Dickstein 2013.
| Study characteristics | ||
| Methods | Half‐crossover study | |
| Participants | Participants were recruited from the registry of Flieman Geriatric Rehabilitation Hospital in Haifa, Israel. Potential participants were screened, and after the project presentation, consent was obtained in their homes by a physical therapist Inclusion criteria: participants were included if they were community‐dwelling individuals, 60 to 80 years of age, who had sustained a unilateral stroke at least 6 months and no more than 2 years before recruitment. Only people reporting limited indoor and outdoor ambulation after the stroke; Mini Mental State Examination score tested at the home visit was 24 points or higher and who were not receiving physical therapy were included Exclusion criteria: wheelchair use, severe ailments including psychiatric disorders and major depression, and communication deficits Mean (SD) age: 72 (SD 6.9) years Stroke details: all participants: 18 ischemic, 5 hemorrhagic. Assigned to intervention: 9 ischemic, 3 hemorrhagic. Assigned to control: 9 ischemic, 2 hemorrhagic. Severity level of stroke: cortical = 6, subcortical = 11, cortical + subcortical = 1. In 5 participants, the stroke site was not determined Stroke phase: chronic |
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| Interventions | Experimental group ('integrated imagery practice'): the participants’ goals were used to select the imagined walking tasks for the imagery practice. The imagery scripts were identical for 3 weekly sessions and changed at the beginning of each week. All sessions were performed while the participants sat on a couch with eyes closed. Each session started and ended with 3 minutes of relaxation exercises. Three minutes of imagery practice were conducted for each of 3 imagery environments: the participant’s home, a 'community interior' (public indoor, such as a mall), and a 'community exterior' (public outdoors, such as a street) environment (for a total of 9 minutes). Imagery vividness was enhanced by using environments that were familiar to the participants. Both kinesthetic and visual imagery of the walking activities were used during practice. Motivational imagery was introduced in each session to enhance arousal, stimulate problem‐solving, and provide a sense of satisfaction Control group: control treatment consisted of physical therapy for upper extremity. It included 3 types of exercises, each conducted for 3 minutes: 1) transport‐reach exercise (e.g. spoon to mouth); 2) bimanual exercise (e.g. folding clothes); and 3) unimanual manipulation with the involved upper extremity (e.g. placing items in a jar). Functional tasks, chosen according to the participant’s needs, did not involve ambulation. The tasks were identical for the 3 weekly sessions and changed at the beginning of each week. All participants had motor limitations of paretic upper limb. Control treatment, similar to the experimental treatment, promoted participants’ collaboration |
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| Outcomes | Outcomes recorded at baseline, post‐intervention, and at 1 month from treatment conclusion Walking speed: 10 Meter Walk Test Pain, falls, and all‐cause deaths: Falls‐Efficacy Scale, Swedish version |
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| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: “... randomisation was based on a minimization scheme, which ensured balance in gait speed (with speed of.42m/s dividing subjects into “low‐” and “high‐level” walkers) as well as in age and sex" |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | All participants had to be aware of the therapies that were submitted to participate in the study, since it involved physical and cognitive exercise |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Quote: “Assessments were performed by 2 physical therapists (M.K., A.D.) blinded to group treatment assignment" |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Missed data balanced between groups |
| Selective reporting (reporting bias) | Low risk | The data of all outcomes were shown |
| Other bias | Low risk | None detected |