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. 2014 Apr 22;2014(4):CD001920. doi: 10.1002/14651858.CD001920.pub3

Zhu 2007 haem.

Study characteristics
Methods Study design: RCT
Method of randomisation: "Stratified block randomisation"
Participants Number of participants: n = 78
Inclusion criteria: "Provided informed consent, medically stable for > 48hours, Glasgow Coma Scale > 8 and functional deficit of limbs"
Exclusion criteria: "Active liver disease, impaired liver, kidney function, congestive heart failure, impaired respiratory system, malignant tumours, history of dementia, history of psychological disorders, paralysis of 4 limbs, more than 4 weeks post stroke, history of previous stroke which resulted in functional deficit of limbs, unable to allow re‐assessments to take place and deafness and/or muteness"
Interventions (1) Cerebral haemorrhage rehabilitation group (n = 12)
"All patients received routine clinical treatment and care. Treatment group was transferred to rehabilitation centre after becoming medically stable, and under guidance from the therapists, utilised physiotherapy and occupational therapy to undergo integrated rehabilitative treatment; patients on being discharged to their homes, were visited by therapists who would teach the required training, until the follow‐up ended"
"Key training contents included: (i) From 1 week after medical stabilisation till one month after onset of stroke, focus was on bed and bed‐side exercises, including anti‐spasticity positioning, passive exercises on affected limbs and neuro‐muscular stimulative technique, active exercises on non‐affected limbs, truncal muscle control training, shifting on bed, rolling (affected side, non‐affected side), sitting up, sitting‐balance training, sitting position–standing position transfer as well as eating, grooming, dressing etc ADL training, once a day, 45 min each time, 5 days a week. (ii) From start of 2nd month till end of 3rd month after onset of stroke, focus was on standing training, including standing‐balance training, single‐leg weight bearing, gait and stair climbing/descending, and other trainings, while providing guidance on toileting, bed‐chair transferring, indoors or outdoors walking, use of stairs, washing and other practical ADLs; twice a day, 45 min each time, 5 days a week. Because muscle tone could increase gradually during this period, it was necessary to increase the intensity of trainings to reduce muscle tone and inhibit abnormal exercise patterns. For some patients who returned to community setting, therapists would conduct weekly home‐visits to guide the patient on rehabilitative treatment. (iii) Once training had commenced, therapists concurrently taught the patients’ family members or caregiver on the correct assistive training methods and care methods, such that they could provide some training outwith therapy time, while also reducing the secondary damage due to inappropriate care. (iv) Patients learned to monitor their own body for discomfort, and report on time to therapist and caregiver"
The individual components delivered are listed in Table 6. Based on the individual components, this intervention is categorised as comprising functional task training and musculoskeletal intervention (passive)
Length of intervention period: not stated
Number of sessions and length of individual sessions: dependent on stage of recovery (see above)
Intervention provider: therapists
(2) Cerebral haemorrhage control group (n = 10)
"Control group was not given standard rehabilitative treatment, but were allowed to perform activities independently under doctor’s advice or with assistance from nurses"
The individual components delivered are listed in Table 6. Based on the individual components, this intervention is categorised as comprising no intervention
Length of intervention period: no intervention
Number of sessions and length of individual sessions: no intervention
Intervention provider: no intervention
This study is classified as intervention (functional task training, musculoskeletal (passive)) versus no treatment (Table 7)
Outcomes Measures of independence in ADL: Barthel Index
Measures of motor function: Fugl‐Meyer Assessment
Time points when outcomes were assessed: at allocation to groups and end of one and three months after stroke
Notes Original study translated from Chinese to English
Data provided are means and ranges. For analysis, standard deviations have been estimated by calculating (upper range ‐ lower range)/four
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk "Stratified block randomisation" (divided by type of stroke before allocation to intervention or control groups)
Allocation concealment (selection bias) Unclear risk No information provided
Blinding of outcome assessment (detection bias)
All outcomes Low risk Blinded assessment
Incomplete outcome data (attrition bias)
All outcomes Unclear risk No dropouts described
Free of systematic differences in baseline characteristics of groups compared? Low risk No statistically significant differences in baseline values
Did authors adjust for baseline differences in their analyses? Low risk No information provided
Other bias Unclear risk No information provided