Effects of a community-based intensive motor training program combined with early supported discharge after treatment in a comprehensive stroke unit: a randomized, controlled trial.

Abstract

Increased amount of therapy seems to be beneficial for motor recovery after stroke. The primary aim of the present study was to evaluate the effect of a 4-week community-based intensive motor training program combined with early supported discharge after initial treatment in a comprehensive stroke unit on balance. Secondary aims were to evaluate the effect on other functional outcome measures. This was a single-blind, randomized, controlled trial with a 26-week follow-up. Sixty-two patients were recruited within 14 days after stroke and were randomly allocated to a standard treatment group (n=32) or to an intensive motor training group (n=30) receiving 3 sessions of physical therapy and a structured home exercise program in addition to standard treatment every week for the first 4 weeks after discharge from hospital. Primary outcome measure was Berg Balance Scale. Secondary measures were Barthel Index, Motor Assessment Scale, Step Test, 5-meter Walk Test, and Stroke Impact Scale. The mean (SD) minutes of physical therapy per week was 171.0 (65.8) in the intensive motor training group vs 85.6(69.9) in the standard treatment group. There were no statistical significant differences between the groups on any measure at end of follow-up except for a trend toward higher Motor Assessment Scale score (P=0.059) and gait speed (P=0.095) in the intensive motor training group. In this randomized, controlled trial, a community-based intensive motor training program, doubling the amount of physical therapy during the first 4 weeks after discharge, did not show significant improvement of balance or any other functional outcomes.