Browsing by Person "Dennis, M."

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Does treadmill training improve walking after stroke - the long-term follow-up from a phase II randomised controlled trial.
(Wiley, 2009) Baer, Gill; Dennis, M.; Pitman, D.; Salisbury, Lisa; Smith, M.
Introduction: A recent Cochrane review has indicated that current evidence for the effectiveness of Treadmill Training (TT) following stroke is inconclusive. This paper reports the 6 month follow up of mobility outcomes from a phase II feasibility randomised-controlled trial investigating an eight week TT programme with ambulant and non-ambulant people with sub-acute stroke. Method: Sub-acute stroke patients within 3 months of stroke onset were recruited from four stroke rehabilitation units. Randomisation based on side of lesion and initial independence or dependence in walking allocated participants to receive either an eight week programme of ''usual physiotherapy'' (control) or physiotherapy including TT (experimental). Mobility outcomes taken at baseline and 6 months after randomisation included: the Modified Rivermead Mobility Index (RMI); Functional Ambulation Classification (FAC); Timed Up and Go (TUG); 10 min walk test (10 mwt); and the 6 min walk test (6 mwt). Results: Seventy-seven participants were recruited, 39 were randomised to control, and 38 to experimental. At 6 months post randomisation, while both groups had improved their mobility scores, Mann-Whitney U-tests showed no significant differences between the groups for RMI (U=481.5; p=0.421); FAC (U=488; p=0.457); TUG (U=204; p=0.678); 10 mwt (U=262; p=0.956) or 6 mwt (U=194.5; p=0.892). Conclusion: The results indicated that while both groups improved their mobility scores from baseline measures, there were no statistically significant differences between the groups at 6 months. The amount and content of ''usual physiotherapy'' and TT is being analysed to determine whether this may be one of the influencing factors.
How feasible is the delivery of treadmill training early after stroke within the NHS: Findings of a Phase II randomised controlled trial
(Wiley, 2009) Smith, M.; Baer, Gill; Dennis, M.; Pitman, D.; Salisbury, Lisa
Introduction: RCP Stroke Guidelines advocate treadmill training (TT) for gait rehabilitation post-stroke. The protocols described in previous studies were intensive, short-term and may not be feasible to deliver within a UK clinical setting. One aim of this Phase II study was to explore key elements of delivering TT in a clinical setting within the NHS. Method: As part of a randomised controlled trial over 8 weeks, participants with stroke were allocated to a control or experimental group. The protocol demanded that all participants received a minimum of three therapy sessions per week of which at least two were on the treadmill for experimental participants. A treadmill system with unweighing harness was used. The content of treadmill sessions was decided by the treating therapists and all parameters were recorded. Results: Seventy-seven participants were recruited with 39 randomised to the experimental group. Experimental participants received a median of two treadmill sessions per week, with an average total walking time on the treadmill of between 8 and 16 min/week, at a median speed of 0.6m/s. Use of a support harness by participants reduced from 49% in week 1 to 23% in week 8. Conclusion: Only the minimum number of treadmill interventions were delivered. Clinical staff cited staffing levels, number of staff required for safety and time required for harness application as some of the reasons for the limited TT. These findings suggest that it may not be feasible to deliver sufficient doses of TT within the current NHS clinical environment.
Treadmill Training to improve mobility for people with sub-acute Stroke: A Phase II Feasibility Randomised Controlled Trial
(SAGE, 2017-07-21) Baer, Gill; Salisbury, Lisa; Smith, M.; Pitman, J.; Dennis, M.
Objective: This phase II study investigated the feasibility and potential effectiveness of treadmill training versus normal gait re-education for ambulant and non-ambulant people with sub-acute stroke delivered as part of normal clinical practice. Design: A single-blind, feasibility randomised controlled trial. Setting: Four hospital-based Stroke units Subjects: Participants within three months of stroke onset. Interventions: Participants were randomised to treadmill training (minimum twice weekly) plus normal gait re-education or normal gait re-education only (control) for up to eight weeks. Main Measures: Measures were taken at baseline, after eight weeks intervention and at six months follow up. The primary outcome was the Rivermead Mobility Index. Other measures included the Functional Ambulation Category, 10 metre walk, six minute walk, Barthel Index, Motor Assessment Scale, Stroke Impact Scale and a measure of confidence in walking. Results: Seventy seven patients were randomised, 39 to treadmill and 38 to control. It was feasible to deliver treadmill training to people with sub-acute stroke. Only two adverse events occurred. No statistically significant differences were found between groups. For example, Rivermead Mobility Index, median (IQR): after eight weeks treadmill 5 (4-9), control 6 (4-11) p = 0.33; or six months follow-up treadmill 8.5 (3 -12), control 8 (6 - 12.5) p = 0.42. The frequency and intensity of intervention was low. Conclusions: Treadmill training in sub-acute stroke patients was feasible but showed no significant difference in outcomes when compared to normal gait re-education. A large definitive randomised trial is now required to explore treadmill training in normal clinical practice.