Farrelly Sinead, Boan Andrea D, Hartnett John, Monsch Emily, Hartis Audrey, Bowden Mark, Kautz Steve, Holmstedt Christine
College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.
Department of Physical Therapy, Medical University of South Carolina, Charleston, SC, USA.
J Acute Care Phys Ther. 2024 Jul;15(3):65-76. doi: 10.1097/jat.0000000000000237. Epub 2024 Jun 21.
The purpose of this pilot trial was to evaluate the impact of increased frequency of physical therapy sessions with error augmentation on functional mobility and disability outcomes in patients with acute stroke. We hypothesized that participants receiving frequent error augmentation physical therapy interventions (F-EA-PT) would demonstrate a higher degree of improvement on functional mobility and disability measures from admission to three post-intervention time points (treatment day 3, discharge, or 90-day follow-up).
We allocated 100 individuals to receive either F-EA-PT or standard-of-care physical therapy (SOC-PT). The F-EA-PT group received physical therapy with error augmentation twice daily for 3 out of the first 5 days of hospitalization, and daily treatment sessions thereafter. Error augmentation training emphasizes impairments throughout mobility to challenge the individual, rather than facilitating normal movement patterns. The SOC-PT group received treatment once daily for 3 to 5 days per week. Assessments included National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), Activity Measure for Post-Acute Care (AM-PAC) and Postural Assessment Scale for Stroke (PASS). A repeated measures mixed model approach compared treatment groups for all outcomes.
The F-EA-PT group demonstrated larger magnitudes of reduction of -1.34 on NIHSS (p=0.0426) and -0.81 on mRS (p=0.0037) from admission to 90-day follow-up compared to the SOC-PT group. The F-EA-PT group demonstrated larger magnitudes of change in AM-PAC of 2.12 at treatment day 3 (p=0.0009) and 2.75 at discharge (p<0.0001) compared to SOC-PT. F-EA-PT group experienced greater improvement in PASS over the SOC-PT group with a difference in change of 4.08 at treatment day 3 (p=0.0019) and 4.45 at discharge (p=0.001).
Intervening with a regimen focused on increased frequency and error augmentation from a physical therapy standpoint was safe with only one adverse event. It demonstrated significant improvements in functional outcomes post stroke above those seen with standard-of-care regimen, as evidenced by PASS and AM-PAC scores.
URL: https://www.clinicaltrials.gov. Unique identifier: NCT04778475.Medical University of South Carolina IRB II Approved 04/20/2021 PRO00108635.
本试点试验的目的是评估增加物理治疗次数并辅以错误增强训练对急性中风患者功能移动性和残疾结局的影响。我们假设，接受频繁错误增强物理治疗干预（F-EA-PT）的参与者在从入院到干预后三个时间点（治疗第3天、出院或90天随访）的功能移动性和残疾测量指标上会有更高程度的改善。
我们将100名个体分配为接受F-EA-PT或标准护理物理治疗（SOC-PT）。F-EA-PT组在住院的前5天中有3天每天接受两次伴有错误增强的物理治疗，此后每天进行治疗。错误增强训练强调整个移动过程中的损伤以挑战个体，而不是促进正常运动模式。SOC-PT组每周接受3至5天的每日一次治疗。评估包括美国国立卫生研究院卒中量表（NIHSS）、改良Rankin量表（mRS）、急性后期护理活动测量量表（AM-PAC）和卒中姿势评估量表（PASS）。采用重复测量混合模型方法比较两组在所有结局指标上的差异。
与SOC-PT组相比，F-EA-PT组从入院到90天随访时NIHSS评分的降幅更大，为-1.34（p=0.0426），mRS评分的降幅为-0.81（p=0.0037）。与SOC-PT组相比，F-EA-PT组在治疗第3天AM-PAC的变化幅度更大，为2.12（p=0.0009），出院时为2.75（p<0.0001）。F-EA-PT组在PASS方面的改善大于SOC-PT组，治疗第3天变化差异为4.08（p=0.0019），出院时为4.45（p=0.001）。
从物理治疗角度采用增加治疗频率和错误增强的方案进行干预是安全的，仅发生了1例不良事件。如PASS和AM-PAC评分所示，该方案显示出中风后功能结局的显著改善，优于标准护理方案。
网址：https://www.clinicaltrials.gov。唯一标识符：NCT04778475。南卡罗来纳医科大学IRB II于2021年4月20日批准，编号PRO00108635。
