Combining specific task-oriented training with manual therapy to improve balance and mobility in patients after stroke: a mixed methods pilot randomised controlled trial

Abstract

Purpose

In absence of existing studies, to describe changes in balance and mobility, following specific task-oriented training (TOT), its combination with talocrural manual therapy (MT-TOT) or no intervention, in chronic stroke patients. To explore the feasibility of a full-scale randomised controlled trial (RCT) based on criteria of recruitment, retention and adherence rates, adverse events, falls and acceptability of the intervention.

Materials and methods

Using an assessor-blinded pilot RCT, 36 stroke patients were allocated to either MT-TOT, TOT, or controls. Supervised interventions were performed 45 min, 2×/weekly, for 4 weeks, and home-based practice 20 min, 4x/weekly for 4 weeks. Qualitative interviews evaluated intervention acceptability. Outcomes of balance, mobility, ankle dorsiflexion range of motion (ROM), falls and health-related quality of life (HRQoL) were assessed at baseline, post-intervention and 4-week follow-up.

Results

Preliminary efficacy of MT-TOT and TOT was shown in improving balance (effect size 0.714), walking speed (0.683), mobility (0.265), dual-tasking mobility (0.595), falls (0.037), active and passive talocrural ROM (0.603; 0.751) and activities and social participation related HRQoL domains (0.332–0.784) in stroke patients. The feasibility of a larger RCT was confirmed.

Conclusions

Specific MT-TOT and TOT appeared effective and are feasible in stroke patients. A larger RCT is needed to validate the results.Trial Registration: German Clinical Trials Register, DRKS00023068. Registered on 21.09.2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023068

IMPLICATIONS FOR REHABILITATION

• A specific goal- and task-oriented training involving timed mobility and dynamic balance activities based on the demands of daily life, of high intensity and progressed in difficulty according to predefined criteria is feasible in patients after stroke.

• In this mixed methods pilot study patients indicated high acceptability of task-oriented training with and without ankle mobilisations, with their descriptions being in line with the Theoretical Framework of Acceptability.

• Specific task-oriented training and its combination with talocrural joint manual therapy improved balance, mobility, talocrural dorsiflexion range of motion and some domains of health-related quality of life in people after stroke.

Keywords:

• Task-oriented training
• rehabilitation exercise
• manual therapy
• walking
• talocrural joint range of motion
• health-related quality of life
• stroke

Acknowledgments

We warmly thank all patients who participated in this study.

Disclosure statement

The authors report no conflicts of interest.

Data availability statement

Data supporting the results or analyses presented in the paper are available from the corresponding author upon reasonable request ([email protected]).

Additional information

Funding

This study was self-funded by the initiating investigator (KT) as part of her Master’s studies in neurological physiotherapy at the Department for Health Sciences, Medicine and Research, Faculty of Health and Medicine, Danube University Krems, Austria. VASCage GmbH, Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria supported the indemnity insurance costs and had no role in the study design and data collection, analysis, and interpretation.