Authors: (including presenting author): :
Law SHY(1), Lau MHL(1), Chung HHY(1), Leung KKL(1)
Affiliation: :
(1)Physiotherapy Department, Kowloon Hospital
Keyword 1: :
Physiotherapy
Keyword 2: :
Chronic Stroke
Keyword 4: :
Functional Mobility
Keyword 5: :
Balance Confidence
Introduction: :
Stroke survivors frequently experience impaired balance, reduced mobility, and fear of fall. Well-established evidence has been reported on effectiveness of physiotherapy in enhancing motor functions after stroke. Post-stroke motor recovery typically follows a non-linear pattern, with the most rapid gains suggested to occur within the first 6 months. However, the effects of stroke rehabilitation on functional recovery in the chronic phase and its relationship with chronicity remains unclear.
Objectives: :
To investigate the effectiveness of physiotherapy in improving balance, functional mobility and balance confidence in chronic stroke patients of different chronicity.
Methodology: :
Chronic stroke patients(disease onset≥6 months) who could walk without manual assistance, were recruited from the out-patient physiotherapy unit of Kowloon Hospital. Participants with stroke onset time between 6-24months and >24months were classified into less chronic and more chronic groups respectively. A 6-week intensive physiotherapy program, composed of 3 sessions of 60-minute land-based training and 2 sessions of 30-minute hydrotherapy per week, was provided to both groups. Assessments were conducted at the baseline, upon completion of the 6-week training, and upon 12-week follow-up. Outcome measures included posturography study by Sensory Organization Test, Berg Balance Scale for fall risk and balance assessment, Time Up and Go Test for functional mobility evaluation, and Cantonese version of the Activities-specific Balance Confidence scale for self-perceived balance confidence. The treatment effects were analysed by Wilcoxon Signed-Rank test and Mann-Whitney U test. Correlations between chronicity and treatment effects were evaluated with bivariate correlations.
Result & Outcome: :
41 eligible stroke patients were recruited and divided into less chronic(n=22; mean time since stroke onset=14.2±5.6months) and more chronic(n=19; mean time since stroke onset=41.8±12.7months) groups. Both groups demonstrated significant post-treatment improvement in all outcome measures, with no significant between-group difference. The improvements were sustained upon 12-week follow-up in both groups. Bivariate correlations indicated insignificant correlation between stroke chronicity and treatment effects. The results suggested that physiotherapy effectively enhanced balance, functional mobility and balance confidence in chronic stroke patients, irrespective of chronicity, supporting continuation of stroke rehabilitation beyond acute and subacute phases. Stratification from out-patient training towards community-based training should be based on patients’ progress and availability of community resources. Nevertheless, potential deconditioning and decline in physical fitness in more chronic patients should be considered when designing and implementing safe and comprehensive stroke rehabilitation programs.
