A study in this week’s issue of THE LANCET suggests that physiotherapy given to patients 1 year after stroke is only of limited value, with short-term benefits three months after the start of treatment that are not sustained in the long term.
Community physiotherapy is often prescribed for stroke patients with long-term mobility problems. John Green and colleagues from St Luke’s Hospital, Bradford, UK, aimed to assess the effectiveness of this treatment in patients who had mobility problems 1 year after stroke.
The investigators did assessments at baseline, 3, 6, and 9 months in 170 patients assigned community-based physiotherapy or no intervention. The primary outcome measure was mobility (measured by the Rivermead mobility index). Other outcome measures were gait speed, number of falls, daily activity, social activity, hospital anxiety and depression scale, and the emotional stress of carers.
Patients given physiotherapy showed minor improvements at 3-month follow-up—an increase of one point on the Rivermead mobility index, and an increased gait speed of 2.6 metres per minute—but these improvements were not sustained over longer periods of follow-up. Physiotherapy had no effect on patients’ daily activity, social activity, anxiety, depression, and number of falls, or on emotional stress of carers.
John Green comments: “The findings suggest that low-intensity physiotherapy given to patients with stroke-related mobility problems persisting a year after the stroke is not associated with clinical benefit. New work is now needed to identify a more effective treatment or treatments and to identify which patients should be particularly targeted.” (quote by e-mail; does not appear in published paper).
In an accompanying Commentary (p 182), W De Weerdt and H Feys from the University of Leuven, Belgium, state: “Further research into physiotherapy for patients with stroke should initially focus on specific components of therapy. Those components that are effective can form an evidence base for treatment. Only then should the full package of therapy be investigated. It is important to identify for which cohort of patients and at what stage of the rehabilitation process a specific therapy is effective.”
Contact: Dr John Green, Department of Health Care for the Elderly, St Luke’s Hospital, Little Horton Lane, Bradford , West Yorkshire, BD5 0NA, UK; T) +44 (0)1274 365556; E) becarrd.1@bradfordhospitals.nhs.uk
Professor W De Weerdt, Faculty of Physical Education and Physiotherapy, University of Leuven, Tervuursevest 101, B 3001 Leuven, Belgium; T) +32 1632 9116; F) +32 1632 9192; E) willy.de weerdt@flok.kuleuven.ac.be
Journal
The Lancet