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Introduction: Intervention studies to date have shown limited evidence of falls reduction in community-dwelling stroke survivors. This study tests the acceptability and feasibility of the Stepping On after Stroke programme in Singapore. Method: A pre–post-intervention study design was used over a 6-month period. Falls incidence was the main outcome measure, with the recruitment process and attendance rate recorded to test feasibility. Data analysis from evaluation questionnaires (descriptive statistics) and interviews (content analysis) were applied to determine acceptability. Results: Eight stroke participants and seven caregivers completed the programme at two community sites facilitated by two programme leaders. Stroke participants achieved full attendance over the 7-week programme but family caregivers did not (38%). All participants highlighted their acceptability of the group-based falls-prevention programme. Both programme leaders achieved 92% fidelity in session delivery. Four stroke participants fell during the study period. Stroke participants demonstrated clinically meaningful improvements in community participation at 1 month post-intervention. Family caregivers reported no changes in pre–post evaluations. Conclusion: The Stepping On after Stroke programme appears feasible and acceptable to therapists and service users in Singapore; however, caregivers' participation was limited. Findings can be used to further improve the programme and its methodology before testing its effectiveness in a larger-scale trial. [ABSTRACT FROM AUTHOR]

Background Residual walking deficits are common in community-dwelling people after stroke. Aims The aim of this study was to determine if a four-month treadmill and overground walking program is more effective than a two-month program, compared with control, at improving walking in community-dwelling people with stroke who walk slowly. Method A three-arm randomized trial with concealed allocation, assessor blinding, and intention-to-treat analysis involving 102 people with stroke living in the community who walked slowly was undertaken. Experimental group 1 undertook 30 min of treadmill and overground walking thrice per week for four-months, experimental group 2 undertook training for two-months, while the control group had no intervention. The primary outcome was walking measured as the distance covered during the six-min walk test. Other outcomes were walking speed, step length and cadence, health status, community participation, self-efficacy and falls. Results By two-months, the experimental groups, who were both undergoing training, had improved their six-min walk distance compared with the control group. The four-month training group continued training beyond two-months and improved further so that by four months they walked 38 m (95% confidence interval 15-60) more than the control group and 29 m (95% confidence interval 4-53) more than the two-month training group. However, by 12 months, well after the cessation of training, both experimental groups had returned to near baseline levels, and there was no difference between the groups. Conclusion Four months of treadmill training results in better walking. However, these effects disappear once training ceases. Therefore, training should be ongoing. [ABSTRACT FROM AUTHOR]

Background. Exercise interventions can enhance mobility after stroke as well as prevent falls in elderly persons. Objective. Investigate whether an exercise intervention can enhance mobility, prevent falls, and increase physical activity among community-dwelling people after stroke. Method. A randomized trial with blinding of physical outcome assessment was conducted through local stroke clubs. Both groups, on average 5.9 years poststroke, received exercise classes, advice, and a home program for 12 months. The experimental group (EG) program (n = 76) aimed to improve walking, prevent falls and increase physical activity. The control group (CG) program (n = 75) aimed to improve upper-limb and cognitive functions. The primary outcomes were walking capacity, walking speed measured before and after the intervention, and fall rates monitored monthly. Results. At 12 months, the EG walked 34 m further in 6 minutes (95% confidence interval [CI] = 19-50; P < .001) and 0.07 m/s faster over 10 m (95% CI = 0.01-0.14; P = .03) than the CG. The EG had 129 falls, and the CG had 133. There were no differences in proportion of fallers (relative risk = 1.22; 95% CI = 0.91-1.62; P = .19) or the rate of falls between groups (incidence rate ratio = 0.96; 95% CI = 0.59-1.51; P = .88). Conclusion. The experimental intervention delivered through stroke clubs enhanced aspects of mobility but had no effect on falls. [ABSTRACT FROM PUBLISHER]

Patients after stroke who are nonambulatory require resources, and independent walking becomes a major determinant of the ability to participate in activities of daily living. Our objective was to determine the probability of walking for patients who are nonambulatory in the first month after stroke. We performed a systematic review and meta-analysis of consecutive, prospective studies of nonambulatory patients within the first month after stroke in rehabilitation and acute units. The outcomes were the probability of achieving independent walking at three-, six- and 12 months after stroke. Twenty-six studies were included in the review. Seventeen studies comprising 2856 participants were entered into meta-analyses. For initially nonambulatory stroke patients managed in a rehabilitation unit, the probability of independent walking was 0·60 (95% CI 0·47-0·74, 1373 participants) at three-months, 0·65 (95% CI 0·53-0·77, 444 participants) at six-months and 0·91 (95% CI 0·81-1·00, 24 participants) at 12 months. For patients managed in an acute unit, the probability of independent walking was 0·39 (95% CI 0·27-0·52, 634 participants) at three-months, 0·69 (95% CI 0·46-0·92, 405 participants) at six-months and 0·74 (95% CI 0·59-0·88, 34 participants) at 12 months. 60% of patients managed in a rehabilitation unit who are nonambulatory in the first month after stroke will regain independent walking compared with 39% of those managed in an acute unit. This information can be used clinically to make decisions about allocation of rehabilitation resources, education of patients and carers, and for discharge planning. [ABSTRACT FROM AUTHOR]

The content validity of the Tardieu Scale and the Ashworth Scale was assessed in 27 independently ambulant children with cerebral palsy (gender: 17 males, 10 females; age: 5—9 years; Gross Motor Function Classification: level I and II). Ashworth and Tardieu Scale scores and laboratory measures of spasticity and contracture were collected from the plantarflexor muscles by 2 examiners who were blinded to the results. The Tardieu Scale was more effective than the Ashworth Scale in identifying the presence of spasticity (88.9%, kappa = 0.73; P = .000), the presence of contracture (77.8%, kappa = 0.503; P = .008) and the severity of contracture (r = 0.49; P = .009). However, neither scale was able to identify the severity of spasticity. The Tardieu Scale can provide useful information in children with cerebral palsy because it differentiates spasticity from contracture. However, a more comprehensive clinical method of testing neural and non-neural contributions to impairments and function is needed. [ABSTRACT FROM PUBLISHER]