STEPS_CSM 2006.ppt

Strength Training Effectiveness Post-Stroke Study : 

Strength Training Effectiveness Post-Stroke Study Multi-site, randomized clinical trial (NWU, USC, RLA) Primary Investigators: David Brown, PhD,PT; Katherine Sullivan PhD, PT; Sara Mulroy, PhD, PT Project Coordinator: Tara Klassen, MS, PT, NCS Data Management/Statistical Analysis Team: Stan Azen, PhD; Tingting Ge, MS STEPS

Background and Significance : 

Background and Significance After stroke, patients exhibit LE weakness that contributes to decreased walking velocity and endurance and contributes to disability. (Perry et al., 1995; Richards & Olney, 1996; Mulroy et al., 2003) Post-stroke, patients respond to strengthening exercises and task-specific training to improve walking ability. (Teixeira-Salmela et al., 1999, 2001; Dean et al., 2000; Sullivan et al.,2002; Patton et al, 2004; Richards et al. 2004) An intervention approach that combines task-specific locomotor training and LE strengthening may decrease gait-related disability and increase participation.

STEPS Research Design : 

STEPS Research Design Specific Aim: To determine the effectiveness of specific strength training programs to promote locomotor recovery after stroke. Inclusion criteria: Unilateral stroke, onset 4 months – 5 years, able to ambulate 10m with/without assistive device with no more than standby assist, slower than before stroke. Recruitment goal: 80 individuals across 3 clinical sites Intervention parameters: 24 sessions: 4 days/week x 6 weeks Measurements: Baseline, after 12 and 24-sessions, 6 month follow-up Primary outcomes: gait velocity and endurance Secondary outcomes: strength, balance, QOL

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Purpose Identify the most appropriate measures of post-stroke participation and subjective quality of life (SQOL) Identify LE impairments (i.e.: weakness, impaired motor control, balance deficits) and activity limitations (i.e.: walking speed and endurance) that are associated with participation post-stroke. Identify walking-related impairments and health status indicators that contribute to SQOL after stroke.

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Body functions and structures (impairments) Activity Health Condition (STROKE) Participation ICF Conceptual Framework: STEPS outcome measures LE-Fugl Meyer motor score Berg Balance Score Paretic LE strength Non-paretic LE strength Walking speed (comfortable) Walking speed (fast) 6-min walk distance SF-36 physical health SF-36 mental health Stroke Impact Scale (SIS) 8 subscales SIS-16 Overall well-being SQOL

Stroke Impact Scale (v 3.0): : 

Stroke Impact Scale (v 3.0): Measure of post-stroke health-related function and quality of life Stroke-specific measure developed from stroke survivors and their caregivers feedback Captures multiple domains of activity, participation, and overall subjective impression of own recovery (Duncan et al., 1999; Lai et al., 2003) Physical function (SIS-16) Mobility ADL/IADL Hand function Strength

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Demographics STEPS Participants (n = 80) Men (n=45), Women (n=35) LCVA (n=42), RCVA (n=38) Age = 60.9 ± 12.4 yrs (range 31.9 to 83.2 yrs) Stroke onset = 24.9 ± 16.2 mos

Baseline Clinical Characteristics : 

Baseline Clinical Characteristics Comfortable velocity (10 meter walk): 0.50 ± .28 m/s (range 0.09 – 1.17) 6-minute walk 184 ± 111 meters (range 17 – 442) LE – Fugl Meyer motor score: 23.8 ± 5.2 (range 11 – 34) Berg Balance score 42.6 ± 11.7 (range 9 – 56)

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Univariate correlations: Activity/ impairment measures & Participation/ QOL measures

Multivariate regression models tested : 

Multivariate regression models tested p < .0001 p < .0001

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Stepwise Multiple regression analysis: Explanatory variables for SIS-16

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Stepwise Multiple regression analysis: Explanatory variables for SQOL

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Predictors of Subjective QOL MODEL SUMMARY

Post-Stroke Participation and QOL measures : 

Post-Stroke Participation and QOL measures SIS-16 and SQOL are appropriate and interpretable measures of post-stroke participation and QOL. While the SF-36 physical and mental health components were not highly correlated to walking related impairments and activity limitations, the SF-36 mental health did reflect the importance of mental well-being in overall QOL post-stroke.

Post-stroke Participation : 

Post-stroke Participation Walking speed and endurance, and LE motor control are important contributors to physical ability post-stroke.

QOL post-stroke : 

QOL post-stroke The impact of a stroke on an individual’s perception of their QOL is a reflection of: physical ability mental well-being weakness post-stroke motor control impairments

Implication for the STEPS study : 

Implication for the STEPS study Will an intervention focused on improving walking ability and LE strength impact participation and SQOL in individuals post-stroke?

QUESTIONS : 

QUESTIONS