Displaying One Session

e-Poster Discussion
Session Type
e-Poster Discussion
Room
Station 10 (E-Poster Area)
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM

EARLY INTRODUCTION TO HIGH-INTENSITY INTERVAL TRAINING IN STROKE ASSOCIATES WITH SUSTAINED VIGOROUS-INTENSITY ACTIVITY AT LONG-TERM FOLLOW-UP - RESULTS FROM THE HITPALS STUDY

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 10 (E-Poster Area)
Lecture Time
06:30 PM - 06:35 PM

Abstract

Background And Aims

Physical inactivity is a major risk factor for stroke. Initiation and adherence to physical activity after stroke is challenging, though it may decrease cardiovascular risk factors in patients with stroke.

We aimed to investigate long-term effect of 3-months early home-based high-intensity interval training (HIIT) measured by cardiorespiratory fitness, physical activity and hospital readmission.

Methods

In the randomised controlled trial, HITPALS (Clinicaltrials.gov: NCT02731235) 71 patients with lacunar stroke were included, intervention vs. control 1:1. Baseline and 3-months data were reported previously. Patients were further assessed at 6- and 12-months post-stroke including cardiorespiratory fitness (power output from the Graded Cycling Test with Talk Test (GCT-TT)), physical activity by the Physical Activity Scale, and number of patients with recurrent stroke.

Results

No significant difference from baseline to 12-months post-stroke was observed within or between groups in GCT-TT power output, mean change was 9 Watts (W) (95% CI: -3;21) and 3.5W (95% CI: -8;15) for intervention and control, respectively. At 6-months, the intervention group remained physically active with vigorous-intensity activity (mean change: -0.18 hours/week (95% CI: -1.28;0.92)), while the control group spontaneously increased their vigorous-intensity activity (mean change: 1.19 hours/week (95% CI: 0.11;2.28)). At 12-months both groups decrease their vigorous-intensity activity, but not significantly different from 3-months or baseline. At 12-months follow-up a total of 4 patients, 2 in each group were diagnosed with a recurrent TIA.

Conclusions

The intervention group remained active with vigorous-intensity activity at 6- and 12-months follow-up, after 3 months initial HIIT intervention. Early training-intervention appears to increase adherence.

Trial Registration Number

Clinical trial.gov ID: NCT02731235

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HAEMORRHAGE, DIABETES, SEVERE STROKE AND OLDER AGE ARE ASSOCIATED WITH SLOWER TIME TO INDEPENDENT WALKING AFTER ACUTE STROKE.

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 10 (E-Poster Area)
Lecture Time
06:35 PM - 06:40 PM

Abstract

Group Name

On behalf of The AVERT Trial Collaboration Group

Background And Aims

Past studies have not consistently identified factors that are associated with walking recovery after stroke. We investigated the relationship between pre-stroke factors and factors collected within 24 hours of stroke that may be associated with the number of days to walking 50 metres independently.

Methods

We used A Very Early Rehabilitation Trial (AVERT) data (n=2104 stroke survivors from 56 international sites, median 73 years), which tracked recovery of independent walking over 50 metres daily from 24 hours post-stroke up to three months. A set of a priori defined characteristics (demographics included age, sex and handedness; pre-stroke included hypertension, ischaemic heart disease, hypercholesterolaemia, diabetes mellitus and atrial fibrillation; and stroke-related included stroke severity, stroke type, infarct location, lesion side, and acute intervention) were investigated for association with independent walking using a cause-specific competing risk Cox proportional hazards model. Respective effect sizes are reported as cause-specific hazard ratio adjusted (caHR) for age, stroke severity and AVERT intervention (mobilisation).

Results

The proportion of stroke survivors achieving independent walking by three months was 75%. Key findings indicated that slower return to independent walking was associated with haemorrhage (caHR 0.790, 95% CI 0.675-0.925), diabetes (caHR 0.836, 95% CI 0.740-0.945), severe stroke (caHR 0.094, 95% CI 0.072-0.122), and older age (caHR 0.651, 95% CI 0.569-0.746).

Conclusions

Our analysis with <1% missing data provides robust evidence for important factors associated with poor walking recovery. These findings highlight the need for tailored mobilisation programs that target subgroups, in particular people with haemorrhage and severe stroke.

Trial Registration Number

ACTRN12606000185561

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DOES LOW FREQUENCY RTMS PLAYS A ROLE IN THE FUNCTIONAL RECOVERY OF PATIENTS WITH ISCHEMIC STROKE AT SUB-ACUTE STAGE

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 10 (E-Poster Area)
Lecture Time
06:40 PM - 06:45 PM
Presenter

Abstract

Background And Aims

Low frequency rTMS onto the contralateral cortex region alongwith Physiotherapy helps in the clinical recovery of Ischemic Stroke patients. We aim to investigate the role of 1Hz rTMS along with conventional physiotherapy in the functional recovery of patients with sub-acute ischemic stroke.

Methods

In this Double blind RCT studyl,total N = 96 patients diagnosed with first ever Ischemic Stroke , onset 15 days, NIHSS score 4-20 were recruited and were randomized after a run in period of 75 ±7days into Real rTMS (n = 47) and Sham rTMS (n = 49) Group

Conventional physical therapy was given to both the groups for 90 ± 7 days post recruitment. Total 10 sessions of 1Hz rTMS on contra lesional premotor cortex was administered to Real rTMS Group for 2 weeks followed by physiotherapy regime for 45-50 minutes.

The primary efficacy outcomes were change in modified Barthel Index (mBI) score (pre to post score) and proportion of participants with mBI score more than 90, measured at 90th ± 7day post recruitment. The secondary outcomes were change in FMA-UE, FMA-LE, Hamilton Depression Scale, mRS and NIHSS (pre to post rTMS) scores at 90th ± 7day post recruitment.

Results

Modified ITT showed a significant increase in the mBI score from pre to post rTMS in Real rTMS group (4.96 ± 4.06) Vs Sham rTMS group (2.65 ± 3.25).

Conclusions

In patients with sub-acute ischemic stroke, 1 Hz low frequency rTMS on contralesional pre motor cortex along with conventional physical therapy resulted in significant change in mBI score.

Trial Registration Number

CTRI Number: CTRI/2016/02/006620

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LONGITUDINAL CHANGES IN FUNCTIONAL MOBILITY AFTER STROKE - A PROSPECTIVE COHORT STUDY

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 10 (E-Poster Area)
Lecture Time
06:45 PM - 06:50 PM

Abstract

Background And Aims

A majority of persons with stroke remain residually impaired in their functional mobility. The aim of the study was to determine longitudinal changes in functional mobility in persons with stroke.

Methods

The study was of a longitudinal and prospective design. The functional mobility was assessed using Timed Up and Go test (TUG) across five different occasions: five days after onset, within 24 hours after discharge, one month, three months and one-year after stroke onset. A cluster analysis and linear mixed-effect models were used for baseline and longitudinal analysis.

Results

One-hundred-thirty-five participants were included at baseline. Two distinct subgroups (moderate impairment [52%] and mild impairment [48%]) were identified based on function and activity level using clustering. Ninety-one participants were included in the longitudinal analysis. Significant improvements were found in functional mobility between baseline and one-year poststroke in both groups (moderate, mean diff TUG time = -6.4s; mild, mean diff TUG time= -1.3s, P≤ 0.001). Improvements were stabilized in mild stroke after discharge and in moderate stroke at one month after onset, respectively. The functional mobility deteriorated significantly in the persons with moderate stroke after three months (12% increase in TUG time, P = 0.02). Age, lower-limb motor function, dependency in activities of daily living and time were associated with longitudinal changes in functional mobility.

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Conclusions

Persons with moderate stroke were susceptible to deterioration in functional mobility after three months poststroke. These findings suggest that long-term rehabilitation is desirable to achieve continuous improvements in the functional mobility.

Trial Registration Number

ClinicalTrials.gov NCT01622205.

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ADVERSE EVENTS IN AEROBIC TREADMILL TRAINING EARLY AFTER STROKE – A DETAILED ANALYSIS OF SAFETY IN THE PHYSICAL FITNESS TRAINING IN SUBACUTE STROKE (PHYS-STROKE) TRIAL

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 10 (E-Poster Area)
Lecture Time
06:50 PM - 06:55 PM

Abstract

Background And Aims

Fitness training during subacute stroke led to a higher rate of serious adverse events (SAE) compared to relaxation sessions in PHYS-STROKE, a recent randomized controlled trial (Nave et al, BMJ, 2019). Here we present further safety analyses among patients enrolled in PHYS-STROKE.

Methods

In PHYS-STROKE we compared a four-week aerobic treadmill training to relaxation sessions in patients with subacute stroke (5–45 days after stroke) with follow-up until six months post stroke. Incident rate ratios (IRR) were calculated for cerebro- and cardiovascular events, readmission to hospital, and death. Poisson regression analyses were conducted to identify prognostic factors of SAE for aerobic training.

Results

Within PHYS-STROKE (n = 200), we observed a total of 50 SAE with a higher incidence rate (in 100 patient-months) in the fitness group compared to relaxation (6.76 vs 3.83; IRR 1.72, 95%CI 0.97–3.16, p=0.069). Specifically, we observed 15 recurrent strokes (IRR 2.44, 95%CI 0.83–8.79), no myocardial infarction, 30 readmissions (IRR 2.07, 95%CI 0.98–4.75), and five deaths (IRR 0.22, 95%CI 0.01–1.50). In separate exploratory analyses, IR of SAE occurrence between fitness versus relaxation group were significantly higher in patients with atrial fibrillation (AF) and diabetes mellitus (DM), compared to no disease (AF: IR 5.16, 95%CI 1.17–22.88 vs. no AF: IR 1.23, 95%CI 0.64–2.38; DM: IR 3.08, 95%CI 1.14 – 8.28 vs. no DM: IR 1.15, 95%CI 0.55 – 2.41).

Conclusions

Analyses of safety parameters suggest that fitness training early after stroke should be performed with caution particularly in patients with atrial fibrillation or diabetes mellitus.

Trial Registration Number

clincialTrials.gov Identifier: NCT01953549

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ADHERENCE TO ONABOTULINUMTOXINA TREATMENT IN POST-STROKE PATIENTS WITH SPASTICITY FROM THE ASPIRE STUDY

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 10 (E-Poster Area)
Lecture Time
06:55 PM - 07:00 PM

Abstract

Background And Aims

To improve clinical strategies to manage spasticity, we aimed to identify baseline clinical characteristics and treatment-related factors that impact adherence to onabotulinumtoxinA treatment in post-stroke patients from the Adult Spasticity International Registry (ASPIRE) study.

Methods

Multicenter, international, prospective, observational registry (NCT01930786). Patients with spasticity treated with onabotulinumtoxinA at clinician’s discretion. Clinically meaningful thresholds for treatment adherence (patients received ≥3 treatment sessions during 2-year study)/non-adherence (patients received ≤2 sessions) applied. Data analyzed using logistic regression; presented as odds ratios (OR) with 95% confidence intervals (CI). Statistical significance P<0.05; non-significant effects of clinical interest P<0.10. Treatment-related factors assessed sessions 1 and 2 only.

Results

Majority of patients had spasticity resulting from stroke (n=411/730; 56.3%). At baseline, 68.6% used assistive devices, 58.6% used orthotics, and 9.0% had prior surgeries/procedures. In the final stroke model (N=346), 288 patients (83.2%) were categorized treatment adherent, with 5.3(±1.6[mean±SD]) sessions, and 58 (16.8%) non-adherent, with 2.0(±0.0). Mean(SD) treatment interval (session 1 to 2) was 18.1(8.5) weeks in adherent and 23.6(16.0) in non-adherent. Baseline characteristics associated with adherence: European patient (OR:2.91;CI:1.35-6.27;P=0.006), use of orthotics (OR:3.12;CI:1.54-6.34;P=0.002), and prior surgeries/procedures (OR:3.22;CI:0.92-11.27;P=0.068); treatment-related: treatment for thumb-in-palm (OR:2.09;CI:0.93-4.71;P=0.076). Baseline risk factors for non-adherence: higher age at enrollment (OR:0.98;CI:0.95-1.00;P=0.096) and use of assistive devices (OR:0.45;CI:0.20-1.01;P=0.053); treatment-related: treatment interval ≥15 weeks (session 1 to 2; OR:0.42;CI:0.21-0.84;P=0.014), moderate/severe disability on upper limb Disability Assessment Scale pain subscale (OR:0.39;CI:0.19-0.82;P=0.013), and clinician dissatisfaction with onabotulinumtoxinA to manage pain (OR:0.18;CI:0.02-1.38;P=0.099).

Conclusions

This analysis can provide real-world insights to improve adherence, and decrease non-adherence, to onabotulinumtoxinA treatment for spasticity to enhance patient care.

Trial Registration Number

NCT01930786

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EFFECTS OF A COMMUNITY EXERCISE PROGRAM ON CARDIOVASCULAR RISK FACTORS AFTER STROKE: RESULTS FROM THE FIT FOR FUNCTION RANDOMIZED CLINICAL TRIAL

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 10 (E-Poster Area)
Lecture Time
07:00 PM - 07:05 PM
Presenter

Abstract

Background And Aims

Exercise interventions are effective in improving cardiovascular risk factors for people with stroke, but whether these benefits are observed with pragmatic, community-based programs remain uncertain. This multi-site, assessor-blinded, randomized trial compared the impact of an innovative, community-partnered, stroke exercise and self-management program (FIT for FUNCTION) to a standard fitness centre membership on indicators of cardiovascular health.

Methods

Participants were randomized to the 12-week FIT for FUNCTION or standard fitness membership. Walking capacity, blood pressure, and body mass index were assessed at baseline, 12 and 24 weeks for the entire cohort (n=216), and blood work (lipid profile, insulin, glucose, glycated hemoglobin, and C-Reactive protein) for a subset (n=74 intervention, n=81 control). Group effects were estimated using generalized estimating equations, controlling for site and walking ability. Analysis was intention to treat.

Results

The intervention group demonstrated greater increase in 6-Minute Walk distance (mean difference (MD) 5.32 meters (95%CI 3.33,7.30), P<0.001), and reduction in body mass index (MD -1.88 kg/m2 (95%CI -1.91,-1.84), P<0.001) and insulin (MD -11.67 pmol/L (95%CI -13.97,-9.36), P<0.001) relative to control. There were also small increases in diastolic blood pressure (MD 1.99 mmHg (95%CI 1.24,2.75), P<0.001) and cholesterol (total cholesterol MD 0.14 mmol/L (0.01,0.27), P=0.03; Cholesterol/HDL ratio MD 0.08 (95%CI 0.03,0.13), P=0.001) in the intervention group. There were no other significant differences between groups.

Conclusions

FIT for FUNCTION improved walking capacity, body mass index, and insulin in individuals with stroke. This study provides evidence to support stroke community exercise programs.

Trial Registration Number

ClinicalTrials.gov NCT02703805

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FEASIBILITY AND IMPACT OF SELF-EMPOWERED UPPER LIMB REPETITIVE ENGAGEMENT (SURE) PROGRAM ON UPPER LIMB RECOVERY EARLY POST-STROKE: A RANDOMIZED CONTROLLED PILOT TRIAL

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 10 (E-Poster Area)
Lecture Time
07:05 PM - 07:10 PM

Abstract

Background And Aims

This study aimed to investigate the feasibility of a program of individualized motor tasks, Self-Empowered UL Repetitive Engagement (SURE) program, and its impact on UL recovery early post-stroke.

Methods

Twenty-three patients (mean(SD) age= 60±10 years) from an inpatient rehabilitation center who were ≤21days post-stroke, Fugl Meyer UL (FMUL) score ≤50 and had a positive motor evoked potential (MEP+) in the forearm were randomly assigned to experimental or control group. The experimental group received the SUREprogram: individualized, progressed UL self-exercise 3x20 minutes/day with booklet outside therapy for 6 days/week for 4 weeks. Control group was given an education booklet. Feasibility was evaluated by adherence, adverse events, and satisfaction. Impact was measured by paretic UL use via accelerometry during intervention and FMUL pre, post and 3-months follow-up by blinded assessors.

Results

Adherence to SURE was high (88% of all sessions completed, mean 397±81 repetitions/day), there were no adverse events related to the trial, and patient satisfaction was rated at mean 7.8/10. Experimental participants achieved an additional 1 hour of UL use (range: 0.3-1.2hour) daily compared to the control. Both groups demonstrated significant improvements in FMUL from pre- to post-intervention (mean difference experimental=21[95%CI 13to29], control=23[95%CI 12to34], and from post to 3-months for experimental (mean difference=9[95%CI 0.6to17]) but not the control group (6[95%CI -2to14]). There were no differences between groups (p<0.119).

Conclusions

The SURE program was a feasible, safe, self-administered program that increased UL use early post-stroke in MEP+ stroke survivors. Further studies with larger sample sizes and higher UL dose are required to investigate efficacy.

Trial Registration Number

NCT03425890

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HIGH-INTENSITY INTERVAL TRAINING AFTER STROKE (THE HIIT-STROKE STUDY) – EFFECTS ON WALKING FUNCTION AND BALANCE - A MULTICENTER RANDOMIZED CONTROLLED TRIAL

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 10 (E-Poster Area)
Lecture Time
07:10 PM - 07:15 PM

Abstract

Background And Aims

There is emerging evidence that High-intensity interval training (HIIT) may improve post stroke mobility. The aim of this study was to investigate if HIIT in addition to standard care was superior to standard care only, in order to improve walking function and balance after stroke.

Methods

These are secondary results from The HIIT-stroke study, a multicenter, single-blinded, parallel group, randomized controlled trial. Participants 3 months to 5 years after first ever stroke were included. The HIIT intervention consisted of 4x4 minutes high-intensity interval treadmill-training at 85-95% of peak heart rate (HRpeak) interspersed with 3 minutes of low intensity walking at 50-70% of HRpeak, three times a week for eight weeks. The outcomes measured immediate after the intervention (post-test) and at 12-month follow-up were distance covered in the 6-minute walk test (6MWT), maximal gait speed and Berg Balance Scale (BBS). Mixed-models were used to evaluate differences between the groups.

Results

On average (SD), 26.4(14.5) months post-stroke, participants were randomly assigned to intervention (n=36) or control group (n=34), mean (SD) age was 57.6(9.3) years. In the intervention and control group respectively, mean (SD) 6MWT distance at post-test was 520.0(154.2) versus 542.6(132.8) meters, p=0.03, and 504.2(144.4) versus 531.8(141.6) meters, p=0.133, at 12-month follow-up. The corresponding results for BBS were 53.0(5.7) versus 54.3(2.3), p=0.03, and 53.6(5.3) versus 52.9(3.8), p=0.07. There were no significant differences between the groups for walking speed.

Conclusions

Our data suggest that supervised HIIT improves walking distance and balance in the short term. However, the beneficial effect was not maintained at 12-month follow-up.

Trial Registration Number

NCT02550015

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