Friday January 18 6:42 PM ET
Therapy May Not Help Lingering Stroke Problems
NEW YORK (Reuters Health) - Patients who still have difficulty walking or other mobility problems a year after having a stroke may not benefit from low-intensity physical therapy, researchers have found.

While such physical therapy has been shown to help stroke patients immediately after leaving the hospital, the new study shows that problems that persist after the one-year mark may be more difficult to remedy.

In the new study, John Green of St. Luke's Hospital in West Yorkshire, UK, and colleagues assigned 359 patients with mobility problems a year after having a stroke to receive either physical therapy or no physical therapy treatment. The patients all had fallen, used a walker or needed help negotiating stairs, slopes or uneven surfaces.

The patients undergoing physical therapy met with a physical therapist and over a 13-week period had at least three appointments at an outpatient rehabilitation center or used a problem-solving approach at home.

The patients were assessed at the beginning of the study and 146 individuals were available for follow-up at 3, 6 and 9 months.

Although some of the patients given physical therapy saw small improvements in mobility and walking speed at the 3-month point, these benefits were not sustained over time, the researchers note in the January 19th issue of The Lancet.

``Our results show that routine (physical therapy) causes a small and transitory improvement in the mobility of patients with persisting difficulties 1 year after stroke. Social activity, mood...and the number of times patients fell were not affected by treatment,'' Green and colleagues write.

``The improvement in patients' mobility at 3 months, although significant, was too small to be clinically important and was not sustained,'' the team concludes.

Problems with walking and other daily activities are common among stroke patients, and doctors often refer patients with such mobility problems for physical therapy, the researchers explain. However, the benefits of physical therapy for patients still having problems a year later have not been confirmed.

The patients may have benefited from more treatments, the authors note, and some small studies have suggested that intense and sustained treatments help reduce disability in such patients.

In a separate study, the research team found that many of the patients felt that the low-intensity treatments ``were not designed to help them with their practical difficulties with daily activities,'' they write. ``The aims of treatment differed from the expectations of patients.''

SOURCE: The Lancet 2002;359:199-203.