Sitting training early after stroke improves sitting ability and quality and carries over to standing up but not to walking: a randomised controlled trial

Question: What is the effect of a sitting training protocol in people early after stroke on sitting ability and quality, and does it carry over to mobility? Design: Randomised placebo-controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. Participants: Twelve individuals who had a stroke less than three months previously and were able to sit unsupported. Intervention: The experimental group completed a 2-week sitting training protocol that involved practising reaching tasks beyond arm's length. The control group completed a 2-week sham sitting training protocol that involved practising cognitive-manipulative tasks within arm's length. Outcome measures: The primary outcome was sitting ability (maximum reach distance). Secondary outcomes were sitting quality (reach movement time and peak vertical force through affected foot during reaching) and carry over to mobility (peak vertical force through affected foot during standing up and walking speed during 10 m Walk Test). Outcome measures were taken before and after training and six months later. Results: After 2 weeks' training, the experimental group had increased their maximum reach distance by 0.17 m (95% Cl 0.12 to 0.21), decreased their movement time by 0.5 s (95% Cl -0.8 to -0.2), increased their peak vertical force through the affected foot during reaching by 13% of body weight (95% Cl 6 to 20) and increased their peak vertical force through the affected foot during standing up by 21% of body weight ('95% Cl 14 to 28) compared with the control group. After 6 months, significant between-group differences were maintained for maximum reach distance and peak vertical force through the affected foot during standing up. Conclusions: The sitting training protocol was both feasible and effective in improving sitting and standing up early after stroke and somewhat effective six months later.