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Intensive early physiotherapy combined with dexamphetamine treatment in severe stroke: a randomized, controlled pilot
Louise Martinsson1, Staffan Eksborg, Nils Gunnar Wahlgren
1Institution of Clinical Neurosciences, Karolinska Institutet, Karolinska Hospital, Stockholm, Sweden.
Background:
The most severely disabled stroke patients are often excluded from studies evaluating effects of physiotherapy. This study intended to investigate the effect of an increased intensity of physiotherapy in combination with dexamphetamine the first week after ischemic stroke in patients with an impaired level of consciousness and severe motor dysfunction.
Methods:
Thirty patients were enrolled within 96 h after onset of symptoms. Patients were randomized to 30-45 min of physiotherapy twice daily or to maximally 15 min per day for 5 days. All patients received dexamphetamine to achieve alertness. Functional outcome measures were assessed at baseline, the day after treatment discontinuation, and 3 and 12 months after stroke onset. Residence of living was registered at long-term follow-ups.
Results:
No statistically significant differences were seen between groups in the outcomes measured at any time point. However, both groups improved over time in all outcomes at 3 and 12 months (p < 0.05), except for sensory functions at 3 months and motor functions at 12 months. The number of patients needed to treat (NNT) to achieve the desired improvement in Lindmark motor score was 8, with the 95% CI being NNT(harm) 10 to NNT(beneficial) 3. The fraction of patients who died was the same in both treatment groups, 47% (95% CI 28-65%).
Conclusions:
An increased intensity of physiotherapy in combination with dexamphetamine during the first week after stroke onset did not affect short- or long-term outcome in this limited sample of patients with severe stroke.