| fullrecord |
[{"key": "dc.contributor.advisor", "value": "Sj\u00f6gren, Tuulikki", "language": "", "element": "contributor", "qualifier": "advisor", "schema": "dc"}, {"key": "dc.contributor.author", "value": "Aalto, Susanne", "language": "", "element": "contributor", "qualifier": "author", "schema": "dc"}, {"key": "dc.date.accessioned", "value": "2019-10-02T06:34:55Z", "language": null, "element": "date", "qualifier": "accessioned", "schema": "dc"}, {"key": "dc.date.available", "value": "2019-10-02T06:34:55Z", "language": null, "element": "date", "qualifier": "available", "schema": "dc"}, {"key": "dc.date.issued", "value": "2019", "language": "", "element": "date", "qualifier": "issued", "schema": "dc"}, {"key": "dc.identifier.uri", "value": "https://jyx.jyu.fi/handle/123456789/65718", "language": null, "element": "identifier", "qualifier": "uri", "schema": "dc"}, {"key": "dc.description.abstract", "value": "Aivoverenkiertoh\u00e4iri\u00f6\u00f6n (AVH) sairastuu Suomessa vuosittain noin 24 000 ihmist\u00e4 ja k\u00e4velyn h\u00e4iri\u00f6t rajoittavat useilla toimintakyky\u00e4. Aiempia tutkimuksia k\u00e4vely- ja kest\u00e4vyysharjoittelun vaikuttavuudesta on tehty usein akuuteilla ja subakuuteilla kuntoutujilla ja vaikuttavuutta on arvioitu kehon toimintojen ja suorituskyvyn tasolla. Tutkimuksen tarkoituksena oli selvitt\u00e4\u00e4 kroonisten AVH-kuntoutujien k\u00e4vely- ja kest\u00e4vyysharjoittelun vaikuttavuutta k\u00e4velykest\u00e4vyyteen verrattuna ei-harjoitteluun/lumeterapiaan, tavanomaiseen fysioterapiaan ja toisenlaiseen harjoitteluun. K\u00e4vely\u00e4 arvioitiin suorituskyvyn ja suoritustason tasolla kansainv\u00e4lisen toimintakyvyn, toimintarajoitteiden ja terveyden luokituksen (ICF) mukaisesti. Tutkimus on osa Kelan vaativan l\u00e4\u00e4kinn\u00e4llisen kuntoutuksen (VAKU) hanketta.\n\nJ\u00e4rjestelm\u00e4llinen kirjallisuushaku (1/2008-5/2017) toteutettiin VAKU-hankkeessa tietokantoihin: Cinahl, CENTRAL, Cochrane Database of Systematic Reviews, Embase, OVID Medline, PEDro sek\u00e4 WOS. Sis\u00e4\u00e4nottokriteerit m\u00e4\u00e4riteltiin PICOS-menetelm\u00e4ll\u00e4: (P) diagnosoitu aivoverenkiertoh\u00e4iri\u00f6 \u2265 6 kuukautta aiemmin (I) k\u00e4vely- tai kest\u00e4vyysharjoittelu, (C) ei-harjoittelua/lumeterapia, tavanomainen fysioterapia, toisenlainen harjoittelu, (O) k\u00e4velykest\u00e4vyys suorituskyvyn tasolla, k\u00e4vely suoritustason tasolla, (S) satunnaistettu kontrolloitu tutkimus. Meta-analyysi tehtiin Review Manager 5.3 \u2013ohjelmalla satunnaisvaikutusten mallia k\u00e4ytt\u00e4en. P\u00e4\u00e4analyysissa k\u00e4vely- ja kest\u00e4vyysharjoittelun vaikuttavuutta arvioitiin suorituskyvyn tasolla keskiarvojen erotuksella (Mean Difference, MD) ja suoritustasolla standardoitujen keskiarvojen erotuksella (Standardized Mean Difference, SMD) ja harjoittelua verrattiin yhdistettyyn kontrolliryhm\u00e4\u00e4n. Ala-analyyseissa arvioitiin erikseen k\u00e4velyharjoittelun ja kest\u00e4vyysharjoittelun vaikuttavuutta verrattuna eri kontrolliryhmiin. Tutkimusten laatu arvioitiin Cochranen Risk of Bias -ty\u00f6kalulla.\n\nTutkimukseen sis\u00e4ltyi 28 tutkimusta ja tutkittavia oli yhteens\u00e4 1270. Keskim\u00e4\u00e4rin interventiot kestiv\u00e4t 9 viikkoa (vaihtelu 1 \u2013 24) ja harjoittelu toteutui nelj\u00e4sti viikossa (SD 1.5). Suorituskyvyn tasolla k\u00e4velykest\u00e4vyys lis\u00e4\u00e4ntyi 6 minuutin k\u00e4velytestiss\u00e4 koeryhm\u00e4ss\u00e4 12.58 metri\u00e4 (95% CI [5.55, 19.60]; p=0.0005; n=919) enemm\u00e4n verrattuna kontrolliryhm\u00e4\u00e4n. K\u00e4vely- ja kest\u00e4vyysharjoittelu on ilmeisesti vaikuttavampi harjoittelumuoto k\u00e4velykest\u00e4vyyden lis\u00e4\u00e4miseksi, kun sit\u00e4 verrataan ei-harjoitteluun/lumeterapiaan, tavanomaiseen fysioterapiaan ja toisenlaiseen harjoitteluun (n\u00e4yt\u00f6n aste B). Suoritustasolla mitattuna ryhmien tuloksien v\u00e4lill\u00e4 ei ollut tilastollisesti merkitsev\u00e4\u00e4 eroa (SMD -0.04; 95% CI [-0.43, 0.35]; p=0.83; n=152) ja luotettava n\u00e4ytt\u00f6 harjoittelun vaikuttavuudesta suoritustasoon puuttuu (n\u00e4yt\u00f6n aste D). Ala-analyyseissa tilastollinen ero oli k\u00e4velyharjoittelun ja toisenlaisen harjoittelun v\u00e4lill\u00e4 (MD 12.81; 95% CI [3.25, 22.38]; p=0.009; n=241), mutta sensitiivisyysanalyysissa eroa ei ollut. K\u00e4velykest\u00e4vyyden lis\u00e4\u00e4ntymiseksi k\u00e4velyharjoittelu on ilmeisesti verrannollinen harjoittelumuoto tavanomaisen fysioterapian kanssa (n\u00e4yt\u00f6n aste B) ja se lienee verrannollinen toisenlaisen harjoittelumuodon kanssa (n\u00e4yt\u00f6n aste C). Kest\u00e4vyysharjoittelu saattaa parantaa k\u00e4velykest\u00e4vyytt\u00e4 enemm\u00e4n verrattuna intensiteetilt\u00e4\u00e4n kevyemp\u00e4\u00e4n harjoitteluun (n\u00e4yt\u00f6n aste C) ja tavanomaiseen fysioterapiaan verrattaessa lienev\u00e4t harjoittelumuodot verrannolliset (n\u00e4yt\u00f6n aste D). Tilastollinen heterogeenisyys oli pient\u00e4 tai kohtalaista, mutta kliininen heterogeenisyys oli suurta interventioiden ja kontrolliryhmien osalta.\n\nKroonisten AVH-kuntoutujien k\u00e4vely- ja kest\u00e4vyysharjoittelu verrattuna ei-harjoitteluun/lumeterapiaan, tavanomaiseen fysioterapiaan ja toisenlaiseen harjoitteluun, on ilmeisesti vaikuttavampaa suorituskyvyn tasolla mitattuna, mutta tulos on kuitenkin kliinisesti pieni. Lis\u00e4\u00e4 tietoa tarvitaan k\u00e4vely- ja kest\u00e4vyysharjoittelun vaikuttavuudesta suoritustasoon, eri intensiteetill\u00e4 toteutettujen harjoittelujen vaikuttavuudesta sek\u00e4 siit\u00e4, miten harjoittelua voidaan toteuttaa kustannustehokkaasti.", "language": "fi", "element": "description", "qualifier": "abstract", "schema": "dc"}, {"key": "dc.description.abstract", "value": "In Finland there is approximately 24,000 people who suffer from stroke each year. Walking disorders are the most important symptoms that limit the ability to function after cerebrovascular accident. The effectiveness of walking and endurance training has been studied in acute and subacute patients and the effectiveness of exercise is often assessed at the level of body structure and activity. The effectiveness of walking and endurance training on participation has been studied less. The purpose of this study was to find out the effectiveness of walking and endurance training on walking endurance compared to no-training/placebo, usual care or other training in patients with chronic stroke. Walking was examined at the level of activity and participation according to international classification of functioning, disability and health (ICF). This study is a part of Kela\u00b4s intensive medical rehabilitation (VAKU) -project.\n\nA systematic literature search was conducted in VAKU-project in databases (1/2008-5/2017): Cinahl, CENTRAL, Cochrane Database of Systematic Reviews, Embase, OVID Medline, PEDro and WOS. Selection criterias were defined with PICOS-strategy: (P) diagnosed with stroke, \u2265 6 months earlier (I) walking or endurance training, (C) no-training/placebo, usual care, other training, (O) walking endurance at the level of activity and walking ability at the level of participation and (S) randomized controlled trial. Meta-analysis was performed with Review Manager 5.3 \u2013 programme using random effect model. In the main analysis effectiveness of walking and endurance training compared to combined control group was evaluated using mean difference (MD) at the level of activity and using standardized mean difference (SMD) at the level of participation. Respectively, the sub-analyses separately assessed the effectiveness of walking and endurance training compared to three different control groups. The quality assessment of the studies was performed with Cochrane Risk of Bias tool.\n\n28 studies were included in the study and there were 1270 participants in total. In average intervention duration was 9 weeks (range 1-24) and frequency 4 times per week (SD 1.5). At the level of activity in groups of walking and endurance training walking endurance increased in the 6 minute walking test 12.58 meters (95% CI [5.55, 19.60]; p=0.0005; n=919) more compared to control group. According to results of the meta-analysis walking and endurance training are probably more effective to increase walking endurance at the level of activity than no-training/placebo, usual care or other training (level B evidence). There was no statistical difference between intervention and control group (SMD -0.04; 95% CI [-0.43, 0.35]; p=0.83; n=152) and there is a lack of reliable evidence about the effectiveness of walking and endurance training on walking at the level of participation (level D evidence). In the sub-analyses a statistical difference was only between walking training compared to other training (MD 12.81; 95% CI [3.25, 22.38]; p=0.009; n=241), but the statistical difference disappeared in the sensitivity analysis. Walking training is probably comparable training model to usual care (level B evidence) and it might be comparable to other type of training (level C evidence) to increase walking endurance. Endurance training might increase walking endurance more than low intensity training (level C evidence) and endurance training might be comparable to usual care, but there is a lack of reliable evidence of that (level D evidence). Statistical heterogeneity was low or moderate and clinical heterogeneity was observed in interventions and control groups.\n\nAccording to this study walking and endurance training in the chronic stage of stroke is probably more effective to increase walking endurance compared to no-training/placebo, usual care or other training. However the result is clinically small. More research is needed on the effectiveness of walking and endurance training on participation and the effectiveness of training at different intensities. In addition, in future it would be important to explore how the training can be implemented cost-effectively.", "language": "en", "element": "description", "qualifier": "abstract", "schema": "dc"}, {"key": "dc.description.provenance", "value": "Submitted by Paivi Vuorio (paelvuor@jyu.fi) on 2019-10-02T06:34:55Z\nNo. of bitstreams: 0", "language": "en", "element": "description", "qualifier": "provenance", "schema": "dc"}, {"key": "dc.description.provenance", "value": "Made available in DSpace on 2019-10-02T06:34:55Z (GMT). No. of bitstreams: 0\n Previous issue date: 2019", "language": "en", "element": "description", "qualifier": "provenance", "schema": "dc"}, {"key": "dc.format.extent", "value": "111", "language": "", "element": "format", "qualifier": "extent", "schema": "dc"}, {"key": "dc.format.mimetype", "value": "application/pdf", "language": null, "element": "format", "qualifier": "mimetype", "schema": "dc"}, {"key": "dc.language.iso", "value": "fin", "language": null, "element": "language", "qualifier": "iso", "schema": "dc"}, {"key": "dc.rights", "value": "In Copyright", "language": "en", "element": "rights", "qualifier": null, "schema": "dc"}, {"key": "dc.subject.other", "value": "k\u00e4velyharjoittelu", "language": "", "element": "subject", "qualifier": "other", "schema": "dc"}, {"key": "dc.title", "value": "K\u00e4vely- ja kest\u00e4vyysharjoittelun vaikuttavuus kroonisten AVH-kuntoutujien k\u00e4velykest\u00e4vyyteen : j\u00e4rjestelm\u00e4llinen kirjallisuuskatsaus ja meta-analyysi", "language": "", "element": "title", "qualifier": null, "schema": "dc"}, {"key": "dc.type", "value": "master thesis", "language": null, "element": "type", "qualifier": null, "schema": "dc"}, {"key": "dc.identifier.urn", "value": "URN:NBN:fi:jyu-201910024306", "language": "", "element": "identifier", "qualifier": "urn", "schema": "dc"}, {"key": "dc.type.ontasot", "value": "Pro gradu -tutkielma", "language": "fi", "element": "type", "qualifier": "ontasot", "schema": "dc"}, {"key": "dc.type.ontasot", "value": "Master\u2019s thesis", "language": "en", "element": "type", "qualifier": "ontasot", "schema": "dc"}, {"key": "dc.contributor.faculty", "value": "Liikuntatieteellinen tiedekunta", "language": "fi", "element": "contributor", "qualifier": "faculty", "schema": "dc"}, {"key": "dc.contributor.faculty", "value": "Faculty of Sport and Health Sciences", "language": "en", "element": "contributor", "qualifier": "faculty", "schema": "dc"}, {"key": "dc.contributor.department", "value": "Liikunta- ja terveystieteet", "language": "fi", "element": "contributor", "qualifier": "department", "schema": "dc"}, {"key": "dc.contributor.department", "value": "Sport and Health Sciences", "language": "en", "element": "contributor", "qualifier": "department", "schema": "dc"}, {"key": "dc.contributor.organization", "value": "Jyv\u00e4skyl\u00e4n yliopisto", "language": "fi", "element": "contributor", "qualifier": "organization", "schema": "dc"}, {"key": "dc.contributor.organization", "value": "University of Jyv\u00e4skyl\u00e4", "language": "en", "element": "contributor", "qualifier": "organization", "schema": "dc"}, {"key": "dc.subject.discipline", "value": "Fysioterapia", "language": "fi", "element": "subject", "qualifier": "discipline", "schema": "dc"}, {"key": "dc.subject.discipline", "value": "Physiotherapy", "language": "en", "element": "subject", "qualifier": "discipline", "schema": "dc"}, {"key": "yvv.contractresearch.funding", "value": "0", "language": "", "element": "contractresearch", "qualifier": "funding", "schema": "yvv"}, {"key": "dc.type.coar", "value": "http://purl.org/coar/resource_type/c_bdcc", "language": null, "element": "type", "qualifier": "coar", "schema": "dc"}, {"key": "dc.rights.accesslevel", "value": "restrictedAccess", "language": null, "element": "rights", "qualifier": "accesslevel", "schema": "dc"}, {"key": "dc.type.publication", "value": "masterThesis", "language": null, "element": "type", "qualifier": "publication", "schema": "dc"}, {"key": "dc.subject.oppiainekoodi", "value": "50422", "language": "", "element": "subject", "qualifier": "oppiainekoodi", "schema": "dc"}, {"key": "dc.subject.yso", "value": "kest\u00e4vyysharjoittelu", "language": null, "element": "subject", "qualifier": "yso", "schema": "dc"}, {"key": "dc.subject.yso", "value": "fysioterapia", "language": null, "element": "subject", "qualifier": "yso", "schema": "dc"}, {"key": "dc.subject.yso", "value": "aivoverenkiertoh\u00e4iri\u00f6t", "language": null, "element": "subject", "qualifier": "yso", "schema": "dc"}, {"key": "dc.subject.yso", "value": "k\u00e4vely", "language": null, "element": "subject", "qualifier": "yso", "schema": "dc"}, {"key": "dc.subject.yso", "value": "ICF", "language": null, "element": "subject", "qualifier": "yso", "schema": "dc"}, {"key": "dc.format.content", "value": "fulltext", "language": null, "element": "format", "qualifier": "content", "schema": "dc"}, {"key": "dc.rights.url", "value": "https://rightsstatements.org/page/InC/1.0/", "language": null, "element": "rights", "qualifier": "url", "schema": "dc"}, {"key": "dc.rights.accessrights", "value": "The author has not given permission to make the work publicly available electronically. Therefore the material can be read only at the archival workstation at Jyv\u00e4skyl\u00e4 University Library (https://kirjasto.jyu.fi/en/workspaces/facilities).", "language": "en", "element": "rights", "qualifier": "accessrights", "schema": "dc"}, {"key": "dc.rights.accessrights", "value": "Tekij\u00e4 ei ole antanut lupaa avoimeen julkaisuun, joten aineisto on luettavissa vain Jyv\u00e4skyl\u00e4n yliopiston kirjaston arkistoty\u00f6semalta. Ks. https://kirjasto.jyu.fi/fi/tyoskentelytilat/laitteet-ja-tilat..", "language": "fi", "element": "rights", "qualifier": "accessrights", "schema": "dc"}, {"key": "dc.type.okm", "value": "G2", "language": null, "element": "type", "qualifier": "okm", "schema": "dc"}]
|