Conductive Education as a Method of Stroke Rehabilitation: A Single Blinded Randomised Controlled Feasibility Study

Hindawi Publishing Corporation Stroke Research and Treatment Volume 2016, Article ID 5391598, 6 pages http://dx.doi.org/10.1155/2016/5391598 Clinical Study Conductive Education as a Method of Stroke Rehabilitation: A Single Blinded Randomised Controlled Feasibility Study Judith Bek,1 Melanie R. Brown,2 Jagjeet Jutley-Neilson,2,3 Nicholas C. C. Russell,4 Pia A. J. Huber,4 and Catherine M. Sackley4 1 Faculty of Medical and Human Sciences, University of Manchester, Manchester M13 9PL, UK National Institute of Conductive Education, Birmingham B13 3RD, UK 3 School of Social Sciences, Birmingham City University, Birmingham B4 7BD, UK 4 Faculty of Life Sciences and Medicine, King’s College London, London SE1 1UL, UK 2 Correspondence should be addressed to Catherine M. Sackley; Received 14 January 2016; Accepted 29 May 2016 Academic Editor: Wai-Kwong Tang Copyright © 2016 Judith Bek et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Conductive Education for stroke survivors has shown promise but randomised evidence is unavailable. This study assessed the feasibility of a definitive randomised controlled trial to evaluate efficacy. Methods. Adult stroke survivors were recruited through local community notices. Those completing the baseline assessment were randomised using an online program and group allocation was independent. Intervention group participants received 10 weekly 1.5-hour sessions of Conductive Education at the National Institute of Conductive Education in Birmingham, UK. The control group participants attended two group meetings. The study evaluated the feasibility of recruitment procedures, delivery of the intervention, retention of participants, and appropriateness of outcome measures and data collection methods. Independent assessments included the Barthel Index, the Stroke Impact Scale, the Timed Up and Go test, and the Hospital Anxiety and Depression Scale. Results. Eighty-two patients were enrolled; 77 completed the baseline assessment (46 men, mean age 62.1 yrs.) and were randomised. 70 commenced the intervention (𝑛 = 37) or an equivalent waiting period (𝑛 = 33). 32/37 completed the 10-week training and 32/33 the waiting period. There were no missing items from completed questionnaires and no adverse events. Discussion. Recruitment, intervention, and assessment methods worked well. Transport issues for intervention and assessment appointments require review. Conclusion. A definitive trial is feasible. This trial is registered with ISRCTN84064492. 1. Introduction Rehabilitation provision for stroke survivors is typically limited to the first few months after stroke [1, 2]. However, improvements in mobility, activities of daily living, and quality of life have been reported following rehabilitation beyond this period [3–5]. The UK Department of Health’s National Stroke Strategy advised that support from stroke services should be available as required by patients and identified a need for the development of long-term community rehabilitation [6]. Similarly, the UK National Service Framework for Older People states that “rehabilitation should continue until it is clear that maximum recovery has been achieved” [7]. Conductive Education (CE) is an approach to rehabilitation that views stroke recovery as a learning process. CE was developed in Hungary in the 1940s as a specialised learning system for adults and children with neurological motor disorders [8]. Programmes are tailored to specific conditions, including stroke, Parkinson’s disease, multiple sclerosis, and cerebral palsy. CE aims to help stroke survivors at any stage of recovery to maintain or increase their range and control of movement, confidence, and coordination. It teaches strategies that participants can apply to their daily activities [9]. Functional tasks are broken down into a series of components, or a “task series,” which is designed to enable participants to develop an increased awareness of their own movement and to learn the basic rules of move-ment solutions. Movements are practised repeatedly and rhythmically with verbal reinforcement or “rhythmical intention” and the tasks are performed in a specific order. Both repeated practice 2 Stroke Research and Treatment [10] and rhythmic auditory cueing [11] have previously been shown to facilitate motor learning in neurological rehabilitation. To date, there have been no randomised trials of CE for stroke. However, three small studies with pre- and postintervention assessments have shown promise, indicating benefits in terms of motor performance, activities of daily living, and quality of life [12–14]. Caregivers have reported improvements in the individuals they cared for, as well as a decrease in their own burden [15]. However, in the absence of a control group, the specific effects of CE are yet to be demonstrated. 2. Methods This study tested the feasibility and acceptability of a larger scale randomised controlled trial to assess the clinical and cost-effectiveness of a CE programme for stroke survivors versus usual care. In accordance with the recommendations by Charlesworth and colleagues [16], the following were assessed: (i) The recruitment process, inclusion and exclusion criteria, and consent rate. (ii) The randomisation procedure and its success. (iii) Feasibility and acceptability of the intervention. (iv) Retention of patients in the study. (v) Adverse events. (vi) Suitability and completeness of the outcome measures. The study was a single blinded feasibility randomised controlled trial, with an intervention group and a waiting list control group. The study was carried out at the National Institute of Conductive Education in Birmingham, UK, between February 2010 and July 2012. Ethical approval for the study was obtained from the Research Governance Committee of Birmingham City Council (Ref.: 2/2/10). Participants were recruited by centre staff through advertisement to local support groups, social care organisations, open days, and local media between February and September 2010. Adults at any stage of postacute recovery from stroke were eligible to take part in the study, provided that they were able to give informed consent and reported no current medical concerns that precluded safe participation in a rehabilitation programme. Participants were required to have a sufficient level of language comprehension to complete the questionnaires administered at baseline assessment (with assistance from a carer if required). No further inclusion or exclusion criteria were specified, with the expectation that the characteristics of the sample would reflect the broad range of individuals who might potentially benefit from a stroke rehabilitation programme. As this was a feasibility study, no formal sample size calculation was conducted, and the nu (...truncated)