Falls are the leading cause of fatal and non-fatal unintentional injuries in older people. The use of Exergames (active, gamified video-based exercises) is a possible innovative, community-based approach. This study aimed to determine the effectiveness of a tailored OTAGO/FaME-based strength and balance Exergame programme for improving balance, maintaining function and reducing falls risk in older people. A two-arm cluster randomised controlled trial recruiting adults aged 55 years and older living in 18 assisted living (sheltered housing) facilities (clusters) in the UK. Standard care (physiotherapy advice and leaflet) was compared to a tailored 12-week strength and balance Exergame programme, supported by physiotherapists or trained assistants. Complete case analysis (intention-to-treat) was used to compare the Berg Balance Scale (BBS) at baseline and at 12 weeks. Secondary outcomes included fear of falling, mobility, fall risk, pain, mood, fatigue, cognition, healthcare utilisation and health-related quality of life, and self-reported physical activity and falls. Eighteen clusters were randomised (9 to each arm) with 56 participants allocated to the intervention and 50 to the control (78% female, mean age 78 years). Fourteen participants withdrew over the 12 weeks (both arms), mainly for ill health. There was an adjusted mean improvement in balance (BBS) of 6.2 (95% CI 2.4 to 10.0) and reduced fear of falling (p = 0.007) and pain (p = 0.02) in the Exergame group. Mean attendance at sessions was 69% (mean exercising time of 33 min/week). Twenty-four percent of the control group and 20% of the Exergame group fell over the trial period. The change in fall rates significantly favoured the intervention (incident rate ratio 0.31 (95% CI 0.16 to 0.62, p = 0.001)). The point estimate of the incremental cost-effectiveness ratio (ICER) was £15,209.80 per quality-adjusted life year (QALY). Using 10,000 bootstrap replications, at the lower bound of the NICE threshold of £20,000 per QALY, there was a 61% probability of Exergames being cost-effective, rising to 73% at the upper bound of £30,000 per QALY. Exergames, as delivered in this trial, improve balance, pain and fear of falling and are a cost-effective fall prevention strategy in assisted living facilities for people aged 55 years or older. The trial was registered at ClinicalTrials.gov on 18 Dec 2015 with reference number NCT02634736 .

Objective: To investigate the effectiveness of a contracture preventive positioning procedure for the hemiplegic arm in subacute stroke patients in addition to conventional physio and occupational therapy. Design: A single-blind pilot randomized controlled trial. Setting: Inpatient neurological units from three rehabilitation centres in the Netherlands. Subjects: Nineteen subacute stroke patients (minus two drop-outs) with a severe motor deficit of the arm. Interventions: All subjects underwent conventional rehabilitation care. Nine subjects additionally received a positioning procedure for two 30-min sessions a day, five days a week, for five weeks. Main measures: Passive range of motion of five arm movements using a hydrogoniometer and resistance to passive movement at the elbow using the Ashworth Scale. Secondary outcome measures were pain at the end range of passive motions, the arm section of the Fugl-Meyer Assessment and Barthel Index scores for ADL-independence. Outcome measures were taken after five weeks and additional measurements after 10 weeks by two assessors blinded to group allocation. Results: Comparison of the experimental ( n = 9) with the control subjects ( n = 8) after five weeks showed that additional positioning significantly slowed down development of shoulder abduction contracture ( P = 0.042, −5.3 degrees versus −23 degrees). No other differences were found between the groups. Conclusions: Applying a contracture preventive positioning procedure for the hemiplegic arm slowed down the development of shoulder abduction contracture. Positioning did not show significant additional value on other outcome measures. Since the sample size was small, results of this study need future verification.

Does static stretch positioning combined with simultaneous neuromuscular electrical stimulation (NMES) in the subacute phase after stroke have beneficial effects on basic arm body functions and activities? Multicentre randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Forty-six people in the subacute phase after stroke with severe arm motor deficits (initial Fugl-Meyer Assessment arm score ≤ 18). In addition to conventional stroke rehabilitation, participants in the experimental group received arm stretch positioning combined with motor amplitude NMES for two 45-minute sessions a day, five days a week, for eight weeks. Control participants received sham arm positioning (ie, no stretch) and sham NMES (ie, transcutaneous electrical nerve stimulation with no motor effect) to the forearm only, at a similar frequency and duration. The primary outcome measures were passive range of arm motion and the presence of pain in the hemiplegic shoulder. Secondary outcome measures were severity of shoulder pain, restrictions in performance of activities of daily living, hypertonia, spasticity, motor control and shoulder subluxation. Outcomes were assessed at baseline, mid-treatment, at the end of the treatment period (8 weeks) and at follow-up (20 weeks). Multilevel regression analysis showed no significant group effects nor significant time × group interactions on any of the passive range of arm motions. The relative risk of shoulder pain in the experimental group was non-significant at 1.44 (95% CI 0.80 to 2.62). In people with poor arm motor control in the subacute phase after stroke, static stretch positioning combined with simultaneous NMES has no statistically significant effects on range of motion, shoulder pain, basic arm function, or activities of daily living. NTR1748.

Purpose. To assess whether our measurement protocol using two raters simultaneously yielded reliable passive range of motion measurements of the hemiplegic arm. Additionally, motion ranges were correlated to several factors to examine the concurrent validity of these measurements. Method. Two raters simultaneously assessed five arm motions at baseline, after five and ten weeks in respectively 18, 13 and 12 stroke patients. One tester made the passive movement and the other read the hydrogoniometer. Raters then switched roles. Results. Intraclass correlation coefficients revealed high agreement between the raters with intraclass correlation coefficients (ICCs) ranging between 0.84 and 0.99. Standard errors of measurement and smallest detectable differences were large for shoulder abduction. Significant correlations were found between shoulder external rotation and flexion. All arm motions correlated negatively to pain at the end range of these motions. Shoulder external rotation and flexion were significantly correlated to the time post stroke. Concurrent validity with Ashworth Scale, Fugl-Meyer Assessment and Barthel Index was limited. Conclusions. The current measurement protocol yielded high reliability indices and seems useful for further use. However, standard error of measurement and smallest detectable difference for shoulder abduction were high, implying the neccesity to include a large sample size in future studies. Correlations revealed that restricted range of arm motions relate to the time post-stroke and coincide with pain.