Muscle weakness after stroke affects peoples' everyday lives. One example is being unable to cross the road before the lights change (community walker). This early phase trial investigated whether adding muscle strengthening to functional training (functional strength training) improved recovery of walking. Functional Strength Training was compared with a course of Physical Therapy which is routinely used in clinical practice (Conventional Physical Therapy).
Participants in the trial were in the early stages after stroke. All 109 participants had difficulty with walking. On average they entered the trial 34 days after a stroke.
Participants were randomly allocated to one of three groups so that they received one of the following interventions:
The standard amount of Conventional Physical Therapy
Extra Conventional Physical Therapy in addition to the standard amount
Functional Strength Training plus the standard amount of Conventional Physical Therapy.
The intervention phase of the trial lasted for 6 weeks.
At the end of the intervention phase the group who received the extra Conventional Physical Therapy did better than those in the Functional Strength Training group who in turn did better than the group receiving the standard amount of Conventional Physical Therapy. This is illustrated in the graphs. However, there was considerable variability between individuals in the way they responded. This means that the differences were not significantly significant.
CPT = standard amount of Conventional Physical Therapy
CPT+CPT = extra Conventional Physical Therapy in addition to the standard amountFST+CPT = Functional Strength Training plus the standard amount of Conventional Physical Therapy.
The trends found in this early phase trial need to be confirmed in a definitive trial involving a larger number of people after stroke in a larger number of clinical centres. The results of this trial justify the costs of such a subsequent trial. We are now preparing an application to conduct the subsequent definitive trial the results of which will be directly applicable to clinical practice.
Cooke E V, Tallis RC, Clark A, Pomeroy VM. Efficacy of Functional Strength Training on restoration of lower-limb motor function early after stroke: Phase I randomized controlled trial. Neurorehabilitation and Neural Repair 2010;24(1):88-96.
Professor Valerie Pomeroy
Faculty of Medicine and Health Sciences
University of East Anglia