After Stroke, Start Physical Therapy Early
Jan. 17, 2002 -- After a stroke, many people have long-term difficulties with walking, getting out of a chair, climbing stairs. Many people have serious falls as a result. Doctors typically refer them for physical therapy to offset this risk.
But when physical therapy starts a year after the stroke, benefits are "limited," says John Green, a geriatric care researcher at St. Luke's Hospital in West Yorkshire, England. His study appears in this week's The Lancet.
In his study, Green saw all 359 patients one year after their strokes; 170 were randomly assigned to physical therapy. He monitored their progress at three, six, and nine months.
After three months, patients showed an increase in walking speed, "a small and transient improvement," says Green. However, the therapy had no effect on their daily activity, social activity, anxiety, depression, or number of falls. It also had no effect on the emotional stress of their caregivers.
Those patients who had fallen before the study began -- and those who had the poorest mobility -- showed the most improvement, but the effect didn't last more than three months.
In other studies, similar low-intensive physical therapy has benefited patients. However, therapy was started soon after discharge from the hospital, says Green.
More comprehensive, longer-term therapy can be effective in reducing disability in patients similar to Green's -- or in patients who have been unable to walk three months after they have the stroke, he points out. These programs are typically hospital-based (either inpatient or outpatient) and include occupational therapy, group activities, and speech therapy.