Background and Purpose—: Treatments that improve function in late phase after stroke are urgently needed. We assessed whether multimodal interventions based on rhythm-and-music therapy or horse-riding therapy could lead to increased perceived recovery and functional improvement in a mixed population of individuals in late phase after stroke. Methods—: Participants were assigned to rhythm-and-music therapy, horse-riding therapy, or control using concealed randomization, stratified with respect to sex and stroke laterality. Therapy was given twice a week for 12 weeks. The primary outcome was change in participants’ perception of stroke recovery as assessed by the Stroke Impact Scale with an intention-to-treat analysis. Secondary objective outcome measures were changes in balance, gait, grip strength, and cognition. Blinded assessments were performed at baseline, postintervention, and at 3- and 6-month follow-up. Results—: One hundred twenty-three participants were assigned to rhythm-and-music therapy (n=41), horse-riding therapy (n=41), or control (n=41). Post-intervention, the perception of stroke recovery (mean change from baseline on a scale ranging from 1 to 100) was higher among rhythm-and-music therapy (5.2 [95% confidence interval, 0.79–9.61]) and horse-riding therapy participants (9.8 [95% confidence interval, 6.00–13.66]), compared with controls (−0.5 [−3.20 to 2.28]); P =0.001 (1-way ANOVA). The improvements were sustained in both intervention groups 6 months later, and corresponding gains were observed for the secondary outcomes. Conclusions—: Multimodal interventions can improve long-term perception of recovery, as well as balance, gait, grip strength, and working memory in a mixed population of individuals in late phase after stroke. Clinical Trial Registration—: URL: http//www.ClinicalTrials.gov. Unique identifier: NCT01372059.

To compare the ability of a rank-invariant non-parametric method with that of kappa statistics to evaluate the reliability of the Swedish version of the Tampa Scale for Kinesiophobia and the Self-Efficacy Scale by identifying systematic and random disagreement. The aim was, further, to compare 2 different statistical approaches to obtain a global value from multi-item scales. A test-retest study. A total of 46 patients with whiplash-associated disorders were enrolled and 39 (85%) completed the test-retest assessment. Data from the multi-item scales were summarized using both sum and median scores. Paired data were evaluated with a rank-invariant statistical method to identify systematic and random disagreement. Data were also evaluated with kappa statistics. The non-parametric approach demonstrated that the Swedish version of the Tampa Scale for Kinesiophobia and the Self-Efficacy Scale are reliable for patients with whiplash-associated disorders. In contrast to the rank-invariant method, kappa statistics provided no information on disagreement between the 2 test occasions. Median scoring improved reliability due to lack of disagreement while the sum scores method was characterized by random individual disagreement. This study has increased understanding of the advantages and limitations of 2 non-parametric statistical methods and, it is hoped, will contribute to the development of reliable measurements.

Objective: To evaluate the effects of a physical training programme which is supervised and tailored to meet the needs of patients with subacute whiplash-associated disorders. Design: A randomized controlled trial with follow-up at three and nine months after randomization. Setting: An interdisciplinary rehabilitation centre. Subjects: Forty-seven patients with subacute disorders following a whiplash trauma. Interventions: Patients were randomized to a supervised training group or a self-administered home training group. Main measures: Primary outcome measures were the Self-Efficacy Scale, the Tampa Scale for Kinesiophobia and the Pain Disability Index. Secondary outcome measures were neck pain intensity, sensory and affective dimensions of pain, pain location and duration, muscle tenderness, grip strength, cervical mobility, sick leave and analgesic consumption. Results: Forty patients (85%) completed the intervention period, and the drop-outs were followed up by intention-to-treat. The results showed that supervised training was significantly more favourable than home training, with a more rapid improvement in self-efficacy (P=0.03), fear of movement/(re)injury (P=0.03) and pain disability (P=0.03) at three months. Further, supervised training significantly reduced the frequency of analgesic consumption (P=0.03). The improvements were partly maintained at nine months, even though there was no amelioration in pain and physical disorders. Despite the favourable outcome, supervised intervention did not reduce sick leave. Conclusions: The findings indicate a treatment approach that is feasible in the rehabilitation of patients with subacute whiplash-associated disorders in the short term, but additional research is needed to extend these findings and elucidate treatment strategies that also are cost effective.