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      Evaluation of Tai Chi Yunshou exercises on community-based stroke patients with balance dysfunction: a study protocol of a cluster randomized controlled trial

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          Abstract

          Background

          Balance dysfunction after stroke limits patients’ general function and participation in daily life. Previous researches have suggested that Tai Chi exercise could offer a positive improvement in older individuals’ balance function and reduce the risk of falls. But convincing evidence for the effectiveness of enhancing balance function after stroke with Tai Chi exercise is still inadequate. Considering the difficulties for stroke patients to complete the whole exercise, the current trial evaluates the benefit of Tai Chi Yunshou exercise for patients with balance dysfunction after stroke through a cluster randomization, parallel-controlled design.

          Methods/Design

          A single-blind, cluster-randomized, parallel-controlled trial will be conducted. A total of 10 community health centers (5 per arm) will be selected and randomly allocated into Tai Chi Yunshou exercise group or balance rehabilitation training group. Each community health centers will be asked to enroll 25 eligible patients into the trial. 60 minutes per each session, 1 session per day, 5 times per week and the total training round is 12 weeks. Primary and secondary outcomes will be measured at baseline and 4-weeks, 8-weeks, 12-weeks, 6-week follow-up, 12-week follow-up after randomization. Safety and economic evaluation will also be assessed.

          Discussion

          This protocol aims to evaluate the effectiveness of Tai Chi Yunshou exercise for the balance function of patients after stroke. If the outcome is positive, this project will provide an appropriate and economic balance rehabilitation technology for community-based stroke patients.

          Trial registration

          Chinese Clinical Trial Registry: ChiCTR-TRC-13003641. Registration date: 22 August, 2013 http://www.chictr.org/usercenter/project/listbycreater.aspx.

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          Most cited references40

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          Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review.

          In a recent study of 655 physical therapists working with a stroke population, the Berg Balance Scale (BBS) was identified as the most commonly used assessment tool across the continuum of stroke rehabilitation. Given the widespread popularity of the BBS, it is important to critically appraise the BBS for its use with a stroke population. The purposes of this study were to conduct a systematic review of the psychometric properties of the BBS specific to stroke and to identify strengths and weaknesses in its usefulness for stroke rehabilitation. Twenty-one studies examining the psychometric properties of the BBS with a stroke population were retrieved. Internal consistency was excellent (Cronbach alpha=.92-.98) as was interrater reliability (intraclass correlation coefficients [ICCs]=.95-.98), intrarater reliability (ICC=.97), and test-retest reliability (ICC=.98). Sixteen studies focused on validity and generally found excellent correlations with the Barthel Index, the Postural Assessment Scale for Stroke Patients, Functional Reach Test, the balance subscale of Fugl-Meyer Assessment, the Functional Independence Measure, the Rivermead Mobility Index (except for weight shift and step-up items), and gait speed. Berg Balance Scale scores predicted length of stay, discharge destination, motor ability at 180 days poststroke, and disability level at 90 days, but these scores were not predictive of falls. Eight studies focused on responsiveness; all reported moderate to excellent sensitivity. Three studies found floor or ceiling effects. The BBS is a psychometrically sound measure of balance impairment for use in poststroke assessment. Given the floor and ceiling effects, clinicians may want to use the BBS in conjunction with other balance measures.
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            Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident.

            This study establishes intratester reliability for all components of physical performance and intertester reliability for the total scores of upper and lower extremity motor performance in a cumulative numerical scoring system devised by Fugl-Meyer et al. Intertester reliability was found to be high for the total scores of upper and lower extremity motor performance. All intratester and intertester reliability coefficients were high and statistically significant. Establishing the reliability of the Fugl-Meyer method of assessing recovery of function following cerebrovascular accident has increased the usefulness of this method for clinical assessment and as a tool for the comparative analysis of the effectiveness of various therapeutic interventions.
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              Multicenter randomized clinical trial evaluating the effectiveness of the Lokomat in subacute stroke.

              To compare the efficacy of robotic-assisted gait training with the Lokomat to conventional gait training in individuals with subacute stroke. A total of 63 participants<6 months poststroke with an initial walking speed between 0.1 to 0.6 m/s completed the multicenter, randomized clinical trial. All participants received twenty-four 1-hour sessions of either Lokomat or conventional gait training. Outcome measures were evaluated prior to training, after 12 and 24 sessions, and at a 3-month follow-up exam. Self-selected overground walking speed and distance walked in 6 minutes were the primary outcome measures, whereas secondary outcome measures included balance, mobility and function, cadence and symmetry, level of disability, and quality of life measures. Participants who received conventional gait training experienced significantly greater gains in walking speed (P=.002) and distance (P=.03) than those trained on the Lokomat. These differences were maintained at the 3-month follow-up evaluation. Secondary measures were not different between the 2 groups, although a 2-fold greater improvement in cadence was observed in the conventional versus Lokomat group. For subacute stroke participants with moderate to severe gait impairments, the diversity of conventional gait training interventions appears to be more effective than robotic-assisted gait training for facilitating returns in walking ability.
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                Author and article information

                Contributors
                taojing01@163.com
                630801992@qq.com
                1023350474@qq.com
                554277685@qq.com
                381168335@qq.com
                zhgh_1969@aliyun.com
                su8055@qq.com
                285577231@qq.com
                593327953@qq.com
                61102547@qq.com
                1938655280@qq.com
                lidianchen87@163.com
                Journal
                BMC Complement Altern Med
                BMC Complement Altern Med
                BMC Complementary and Alternative Medicine
                BioMed Central (London )
                1472-6882
                25 February 2015
                25 February 2015
                2015
                : 15
                : 31
                Affiliations
                [ ]Rehabilitation Medicine College, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122 China
                [ ]Fujian University of Traditional Chinese Medicine Subsidiary Rehabilitation Hospital, Fuzhou, 350122 China
                [ ]Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122 China
                [ ]Fujian University of Traditional Chinese Medicine, Fuzhou, 350122 China
                Article
                555
                10.1186/s12906-015-0555-1
                4359558
                25888114
                6451135d-b0f8-40fb-abb6-d90fb3c9d9a4
                © Tao et al.; licensee BioMed Central. 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 31 December 2014
                : 17 February 2015
                Categories
                Study Protocol
                Custom metadata
                © The Author(s) 2015

                Complementary & Alternative medicine
                tai chi yunshou exercises,balance dysfunction after stroke,community patients,cluster randomized controlled trial

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