PDF Booklet with all IVSTEP-Abstracts (password protected)
Research Report
Population: Adult
Laura S Plummer, PT, MS, DPT, NCS, Assistant Professor, MGH Institute of Health Professions lplummer@mghihp.edu
Jane Baldwin, PT, DPT, NCS, Assistant Professor, MGH Institute of Health Professions jbaldwin@mghihp.edu
Flora Gilder, PT, Graduate Assistant, MGH Institute of Health Profesisons floragilder@gmail.com
Jinesh Gandhi, PT, Graduate Assistant, Institute of Health Professions physio.jinesh@gmail.com
Keywords: Prevention, stroke, stroke, pro bono
Purpose/Hypothesis: Individuals with chronic neurological conditions often live with participation restrictions, activity limitations and altered mobility. Deterioration of walking ability long term is regarded as a major problem, resulting in a loss of activities of daily living, independency, and social isolation. A recent study found that approximately one-third of cardiac disease and osteoporosis cases were attributable to lack of physical activity and pose a tremendous burden on the healthcare system. Modifiable risk factors post stroke, such as inactivity, that are inadequately managed increase risk of recurrent stroke, development of new comorbidities and premature mortality. Given changes in the current healthcare system, individuals who live with chronic disabilities often do not receive continued therapy. Despite this, evidence indicates that improvements can continue well into the “chronic” phase of recovery; however these interventions are generally at high frequency and intensity. The primary aims of this retrospective study was to describe physical therapy practice provided in a pro bono clinical education center and to assess if there were any meaningful changes in standardized outcome measures scores after receiving standard physical therapy (PT) care. Methods: Sixty-eight clients with complete records, 60% of whom had a diagnosis of chronic stroke (>6 months), were included in the study. Data was obtained through retrospective review of records (May 2010-August 2013) from a university-based, pro bono PT Center. Demographic information and change in standardized outcome measure scores were analyzed. Results: The average age of the clients was 62 (+14) years. Clients attended an average of 30 (range 10-90) weeks over their course of care. At the start of therapy, 72% of subjects classified themselves as independent ambulators with or without a device. The most commonly utilized outcome measures were Six Minute Walk Test (6MWT), Berg Balance Scale (BBS), and the Timed Up and Go (TUG). For the 6MWT, 86% (n=80) showed a positive change with 40% (n=37) demonstrating a change greater than then the minimal detectable change (MDC). For the BBS, 83% (n=15) showed improvement with 22% (n=4) achieving improvement at or greater than the MDC. Eighty-five percent (n=35) of clients showed improvement on the TUG with 63% (n=26) demonstrating change greater than the MDC. Survey data collected from clients and caregiver interviews also indicate improvements in activity level, confidence and independence in household and community mobility. Conclusions: Evidence regarding efficacy of PT interventions in individuals with chronic stroke have primarily focused on high frequency and intensity interventions. This descriptive study of individuals with chronic stroke receiving 1-2 hours of pro bono PT intervention per week demonstrates modest gains in some subjects and prevention of decline in the majority of other subjects.
Clinical Relevance: Prevention of functional decline and secondary impairments in individuals with chronic disability is a public health issue. Studies like this demonstrating effectiveness of PT intervention at lesser treatment frequencies may represent a more sustainable approach for service provision to this underserved population. Interpretation of these findings is limited due to lack of control group and sample of convenience.
Citation:
Plummer, Laura S, PT, MS, DPT, NCS; Baldwin, Jane S, PT, DPT, NCS; Gilder, Flora , PT; Gandhi, Jinesh , PT. Prevention of Decline in Function in Individuals with Chronic Stroke.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online. https://u.osu.edu/ivstep/poster/abstracts/entry/9g5h90