A randomised controlled trial of integrated electrical stimulation and physiotherapy to improve mobility for people less than 6 months post stroke

Abstract

Purpose: To investigate the feasibility of combining physiotherapy and functional electrical stimulation to improve gait post stroke. Methods: A parallel group partially single-blinded randomised clinical trial. Adults living at home, less than 6 months post stroke, were randomised to Group A (physiotherapy, n = 10) or Group B (physiotherapy and common peroneal nerve stimulation, n = 10). Assessments were conducted before randomisation (Week 1), after intervention (Week 8) and after 12 weeks follow-up (Week 20). Results: No between group differences were observed. There were statistically significant within group differences after the intervention period in both groups for walking speed and distance walked (without stimulation), Rivermead Mobility Index and Canadian Occupational Performance Measure, maintained at Week 20. There was statistically significant improvement in 10-m walking speed (Group B) when the stimulator was used at Week 8 (p = 0.03, median 0.04 m/s (8%)). Only Group B had statistically significant within group change in Rivermead Visual Gait Analysis (Week 8), maintained at Week 20. Conclusions: Integrating electrical stimulation and physiotherapy was feasible and improved walking speed. There was no evidence of a training effect compared with physiotherapy alone. One-hundred forty-four participants per group would produce an adequately powered study based on this protocol.

Implications for Rehabilitation

• At the end of the intervention period participants using electrical stimulation to correct dropped foot walked faster.

• It was feasible for electrical stimulation to be combined with physiotherapy for people less than 6 months post stroke.

• A larger adequately powered study is required to establish whether there are training effects associated with use of stimulation in this population.

• CVA
• drop foot
• electrical stimulation
• gait
• physical therapy modalities
• physiotherapy

Acknowledgements

We would like to thank the participants and their families, as well as all staff involved in this study especially Julie Esnouf, Geraldine Mann, Ian Swain, Darren Hart and Julie Wintrup for their advice/assistance.

Declaration of interest

We are very grateful to the UK Stroke Association for funding this study. Two authors (IW and PT) are employed by Salisbury NHS Foundation Trust and are seconded part time to Odstock Medical Ltd., Salisbury, however this NHS owned company had no influence over the interpretation of the data or the conclusions presented here.