Patients ́ Postural Control and Development of Physiotherapy in Stroke Rehabilitation Reliable Clinical Assessment of Stroke

Outi Pyöriä Reliable clinical assessment of stroke patients’ postural control and development of physiotherapy in stroke rehabilitation. Jyväskylä: University of Jyväskylä, 2007, 94 p. (Studies in sport, Physical Education and Health ISSN 0356-1070; 125) ISBN 978-951-39-2912-1 (PDF), 978-951-39-2895-7 (nid.) Finnish Summary Diss. The main goal of the long-standing clinical research project in the district of East-Savo was to develop an active role in physiotherapy for patients with stroke. A novel assessment instrument, the Postural Control and Balance for Stroke (PCBS) test, was developed side by side with the activating treatment. This thesis includes reliability and validity studies of the Postural Control and Balance for Stroke (PCBS) test developed during the project, and the results of the controlled follow-up study concerning the influence of activating physiotherapy on stroke patients’ cognitive and physical functions and independent coping at home compared with traditional treatment. This thesis also reports the results of the investigation into how physiotherapists use test results in counselling sessions. The PCBS test contains three subscales: items for postural changes, sitting balance and standing balance. In all 137 (age 42-89) stroke patients were measured to assess the reliability and validity of the PCBS test. Intraand interrater reliability was assessed by using videotaped test performances of the patients. The construct validity of the PCBS test was investigated by comparing measurements obtained using the scores of the PCBS test with values obtained for the Barthel Index (BI) and for the four neuropsychological domains most widely studied in the literature: memory, language, visuospatial functions and visual inattention. The ability of the PCBS test at an early stage in rehabilitation to predict functional capacity measured by the BI, and risk for falls at 90 days after stroke was also studied. The criterion validity of the standing balance tasks of the PCBS test was evaluated by comparing the results obtained with those for postural sway velocity measured on a force platform. Eighty (age 47– 89) stroke patients participated in the 12-month follow-up study: 40 patients received activating physiotherapy and 40 patients received traditional therapy. Patients’ physical functional capacity was measured one week and 12 months post stroke with the Barthel Index (BI), the PCBS test, 10-meter gait speed, walking distances and patients’ abilities to cope without institutional help. Cognitive capacity was measured with specific neuropsychological tests: language, visuospatial functions, visual inattention and memory. Three physiotherapists and 7 patients participated in the counseling study. The content of communication in the counseling sessions was explored using discourse analysis. The PCBS test showed an acceptable level of reliability and the results confirm that the PCBS test has good construct validity. The score for postural changes predicted functional capacity and standing balance predicted falls at the 3-month follow-up. The standing balance items of the PCBS test have good criterion validity. The follow-up study showed that activating therapy can contribute more than traditional physiotherapy to patients’ independent living at home and also improve patients’ cognitive function. In particular improvement in memory in the intervention group differed significantly from that in the control group. The counseling study showed that successful counseling with reference to the results of the balance test calls for physiotherapists to develop dialogic communication skills to help patients in co-constructing their home exercise together with their social network. The results suggest that the PCBS test is a reliable and valid method of measuring balance ability in different phases after stroke. With respect to validity, the improvement is an ongoing process. The results of this study support the idea that activating physiotherapy can lead a comprehensive functional recovery after stroke.