Effectiveness of walking training on balance, motor functions, activity, participation and quality of life in people with chronic stroke: a systematic review with meta-analysis and meta-regression of recent randomized controlled trials

Purpose: To review and quantify the effects of walking training for the improvement of various aspects of physical function of people with chronic stroke. Methods: We conducted a systematic search and meta-analysis of randomized controlled trials (RCTs) of chronic stroke rehabilitation interventions published from 2008 to 2020 in English or French. Of the 6476-screened articles collated from four databases, 15 RCTs were included and analyzed. We performed a meta-regression with the total training time as dependent variable in order to have a better understanding of how did the training dosage affect the effect sizes. Results: Treadmill walking training was more effective on balance and motor functions (standardized mean difference (SMD)=0.70[0.02, 1.37], p = 0.04) and 0.56[0.15, 0.96], p = 0.007 respectively). Overground walking training improved significantly walking endurance (SMD = 0.38[0.16, 0.59], p < 0.001), walking speed (MD = 0.12[0.05, 0.18], p < 0.001), participation (SMD = 0.35[0.02, 0.68], p = 0.04) and quality of life (SMD = 0.46[0.12, 0.80], p = 0.008). Aquatic training improved balance (SMD = 2.41[1.20, 3.62], p < 0.001). The Meta-regression analysis did not show significant effect of total training time on the effect sizes. Conclusion: Treadmill and overground walking protocols consisting of ≥30 min sessions conducted at least 3 days per week for about 8 weeks are beneficial for improving motor impairments, activity limitations, participation, and quality of life in people with chronic stroke.Implications for rehabilitationTreadmill walking training is effective for improving balance and motor functions.Overground walking training improved significantly walking endurance, walking speed, participation and quality of life.Treadmill and overground walking protocols consisting of ≥30 min sessions conducted at least 3 days per week for about 8 weeks are beneficial for improving motor impairments, activity limitations, participation, and quality of life in patient with chronic stroke

Physical activity intervention for chronic stroke rehabilitation in low-income settings : effectiveness of mixed, community and collective physical activity intervention

Stroke is the first leading cause of disability in adults worldwide (GBD, 2021), and low-income countries are the most affected. In these countries, access to health care, particularly rehabilitation, is a great challenge. As the prevalence of stroke is increasing and the number of stroke survivors is rising, the economic charge of stroke rehabilitation will continue to expand, unless appropriate strategies are developed. This thesis contributed by mapping the clinical profile of stroke survivors from a sub-Saharan Africa low-income country to raise awareness of a critical need for cost-effective and accessible rehabilitation intervention. In addition, this thesis demonstrated the feasibility and effectiveness of a mixed community and group-based physical activity intervention. This community-based physical activity would be an efficient way to improve access to rehabilitation in low-income countries.L'accident vasculaire cérébral (AVC) est la première cause de handicap chez l'adulte dans le monde (GBD, 2021) et les pays à faible revenu sont les plus touchés. Dans ces pays, l'accès aux soins de santé, et notamment à la réadaptation, est un grand défi. Comme la prévalence de l'AVC ne cesse d’augmenter et par conséquent, le nombre de survivants d'AVC, la charge économique de la réadaptation post-AVC continuera de croître, à moins que des stratégies appropriées ne soient développées. Cette thèse a contribué à la description du profil clinique des survivants d'un AVC dans un pays à faible revenu d'Afrique subsaharienne, afin de sensibiliser au besoin d’interventions de réadaptation rentable et accessible. En outre, cette thèse a démontré la faisabilité et l'efficacité d'une intervention mixte d'activité physique réalisée en communauté et en groupe. Cette activité physique communautaire serait un moyen efficace d'améliorer l'accès à la réadaptation dans les pays à faible revenu.(MOTR - Sciences de la motricité) -- UCL, 202

Effectiveness of walking versus mind-body therapies in chronic low back pain: A systematic review and meta-analysis of recent randomized controlled trials.

PURPOSE: Walking and mind-body therapies (MBTs) are commonly recommended to relieve pain and improve function in patients with chronic low back pain (CLBP). The purpose of this study was to compare the effectiveness of walking and MBTs in CLBP. METHODS: We included randomized controlled trials (RCTs) comparing walking or MBTs to any other intervention or control in adults with CLBP. Studies were identified through PubMed, Cochrane Library, PsycINFO, Scopus, and ScienceDirect databases. The research was limited to studies published in English and French between January 2008 and December 2018. Two reviewers independently selected the studies, extracted data, and assessed studies quality using the Physiotherapy Evidence Database (PEDro) scale. Statistical analyses were performed under a random-effects model. We analyzed pain and activity limitation, with the calculation of standardized mean differences and 95% confidence intervals for the different treatment effects. RESULTS: Thirty one randomized controlled trials involving 3193 participants were analyzed. Walking was as effective as control interventions in the short-term and slightly superior in the intermediate term with respect to pain (Standardized mean differences (SMD) = -0.34; 95% CI, -0.65 to -0.03; P = .03) and activity limitation (SMD = -0.30; 95% CI, -0.50 to -0.10; P = .003). In contrast, yoga was more effective than control interventions in the short term in terms of pain (SMD = -1.47; 95% CI, -2.26 to -0.68; P = .0003) and activity limitation (SMD = -1.17; 95% CI, -1.80 to -0.55; P = .0002). Yoga was no longer superior to the control interventions for pain at the 6-month follow-up. CONCLUSION: MBTs, especially yoga, seem to be more effective in the short term, and walking seems to be more effective in the intermediate term, for the relief of pain and activity limitation in patients with CLBP. A combination of walking and MBTs fits the biopsychosocial model and might be valuable therapy for CLBP throughout follow-up due to combined effects

Determinants of Social Participation at 1, 3, and 6 Months Poststroke in Benin.

OBJECTIVE: To build a model of prediction of social participation of community-dwelling stroke survivors in Benin at 1 month, 3 months, and 6 months. DESIGN: An observational study with evaluations at 1 month, 3 months, and 6 months poststroke. Correlational analyses and multivariate linear regressions were performed. SETTING: Outpatient rehabilitation centers in Benin. PARTICIPANTS: A volunteer sample of 91 stroke patients was enrolled at baseline; 64 (70%) patients completed all the study (N=64): 70% male and 52% right hemiparesis. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Participants were evaluated with the Participation Measurement Scale, ACTIVLIM-Stroke (activities of daily living [ADL]), Stroke Impairment Assessment Set, 6-minute walk test, Hospital Anxiety and Depression Scale, and the modified Rankin Scale. RESULTS: The significant predictors of social participation after controlling the confounders were the following: at 1 month ADL (0.4 [0.3, 0.6]) and depression (‒0.6 [‒0.8, ‒0.2]) with total model R2=0.44; at 3 months ADL (0.58 [0.4, 0.7]) and depression (‒0.58 [‒0.5, ‒0.7]) with total model R2=0.65; and at 6 months ADL (0.31 [0.2, 0.5]), impairments (‒0.82 [‒0.5, ‒0.7]), and depression (‒0.94 [‒0.8, ‒0.2]) with total model R2=0.78. CONCLUSIONS: Using socioculturally tailored tools, the present study identified ADL performance (ACTIVLIM-Stroke), depression (Hospital Anxiety Depression Scale), and overall impairments (Stroke Impairment Assessment Set) as the significant determinants of social participation (Participation Measurement Scale) poststroke in Benin. These findings will be a valuable resource for rehabilitation stakeholders in evaluating interventions, programs, and policies designed to encourage social participation for stroke patients

Relationships between walking speed, activities and participation in people with chronic stroke in Burundi.

BACKGROUND: Reduced walking speed because of a stroke may limit activities of daily living (ADLs) and restrict social participation. OBJECTIVES: To describe the level of balance impairment, activity limitations, and participation restrictions and to investigate their relationship with walking speed in Burundians with chronic stroke. METHODS: This cross-sectional study involved adult stroke survivors. Walking speed, balance, ADLs and social participation were assessed with the 10-meter walk test (10 mWT), the Berg balance scale (BBS), the activity limitation stroke scale and the participation measurement scale, respectively. In order to determine ambulatory independence status, participants were stratified into three walking speed groups (household ambulation, limited ambulation and full-community ambulation), based on the Perry classification. RESULTS: Fifty-eight adults (mean age 52.1 ± 11.4 years) with chronic stroke were included in our study. Most participants had severe balance impairments (median BBS score, 27). Their mean (± standard deviation [SD]) walking speeds, ADL levels and social participation levels were 0.68 ± 0.34 m/s, 50.8% ± 9.3% and 52.8% ± 8.6%, respectively. Walking speed correlated moderately with balance (rho = 0.5, p < 0.001) and strongly with ADL level (r = 0.7, p < 0.001) but not with participation level (r = 0.2, p = 0.25). CONCLUSION: Using socio-culturally suitable tools, our study showed that walking speed correlates robustly with balance and ADL ability, but not with social participation, in Burundi, a low-income country. CLINICAL IMPLICATIONS: Exercises targeting walking speed would be very useful for people with chronic stroke living in low-resource countries, in order to promote their functional independence

Biopsychosocial factors associated with chronic low back pain-related activity limitations in Burundi.

BACKGROUND: Chronic low back pain (CLBP) is an increasing burden worldwide. The biopsychosocial factors associated with CLBP-related activity limitations have not yet been investigated in Burundi. OBJECTIVE: The aim of our study was to investigate the biopsychosocial factors that influence the CLBP-related activity limitations in a Burundian sample population. METHOD: We carried out a cross-sectional study of 58 adults with nonspecific CLBP from Bujumbura city. Univariate and bivariate analyses were used to investigate the association between biopsychosocial factors and CLBP activity limitations. Sequential multiple regression analyses were subsequently used to predict CLBP activity limitations. RESULTS: Fifty-eight individuals with a mean age of 41.3 ± 10.20, 58.6% of female gender, were recruited. The univariate and bivariate analyses demonstrated that educational level, gender, healthcare coverage, profession, height, pain intensity, depression and physical fitness were significantly associated with CLBP-related activity limitations (p range, < 0.001 to < 0.05). The multivariate regression analysis showed that the significant biopsychosocial factors accounted for 49% of the variance in self-reported activity limitations. Predictors of activity limitations were education level (β = -0.369; p = 0.001), abdominal muscle endurance (β = -0.339; p = 0.002) and depression (β = 0.289; p = 0.011). CONCLUSIONS: Our study provides evidence of biopsychosocial factor associations with CLBP-related activity limitations in Burundi. Evidence-based management and prevention of CLBP in Burundi should incorporate a biopsychosocial model. CLINICAL IMPLICATIONS: Biopsychosocial factors should be regularly evaluated in people with chronic low back pain and efforts to improve the burden of chronic low back pain in Burundi should take these factors into account

Measuring Participation after Stroke in Africa: Development of the Participation Measurement Scale.

To develop a valid stroke-specific tool for the measurement of participation in Africa, named the Participation Measurement Scale (PM-Scale). Observational study and questionnaire development. Outpatient Rehabilitation centers. Stroke patients (N = 276); mean age ± standard deviation of 58.5 ± 11.1 years; 57% male. Not applicable. Participants completed a 100-item experimental questionnaire of the PM-Scale. Items were scored as "not at all", "weakly" or "strongly". The Hospital Anxiety and Depression Scale was used to evaluate the depression and the modified Rankin Scale was used to categorize the severity of disability on the basis of observation. After successive Rasch analyses using RUMM2030 software package under unrestricted partial-credit parameterization, a valid, unidimensional and linear 22-item scale for the measurement of participation was constructed. All 22 items fulfilled the measurement requirements of overall and individual item and person fits, category discrimination, invariance, and local response independence. The PM-Scale showed good internal consistency (person separation index = 0.93). The test-retest reliability of item difficulty hierarchy (r = 0.96, p <0.001) and patient location (r = 0.99, p <0.001) were excellent. This patient-based scale covers all nine ICF domains of participation. The PM-Scale has good psychometric qualities and provides accurate measures of participation in patients with stroke in Africa

Measuring Participation After Stroke in Africa: Development of the Participation Measurement Scale

International audienceObjective: To develop a valid stroke-specific tool, named the Participation Measurement Scale (PM-Scale), for the measurement of participation after stroke. Design: Observational study and questionnaire development. Setting: Outpatient rehabilitation centers. Participants: Patients with stroke (N=276; mean age, 58.5±11.1y; 57% men). Interventions: Not applicable. Main outcome measures: Participants completed a 100-item experimental questionnaire of the PM-Scale. Items were scored as "not at all," "weakly," or "strongly." The Hospital Anxiety and Depression Scale was used to evaluate depression, and the modified Rankin Scale was used to categorize the severity of disability on the basis of observation. Results: After successive Rasch analyses using unrestricted partial credit parameterization, a valid, unidimensional, and linear 22-item scale for the measurement of participation was constructed. All 22 items fulfilled the measurement requirements of overall and individual item and person fits, category discrimination, invariance, and local response independence. The PM-Scale showed good internal consistency (person separation index, .93). The test-retest reliability of item difficulty hierarchy (r=.96; P<.001) and patient location (r=.99; P<.001) were excellent. This patient-based scale covers all 9 International Classification of Functioning, Disability and Health domains of participation. Conclusions: The PM-Scale has good psychometric qualities and provides accurate measures of participation in patients with stroke in Africa