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[{"key": "dc.contributor.advisor", "value": "Sj\u00f6gren, Tuulikki", "language": "", "element": "contributor", "qualifier": "advisor", "schema": "dc"}, {"key": "dc.contributor.author", "value": "Niemi, Heidi", "language": "", "element": "contributor", "qualifier": "author", "schema": "dc"}, {"key": "dc.date.accessioned", "value": "2020-03-16T10:03:33Z", "language": null, "element": "date", "qualifier": "accessioned", "schema": "dc"}, {"key": "dc.date.available", "value": "2020-03-16T10:03:33Z", "language": null, "element": "date", "qualifier": "available", "schema": "dc"}, {"key": "dc.date.issued", "value": "2020", "language": "", "element": "date", "qualifier": "issued", "schema": "dc"}, {"key": "dc.identifier.uri", "value": "https://jyx.jyu.fi/handle/123456789/68173", "language": null, "element": "identifier", "qualifier": "uri", "schema": "dc"}, {"key": "dc.description.abstract", "value": "Tutkimuksen tarkoitus: Aivoverenkiertoh\u00e4iri\u00f6 (AVH) on yhteisnimitys aivoverenkierron sairauksille. Vuosittain aivoverenkiertoh\u00e4iri\u00f6\u00f6n sairastuu 25 000 henkil\u00f6\u00e4 ja v\u00e4est\u00f6n ik\u00e4\u00e4ntyess\u00e4 m\u00e4\u00e4r\u00e4 lis\u00e4\u00e4ntyy. Noin puolelle j\u00e4\u00e4 tuntuva toimintakyvyn haitta, joka voi ilmet\u00e4 mm. tasapainovaikeuksina. Tutkimuksen tarkoituksena on selvitt\u00e4\u00e4 terapeuttisen harjoittelun vaikuttavuutta kroonisten AVH-kuntoutujien tasapainoon kansainv\u00e4lisen toimintakyvyn, toimintarajoitteiden ja terveyden luokituksen (ICF) suorituskyvyn tasolla asennon yll\u00e4pit\u00e4misess\u00e4 ja vaihtamisessa. Tutkimus kuuluu Jyv\u00e4skyl\u00e4n yliopiston hallinnoimaan Kelan Vaativan l\u00e4\u00e4kinn\u00e4llisen Kuntoutuksen (VAKU) -tutkimushankkeeseen.\n\nTutkimusmenetelm\u00e4t: Kirjallisuushaku suoritettiin Cinahl, CENTRAL, Cochrane Database of Systematic Reviews, Embase, OVID Medline, PEDro sek\u00e4 WOS -tietokantoihin 1/2008-5/2017. Sis\u00e4\u00e4nottokriteerit m\u00e4\u00e4riteltiin PICOS-menetelm\u00e4ll\u00e4: (P) krooninen AVH, (I) terapeuttinen harjoittelu, (C) tavanomainen fysioterapia tai ei-harjoittelua tai maalla tapahtuva harjoittelu (O) tasapaino asennon yll\u00e4pit\u00e4misess\u00e4 ja vaihtamisessa sek\u00e4 (S) RCT-asetelma. Kolmessa p\u00e4\u00e4analyysissa verrattiin terapeuttista harjoittelua tavanomaiseen fysioterapiaan ja/tai ei-harjoitteluun ja yhdess\u00e4 p\u00e4\u00e4analyysissa verrattiin altaassa tapahtuvaa terapeuttista harjoittelua maalla tapahtuvaan harjoitteluun. Lis\u00e4ksi kahdessa ala-analyysissa verrattiin lihasvoima- ja kest\u00e4vyysharjoittelun vaikuttavuutta tavanomaiseen fysioterapiaan tai ei-harjoitteluun. Meta-analyysi tehtiin Review Manager 5.3 -ohjelmalla satunnaisvaikutusten mallia k\u00e4ytt\u00e4en. P\u00e4\u00e4- ja ala-analyyseissa k\u00e4ytettiin standardoitujen keskiarvojen erotusta (SMD). Lis\u00e4ksi p\u00e4\u00e4analyyseissa k\u00e4ytettiin Bergin tasapainotestin osalta keskiarvojen erotusta (MD). Harhariski arvioitiin Cochrane tool for assessing Risk of Bias -ty\u00f6kalulla. N\u00e4yt\u00f6naste m\u00e4\u00e4riteltiin GRADE-luokituksella.\n\nKeskeiset tulokset: Sis\u00e4\u00e4nottokriteerit t\u00e4yttyiv\u00e4t 33 tutkimuksessa, joista 32 sis\u00e4llytettiin meta-analyysiin. Tutkimusten kokonaisosallistujam\u00e4\u00e4r\u00e4 oli 1 132, keskim\u00e4\u00e4r\u00e4inen ik\u00e4 60,3 (SD 8,8) vuotta ja sairastumisesta oli kulunut 28,6 (SD 22) kuukautta. AVH-kuntoutujat harjoittelivat keskim\u00e4\u00e4rin nelj\u00e4 kertaa viikossa kahdeksan viikon ajan ja yksi harjoittelukerta kesti 50 minuuttia. Meta-analyyseissa terapeuttisen harjoittelun vaikuttavuus asennon yll\u00e4pit\u00e4miseen ja vaihtamiseen verrattuna tavanomaiseen fysioterapiaan tai ei-harjoitteluun oli suurta (SMD 0,64; 95% CI [0,42-0,86]; p<0,001; n=774; I\u00b2=50%) (n\u00e4yt\u00f6naste B), ja ero ryhmien v\u00e4lill\u00e4 Bergin tasapainotestiss\u00e4 oli 2.71 pistett\u00e4 (MD 2.71 pistett\u00e4; 95% CI [1.72-3.70]; p<0,001; n=687; I\u00b2=52%). Terapeuttisen harjoittelun vaikuttavuus verrattuna tavanomaiseen fysioterapiaan oli suurta (SMD 0.82; 95% CI [0.46-1.17]; p<0.0001; n=460; I\u00b2=65%) (C) ja verrattuna ei-harjoitteluun keskitasoa (SMD 0.42; 95% CI [0.19-0.65]; p<0,001; n=314; I\u00b2=0%) (B). Allasharjoittelu lis\u00e4si tasapainoa enemm\u00e4n kuin maalla tapahtuva harjoittelu (SMD 0,76; 95% CI [0,22-1,31]; p<0,001; n=152; I\u00b2=60%) (C) ja Bergin tasapainotestill\u00e4 mitattuna ero ryhmien v\u00e4lill\u00e4 oli 4.35 pistett\u00e4 (MD 4.35 pistett\u00e4; 95% CI [3.05-5.66]; p<0,001; n=68; I\u00b2=0%). Ala-analyyseissa lihasvoimaharjoittelun vaikuttavuus oli suurta (SMD 0,83; n=89) (C), kun taas kest\u00e4vyysharjoittelun vaikuttavuus oli pient\u00e4 (SMD 0,25; n=184) (D) verrattuna tavanomaiseen fysioterapiaan tai ei-harjoitteluun. Tutkimusten harhariski vaihteli matalan (15%) ja suuren v\u00e4lill\u00e4 (39%). Tilastollinen heterogeenisyys oli kohtalalaista tai alhaista.\n\nJohtop\u00e4\u00e4t\u00f6kset: Terapeuttisesta harjoittelusta on vahvempaa n\u00e4ytt\u00f6\u00e4 kuin tavanomaisesta fysioterapiasta tai ei-harjoittelusta tasapainon hallintaan kroonisilla AVH-kuntoutujilla. Bergin tasapainotestin osalta ryhmien v\u00e4linen ero ei ollut kliinisesti merkitsev\u00e4\u00e4. Sen sijaan allasharjoittelu on kliinisesti merkitsev\u00e4mp\u00e4\u00e4 kuin maalla tapahtuva fysioterapia. Tutkimustuloksia voidaan yleist\u00e4\u00e4 yli vuoden AVH:ta sairastaviin 60,3-vuotiaisiin. Jatkossa tarvitaan tutkimusta terapeuttisen harjoittelun kustannustehokkuudesta, ja sen vaikuttavuudesta osallistumisen tasolla.", "language": "fi", "element": "description", "qualifier": "abstract", "schema": "dc"}, {"key": "dc.description.abstract", "value": "Introduction: Stroke is a common name for ischemic and hemorrhage brain diseases. Every year 25 000 people get a stroke and it will be more common while the age of population increases. Approximately half of the stroke survivors has reduced ability to function, which appears for example as difficulties in balance. The purpose of this study is to find out the effectiveness of therapeutic exercise on balance capacity in chronic stroke survivors. The balance capacity was observed according to ICF in changing and maintaining basic body position and transferring oneself. The study is govern by the University of Jyv\u00e4skyl\u00e4 and it belongs to VAKU -studyproject of Kela.\n\nMethods: The systematic literature search was conducted into different databases (1/2008 to 5/2017): Cinahl, CENTRAL, Cochrane Database of Systematic Reviews, Embase, OVID Medline, PEDro and WOS. The inclusion criteria were described according to PICOS-method: (P) chronic stroke, (I) therapeutic exercise, (C) usual care or no-treatment or land-based exercise, (O) balance in changing and maintaining basic body position and (S) RCTs. In the three main analysis the effectiveness to balance capacity was found out by comparing the therapeutic exercise to usual care and/or no-treatment and in the one main analysis the water-based physiotherapy was compared to land-based physiotherapy. In the two sub-analysis the effectiveness was found out by comparing the resistance and aerobic exercise to usual care or no-treatment. Meta-analysis was run with the program of Review Manager 5.3 using random effects model. In the main and sub-analysis standard mean difference (SMD) was used. Moreover, in the main analysis the mean difference (MD) was used for Berg Balance Scale. The risk of bias was evaluated with the Cochrane tool for assessing Risk of Bias. The level of evidence was defined the classification of GRADE.\n\nResults: Total of 33 studies met the inclusion criteria and 32 were included in the meta-analysis. There were 1132 participants with the mean age 60,3 (SD 8,8) years and mean time since stroke diagnosis was 28,6 (SD 22) months. Stroke survivors were exercising average four times a week 50 minutes per session for eight weeks. The effectiveness of therapeutic exercise on balance capacity versus usual care or no-treatment was large (SMD 0,64; 95% CI [0,42-0,86]; p<0,001; n=774; I\u00b2=50%) (level of evidence B) and difference between groups in the Berg Balance Scale was 2.71 points (MD 2.71 points; 95% CI [1.72-3.70]; p<0,001; n=687; I\u00b2=52%). The effectiveness of therapeutic exercise versus usual care was large (SMD 0.82; 95% CI [0.46-1.17]; p<0.0001; n=460; I\u00b2=65%) (C) and versus no-treatment moderate (SMD 0.42; 95% CI [0.19-0.65]; p<0,001; n=314; I\u00b2=0%) (B). Water-based exercise increased balance more than land-based exercise (SMD 0,76; 95% CI [0,22-1,31]; p<0,001; n=152; I\u00b2=60%) (C) and measured with the Berg Balance Scale the difference between groups was 4.35 points (MD 4.35 points; 95% CI [3.05-5.66]; p<0,001; n=68; I\u00b2=0%). In the sub-analysis the effectiveness of resistance exercise was large (SMD 0,83; n=89) (C), whereas the effectiveness of aerobic exercise was small (SMD 0,25; n=184) (D) compared to usual care or no-treatment. The risk of bias ranged from low (15%) to high (39%). The statistic heterogeneity was moderate or low.\n\nDiscussion: Therapeutic exercise has stronger evidence than usual care or no-treatment on balance in changing and maintaining basic body position in chronic stroke survivors. The difference between groups was not clinically significant according to Berg Balance Scale. Whereas water-based exercise is clinically more significant than land-based exercise. The results can be related to 60,3-year-old people, who got stroke over a year ago. In the future research about cost effectiveness of therapeutic exercise is needed. Moreover, the effectiveness of therapeutic exercise on balance performance in changing and maintaining basic body position is also needed.", "language": "en", "element": "description", "qualifier": "abstract", "schema": "dc"}, {"key": "dc.description.provenance", "value": "Submitted by Miia Hakanen (mihakane@jyu.fi) on 2020-03-16T10:03:33Z\nNo. of bitstreams: 0", "language": "en", "element": "description", "qualifier": "provenance", "schema": "dc"}, {"key": "dc.description.provenance", "value": "Made available in DSpace on 2020-03-16T10:03:33Z (GMT). No. of bitstreams: 0\n Previous issue date: 2020", "language": "en", "element": "description", "qualifier": "provenance", "schema": "dc"}, {"key": "dc.format.extent", "value": "145", "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": "terapeuttinen harjoittelu", "language": "", "element": "subject", "qualifier": "other", "schema": "dc"}, {"key": "dc.subject.other", "value": "ICF", "language": "", "element": "subject", "qualifier": "other", "schema": "dc"}, {"key": "dc.title", "value": "Terapeuttisen harjoittelun vaikuttavuus kroonisten aivoverenkiertoh\u00e4iri\u00f6-kuntoutujien tasapainon hallintaan asennon yll\u00e4pit\u00e4misess\u00e4 ja vaihtamisessa : 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-202003162418", "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": 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"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": "Aineistoon p\u00e4\u00e4sy\u00e4 on rajoitettu tekij\u00e4noikeussyist\u00e4. Aineisto on luettavissa Jyv\u00e4skyl\u00e4n yliopiston kirjaston <a href=\"https://kirjasto.jyu.fi/fi/tyoskentelytilat/laitteet-ja-tilat\">arkistoty\u00f6asemalta</a>.", "language": "fi", "element": "rights", "qualifier": "accessrights", "schema": "dc"}, {"key": "dc.rights.accessrights", "value": "<br><br>This material has a restricted access due to copyright reasons. It can be read at the <a href=\"https://kirjasto.jyu.fi/en/workspaces/facilities\">workstation</a> at Jyv\u00e4skyl\u00e4 University Library reserved for the use of archival materials.", "language": "en", "element": "rights", "qualifier": "accessrights", "schema": "dc"}, {"key": "dc.type.okm", "value": "G2", "language": null, "element": "type", "qualifier": "okm", "schema": "dc"}]
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