Implementing circuit class training can increase therapy time and functional independence in people with stroke receiving inpatient rehabilitation: findings from a retrospective observational clinical audit

If you can do circuit training then you are already high functioning and this research has no applicability to most survivors. Try again with  better research goals.

Implementing circuit class training can increase therapy time and functional independence in people with stroke receiving inpatient rehabilitation: findings from a retrospective observational clinical audit

Imogen McDonell

,

Chris Barr

&

Maayken van den Berg

Received 10 Feb 2022, Accepted 20 Jan 2023, Published online: 01 Feb 2023

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• https://doi.org/10.1080/09593985.2023.2172634
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ABSTRACT

Background

Increased therapy time and task-specific practice can improve functional recovery post stroke. This observational study aimed to determine whether the clinical implementation of circuit training increases therapy time and improves function in stroke rehabilitation.

Methods

In a retrospective clinical audit, medical records of 110 people (mean age 78.7, standard deviation 13.0, 49.1% male, 57.3% severe stroke) admitted to a stroke inpatient rehabilitation ward were evaluated to determine the differences between pre (Individual Therapy (IT), n = 55) and post (Circuit Class Therapy (CCT), n = 55) service change implementation. The primary outcome was the amount of time spent in physiotherapy daily (minutes). Secondary outcomes included the Functional Independence Measure (FIM) score and length of stay (LOS).

Results

The CCT Group spent significantly more time in physiotherapy daily during their rehabilitation LOS compared to the IT Group (mean difference 8.45 (95% CI 5.99 to 10.90) mins, p < 0.001). No significant between-group differences were observed for FIM scores or LOS (p ≥ 0.066).

Conclusion

This study suggests that the clinical implementation of CCT can significantly increase therapy time by close to 9 minutes per session, with functional gains that are equivalent to usual care. This was achieved with a patient-to-staff ratio of 3:1, compared to the 1:1 ratio in IT, concurring with existing evidence in support of CCT as an alternative service delivery model for inpatient stroke rehabilitation.

 

Prioritization of neurologic rehabilitation interventions by ELECTRE-III analysis in subacute stroke patients

Bobath should have been shitcanned since 2003.

Who still uses NDT(Bobath) in stroke rehab when it should have been shitcanned since 2003? Physiotherapy Based on the Bobath Concept for Adults with Post-Stroke Hemiplegia: A Review of Effectiveness Studies 2003)

My best therapist supposedly used it but I really think her competence came from her knowledge of anatomy.

Physiotherapy Based on the Bobath Concept for Adults with Post-Stroke Hemiplegia: A Review of Effectiveness Studies 2003

The latest here:

Prioritization of neurologic rehabilitation interventions by ELECTRE-III analysis in subacute stroke patients

• Ceyhun Türkmen,
• Murat Konca &
• Birol Yetim 

Acta Neurologica Belgica (2022)Cite this article

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Abstract

Background

Elimination and Choice Translating Reality (ELECTRE) III is a commonly used multicriteria decision-making (MCDM) method when alternatives are being prioritized in health sciences. The selection of the rehabilitation approach is the key factor to improve the upper extremity functions of stroke patients. Thus, choosing a reasonably good treatment approach will directly reduce the patient's cost to the government and caregivers, while also improving quality of life. The aim of our study was to prioritize the six different methods used in the rehabilitation of stroke patients with mild or moderate upper extremity dysfunction, using one of the MCDM methods based on experts' opinions.

Methods

A three-stage face-to-face interview across Turkey, based on the ELECTRE-III method, was conducted with 18 physiotherapists specializing in the rehabilitation of mild or moderate stroke-induced upper extremity disorders.

Results

According to ELECTRE-III, Circuit Class Therapy (CCT) is the best choice for treating upper extremity functional loss in general. It is also the best alternative in both the ascending and descending distillation processes of ELECTRE-III. On the other hand, Bobath neurodevelopmental treatment (NDT) has a similar success level according to ascending distillation. Mirror therapy and constraint-induced movement therapy are the third-best methods in the analysis. However, robotic rehabilitation is the least preferable treatment method according to the experts’ judgments.

Conclusions

The results showed that rehabilitation interventions such as Bobath-NDT and proprioceptive neuromuscular facilitation, which are frequently used in developing countries, are still useful(NOT), and CCT is the most appropriate intervention for the transition from conventional methods to innovative models in these countries.

 

The Effects of Task-Oriented Circuit Training Using Rehabilitation Tools on the Upper-Extremity Functions and Daily Activities of Patients with Acute Stroke: A Randomized Controlled Pilot Trial

Bad research, NDT/Bobath is not an effective treatment. Why are we comparing to this?

Who still uses NDT(Bobath) in stroke rehab when it should have been shitcanned since 2003? Physiotherapy Based on the Bobath Concept for Adults with Post-Stroke Hemiplegia: A Review of Effectiveness Studies 2003)

Comparison Of Two Physiotherapy Approaches InAcute Stroke Rehabilitation: Motor Relearning Program Versus Bobath Approach.

 

Motor Relearning Program vs. Bobath:
http://cre.sagepub.com/content/14/4/361.short

 

And here is Peter Levines take on NDT:
http://recoverfromstroke.blogspot.com/2013/01/neuro-developmental-treatment.html

 

  The latest here:

The Effects of Task-Oriented Circuit Training Using Rehabilitation Tools on the Upper-Extremity Functions and Daily Activities of Patients with Acute Stroke: A Randomized Controlled Pilot Trial

Jong-Hoon Moon,^a Kyoung-Young Park,^b,* Hee-Jin Kim,^c and Chang-Ho Na^c

Author information Article notes Copyright and License information Disclaimer

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Abstract

Objectives

The purpose of this study was to investigate the effect of task-oriented circuit training (TOCT) using the rehabilitation tools for upper extremity function upon the daily life of patients with acute stroke.

Methods

Eighteen patients with acute stroke were randomly allocated into either the experimental group or the control group. The experimental group performed the TOCT program using rehabilitation tools, whilst the control group had neuro-developmental treatment(Bobath). Both groups received 30 minutes of treatment per session, 5~6 times per week, for 4 weeks. The assessments conducted were the Fugl-Meyer assessment, motor activity log and stroke impact scale to compare the upper extremity function and activities of daily living.

Results

The results showed a significant improvement in the TOCT group compared with the neuro-developmental treatment group in the amount of motor activity use and high stroke impact score, indicating recovery (p < 0.05).

Conclusion

The TOCT program using rehabilitation tools could have a positive impact on acute stroke patients use of their upper extremity.

Group rehabilitation activities improve walking after stroke

I can only see this as being helpful for survivors fairly similar in disability. High functioning persons would likely get nothing out of it and be resented by the lower functioning. 

Group rehabilitation activities improve walking after stroke

Group-based circuit class therapy (CCT) focused on repetitive mobility, and functional tasks improved walking ability in people after stroke. People walked on average 61m further during six minutes than those receiving comparison interventions. CCT involves stroke survivors practising different activities at workstations in sight of each other.
This Cochrane review identified 17 trials of group-based CCT, given at least weekly for four weeks, compared with other physical therapies or no intervention. Those receiving CCT showed clinically meaningful improvements in walking distance and speed, as well as independence and balance.
Regular multidisciplinary team rehabilitation is a central component of post-stroke care. However, there are no specific recommendations around the format of rehabilitation. Cost effectiveness was not assessed, but it is possible that group-based physical rehabilitation programmes could reduce staff resources and offer cost savings.
Local availability may be an issue. There is also the question of whether it would be practical and appropriate for individuals to attend group sessions, depending on their stroke severit

Effects of circuit training as alternative to usual physiotherapy after stroke: randomised controlled trial

No idea what the hell this is. This is totally useless unless your doctor contacts the researchers for the stroke protocol.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3349299/

Ingrid G L van de Port, assistant professor,¹ Lotte E G Wevers, PhD student,¹ Eline Lindeman, professor,¹ and Gert Kwakkel, professor^1,2

Author information ► Article notes ► Copyright and License information ►

This article has been cited by other articles in PMC.

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Abstract

Objective To analyse the effect of task oriented circuit training compared with usual physiotherapy in terms of self reported walking competency for patients with stroke discharged from a rehabilitation centre to their own home.

Design Randomised controlled trial with follow-up to 24 weeks.

Setting Multicentre trial in nine outpatient rehabilitation centres in the Netherlands

Participants Patients with stroke who were able to walk a minimum of 10 m without physical assistance and were discharged from inpatient rehabilitation to an outpatient rehabilitation clinic. Patients were randomly allocated to circuit training or usual physiotherapy, after stratification by rehabilitation centre, with an online randomisation procedure.

Intervention Patients in the intervention group received circuit training in 90 minute sessions twice a week for 12 weeks. The training included eight different workstations in a gym and was intended to improve performance in tasks relating to walking competency. The control group received usual outpatient physiotherapy.

Main outcome measures The primary outcome was the mobility domain of the stroke impact scale (SIS, version 3.0). Secondary outcomes were standing balance, self reported abilities, gait speed, walking distance, stair climbing, instrumental activities of daily living, fatigue, anxiety, and depression. Differences between groups were analysed according to the intention to treat principle. All outcomes were assessed by blinded observers in a repeated measurement design lasting 24 weeks.

Results 126 patients were included in the circuit training group and 124 in the usual care group (control), with data from 125 and 117, respectively, available for analysis. One patient from the circuit training group and seven from the control group dropped out. Circuit training was a safe intervention, and no serious adverse events were reported. There were no significant differences between groups for the stroke impact scale mobility domain (β=0.05 (SE 0.68), P=0.943) at 12 weeks. Circuit training was associated with significantly higher scores in terms of gait speed (0.09 m/s (SE 0.02), P<0.001), walking distance (20.0 m (SE 7.4), P=0.007), and modified stairs test (−1.6 s (SE 0.7), P=0.015). There were no significant differences between groups for the other secondary outcomes, except for the leisure domain of the Nottingham extended activities of daily living and the memory and thinking domain of the stroke impact scale. With the exception of gait speed (−0.04 m/s (SE 0.02), P=0.040), there were no significant differences between groups at follow-up.

Conclusion Task oriented circuit training can safely replace usual physiotherapy for patients with stroke who are discharged from inpatient rehabilitation to the community and need further training in gait and gait related activities as an outpatient.

Trial registration Dutch Trial Register (NTR1534).

Two of the doctors being interviewed here, still no help in understanding this at all.

  Circuit class training in stroke rehabilitation 

Anne Moseley talked to Dr Jannette Blennerhassett and Dr Wayne Dite (Austin Health Royal Talbot Rehabilitation Centre, Australia) whose trial evaluating circuit class training in stroke rehabilitation is one of the most significant trials in physiotherapy.