Author Names
Arabzadeh, S., Kamali, F., Bervis, S., & Razeghi, M.
Reviewer Name
Aruna Priya, SPT
Reviewer Affiliation(s)
Duke University School of Medicine – Doctor of Physical Therapy Division
Paper Abstract
People with stroke generally experience abnormal muscle activity and develop balance disorder. Based on the important role of the proximal joints of the lower extremity in balance maintenance, hip joint mobilization with movement technique can be applied to enhance normal joint arthrokinematics. Therefore, the present study aimed to investigate the effectiveness of hip joint mobilization with movement technique on stroke patients’ muscle activity and balance. Twenty patients aged between 35 and 65 years old with chronic stroke were randomly assigned either to an experimental group (n = 10) or to a control group (n = 10). Both groups participated in a 30-minute conventional physiotherapy session 3 times per week for 4 weeks. The experimental group received an additional 30-minute’s session of hip joint mobilization with movement technique on the affected limb. The muscle activity, berg balance scale, time up and go, and postural stability were measured at baseline, 1-day and 2-week follow-up by a blinded assessor. The experimental group showed a significant improvement in berg balance scale, time up and go, and postural stability (p ≤ 0.05). The rectus femoris, tibialis anterior, biceps femoris, and medial gastrocnemius muscles’ activations of the affected limb during static balance test markedly changed along with the biceps femoris, erector spine, rectus femoris, and tibialis anterior muscles during dynamic balance test after hip joint mobilization with movement technique. The mean onset time of rectus abdominus, erector Spine, rectus femoris, and tibialis anterior muscles activity significantly decreased in the affected limb after hip joint mobilization with movement technique compared to the control group (p ≤ 0.05). The results of the present study suggest that a combination of hip joint mobilization with movement technique and conventional physiotherapy could improve muscle activity and balance among chronic stroke patients.
NIH Risk of Bias Tool
Quality Assessment of Controlled Intervention Studies
- Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT?
- Yes
- Was the method of randomization adequate (i.e., use of randomly generated assignment)?
- Yes
- Was the treatment allocation concealed (so that assignments could not be predicted)?
- No
- Were study participants and providers blinded to treatment group assignment?
- Yes
- Were the people assessing the outcomes blinded to the participants’ group assignments?
- Yes
- Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
- Yes
- Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
- Yes
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- No
- Was there high adherence to the intervention protocols for each treatment group?
- Yes
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- Yes
- Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
- Yes
- Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
- No
- Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
- No
- Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
- Yes
Key Finding #1
Hip joint mobilizations combined with conventional physical therapy modalities (AROM/PROM, WB exercises, balance, and gait training) improved muscle activity, postural stability, and balance as shown by the improved clinical outcome scores.
Key Finding #2
There was no difference in muscle activity at baseline between the control and experimental group, therefore improvements seen in muscle activity in the experimental group can be attributed to Mulligan’s principles.
Key Finding #3
To maintain standing balance, it is important to have coordinated activity of the lower extremity and trunk muscles.
Please provide your summary of the paper
This blinded-randomized controlled study investigated the effectiveness of hip joint mobilizations on muscle activity, postural stability, and balance in patients with hemiplegia secondary to chronic stroke. 20 participants were divided into two groups: the control and experimental group. Assessments for all participants included postural stability, Berg balance scale, TUG, and muscle activity pattern performed at baseline and post-treatment. Treatment for both groups consisted of 30-minute sessions, 3 times a week for 4 weeks consisting of physical therapy modalities such as AROM/PROM, WB exercises, balance, and gait training. The experimental group received an additional 30 minutes of Mulligan hip joint mobilizations with movement which included internal-external rotation, flexion, and abduction-adduction during each session. Grade III mobilizations were performed for 10 seconds in 3 sets of 6 repetitions with a 1-minute break between sets and a 5-second break between reptations. SPSS was used for statistical analysis of the raw data collected during the experiment. 4 participants dropped out of the experiment, 1 from the experimental group and 3 from the control group. The experimental group had significant improvements in their outcome measures indicating hip mobilizations with movement positively impacted patients with hemiplegia.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
From the findings, hip joint mobilizations with movement increased muscle activity and improved balance in patients with hemiplegia. Therefore, hip joint mobilizations such as internal-external rotation, flexion, and abduction-adduction are valuable additions to treating chronic post-stroke patients with hemiplegia. A few limitations of this study include a relatively small sample size and the population that was not diverse. Yet, researchers were able to relate the findings to other studies to further provide evidence for the conclusions from this study. However, further research is needed to investigate the effectiveness of these mobilizations on patients with different types of strokes.
