London, United Kingdom 2013 5 Rehabilitation and reorganisation after stroke A 9:10 - 9:20 Change in walking speed and functional ambulatory category following the use of func-tional electrical stimulation for the correction of dropped foot. An 11 year cost effective-ness study. P.N. Taylor1, L. Humphreys2, I.D. Swain3 Salisbury District Hospital, Salisbury, UNITED KINGDOM1,Salisbury District Hospital, Salisbury, UNITED KINGDOM2, Salisbury District Hospital, Salisbury, UNITED KINGDOM3 Background Drop foot can be correct using Functional Electrical Stimulation (FES). Stimulation is applied to the common peroneal nerve. Stimulation causes dorsiflexion with eversion and is timed to the gait using a footswitch. FES can increase walking speed, reduce falls and improve QoL1. The effect on functional ambulation category (FAC), the length of treatment and the total cost has not been reported. Method Patients were assessed by trying the device and if successful, taught the use of the device over 2 sessions and follow up at 6, 18 and 42 weeks and then every 6 or 12 months. All patients who began use of the Odstock Dropped Foot Stimulator in 1999 were identified. The time to stopping treatment, the number of clinic appointments and changes in 10m walking speed were recorded. Costs were calculated by taking the mean number of clinic appointments, (£140 for the assessment and £300 for each clinic appointment, which includes all clinical costs). The mean cost was divided by the mean time of FES use and divided by the published QALY (Quality Adjusted Life Years) gain to give the mean cost per QALY2. FAC was calculated us-ing the walking speeds defined by Perry3. Results 62 people began FES (mean time since stroke 4.8 years). The mean time of FES use was 5.0 years (SD 4.1 median 3.6) with 17 people still using FES after 11 years. The mean number of clinic sessions was 11 giving a total cost of £3,130 and a cost per QALY of £15,268. The will-ingness to pay ceiling used by NHS is £20,000 per QALY. Walking speed with and without FES was 45% (p<0.001) and 24% faster after 100 days use. 47% improved their FWC. Conclusions FES is a cost-effective long term mobility intervention that produces clinically meaningful im-provements Cerebrovasc Dis 2013; 35 (suppl 3)1-854 97 in functional walking. References 1. Burridge J et al. (1997) The effects… Clint Rehabil 11. 201-210. 2. CEP 10012 (2010) www.wales.nhs.uk/sites3/docmetadata.cfm?orgid=443&id=163254 3. Perry J et al. Classification… Stroke 1995; 26: 982–989 4 Rehabilitation and reorganisation after stroke A 9:00 - 9:10 Natural History and Response Prediction of Gait Speed Improvements for Functional Electrical Stimulation in Post-Stroke Drop Foot: Data from the FASTEST Trial M.W. O’Dell1, K. Dunning2, P. Kluding3, S.S. Wu4, J. Feld5, J. Ginosian6, K. McBride7 Department of Rehabilitation Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, USA1,Department of Rehabilitation Sciences, University of Cin-cinnati College of Medicine, Cincinnati, USA2, Department of Physical Therapy and Rehabili-tation Sciences, University of Kansas Medical Center, , 3, Department of Biostatistics, Univer-sity of Florida, Gainsville, Gainsville, USA4, Department of Community and Family Medicine, Duke Univeristy School of Medicine, Durham, USA5, Bioness, Inc, Valencia, USA6, Bioness, Inc, Valencia, USA7 Background. Foot drop stimulation (FDS) is an effective treatment for post-stroke drop foot but more data is needed on the characteristics and prediction of response. We report the nature and predictors of gait speed (GS) changes after 42w of FDS. Methods. Data is from the Functional Ambulation: Standard Treatment v. Electrical Stimulation Therapy (FASTEST) trial compar-ing the L300™ to bracing. Subjects were >3m post-stroke with a GS<0.8m/sec and drop foot as a primary gait limitation. Physical therapy training occurred in the first 6w and ad lib walk-ing with FDS after. GS was measured at baseline with and without and 6, 12, 30, 36 & 42w with FDS. “Responders” gained >0.1m/sec (MCID) or advanced 1 Perry Ambulation Category (PAC) by 42w. Other variables were demographics, age, Berg Balance Score (BBS), 6 minute walk test (6MWT), lower extremity Fugl-Meyer Assessment (FMA), Timed Up and Go (TUG), and baseline GS. Beyond descriptive statistics and univariant correlations, multivariant logistic regression (with backward selection) identified variables predicting “responders.” Results. The 99 subjects were age 60.7y and 4.8y post-stroke. 80% had ischemic strokes. 74% of subjects completed the 30w and 65% the 42w assessment. Baseline GS was .42 without and .49 with FDS. GS increased to .54, .55, .58, .60 and .61 at 6, 12, 30, 36 & 42w, respectively. Even base-line (without FDS) to 6w improvements were significant (p<0.003.) 67% were MCID and 55% PAC “responders.” Correlations between age, comfortable and fast GS, 6MWT, TUG and BBS and both MCID and PAC were significant (p<0.002.) Regression showed independent contribu-tions for age and comfortable GS for PAC “responders” (p<0.003) and age and BBS for MCID “responders” (p<0.006.) Conclusions. FDS treatment improved GS even after 6w. The major-ity achieved clinically important endpoints by 42w. Baseline age, balance and GS predicted response, but not motor status (FMA.) Further research should examine the therapeutic effects FDS.
Karger_ESC London_2013
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