19(2):203–214.
    1. Robinson BC. Validation of a caregiver strain index. Journals of Gerontology. 1983;38(3):344–348.
    1. Kurtze N, Rangul V, Hustvedt BE, Flanders DW. Reliability and validity of self-reported physical activity in the Nord-Trøndelag health study—HUNT 1. Scandinavian Journal of Public Health. 2008;36(1):52–61.
    1. Craig CL, Marshall AL, Sjöström M, et al. International physical activity questionnaire: 12-country reliability and validity. Medicine and Science in Sports and Exercise. 2003;35(8):1381–1395.
    1. Taraldsen K, Askim T, Sletvold O, et al. Evaluation of a body-worn sensor system to measure physical activity in older people with impaired function. Physical Therapy. 2011;91(2):277–285.
    1. Langhammer B, Stanghelle JK, Lindmark B. An evaluation of two different exercise regimes during the first year following stroke: a randomised controlled trial. Physiotherapy Theory and Practice. 2009;25(2):55–68.
    1. Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: Updated guidelines for reporting parallel group randomized trials. Annals of Internal Medicine. 2010;152(11):726–732.

Source: PubMed

3
Suscribir