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Abstract

Objective:

To determine feasibility of a randomised controlled trial (RCT) of home-based Reach-to-Grasp training after stroke.

Design:

single-blind parallel group RCT.

Participants:

Residual arm deficit less than 12 months post-stroke.

Interventions:

Reach-to-Grasp training in 14 one-hour therapist’s visits over 6 weeks, plus one hour self-practice per day (total 56 hours). Control: Usual care.

Main Measures:

Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), pre-randomisation, 7, 12, 24 weeks post-randomisation.

Results:

Forty-seven participants (Reach-to-Grasp=24, usual care=23) were randomised over 17 months. Reach-to-Grasp participants received a median (IQR) 14 (13,14) visits, and performed 157 (96,211) repetitions per visit; plus 30 minutes (22,45) self-practice per day. Usual care participants received 10.5 (5,14) therapist visits, comprising 38.6 (30,45) minutes of arm therapy with 16 (6,24) repetitions of functional tasks per visit. Median ARAT scores in the reach-to-grasp group were 8.5 (3.0,24.0) at baseline and 14.5 (3.5,26.0) at 24 weeks compared to median of 4 at both time points (IQR: baseline (3.0,14.0), 24 weeks (3.0,30.0)) in the usual-care group. Median WMFT tasks completed at baseline and 24 weeks were 6 (3.0,11.5) and 8.5 (4.5,13.5) respectively in the reach-to-grasp group and 4 (3.0,10.0), 6 (3.0,14.0) in the usual care group. Incidence of arm pain was similar between groups. The study was stopped before 11 patients reached the 24 weeks assessment.

Conclusions:

An RCT of home-based Reach-to-Grasp training after stroke is feasible and safe. With ARAT being our preferred measure it is estimated that 240 participants will be needed for a future two armed trial.

Keywords

Stroke upper extremity (arm)hand function randomized controlled trial home rehabilitation

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References

Mackay

Mensah

. The Atlas of Heart Disease and Stroke. Geneva, Switzerland, World Health Organization. Available at: http://www.who.int/cardiovascular_diseases/en/cvd_atlas_15_burden_stroke.pdf (2004, accessed 27 June 2016)

Lawrence

Coshall

Dundas

. Estimates of the Prevalence of Acute Stroke Impairments and disability in a multiethnic population. Stroke 2001;32: 1279–1284.

Houwink

Nijland

Geurts

. Functional recovery of the paretic upper limb after stroke: Who regains hand capacity? Arch Phys Med Rehabil 2013; 94: 839–844.

Pollock

Farmer

Brady

. Interventions for improving upper limb function after stroke. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD010820. DOI: 10.1002/14651858.CD010820.pub2.

Intercollegiate Stroke Working Party. National Clinical Guideline for Stroke, 4th edition. London: Royal College of Physicians. Available at: https://www.rcplondon.ac.uk/sites/default/files/national-clinical-guidelines-for-stroke-fourth-edition.pdf (2012, accessed 27 June 2016)

National Stroke Foundation. Clinical Guidelines for Stroke Management, Australia. Available at: https://informme.org.au/guidelines (2010, accessed 27June 2016)

Dawson

Knox

McClure

., on behalf of the Stroke Rehabilitation Writing Group. Chapter 5: Stroke Rehabilitation. In: Lindsay

Gubitz

Bayley

Phillips

(Eds) on behalf of the Canadian Stroke Best Practices and Standards Advisory Committee. Canadian Best Practice Recommendations for Stroke Care: Heart and Stroke Foundation and the Canadian Stroke Network. Available at: http://strokebestpractices.ca/wp-content/uploads/2013/07/SBP2013_Stroke-Rehabilitation-Update_July-10_FINAL.pdf (2013, accessed 27June 2016)

Kilbreath

Heard

. Frequency of hand use in healthy older persons. Aust J Physiother 2005; 51: 119–122.

Cunningham

Turton

van Wijck

. Task-specific Reach-to-Grasp training after stroke: development and description of a home-based intervention. Clin Rehabil. 2016; 30: 731–740

10.

Turton

Cunningham

Heron

. Home-based Reach-to-Grasp training for people after stroke: study protocol for a feasibility randomized controlled trial. Trials 2013; 14: 109.

11.

Lyle

. A performance test for assessment of upper limb function in physical rehabilitation treatment and research. Int J Rehab Res 1981; 4: 483–492

12.

Bohannon

Smith

. Inter-rater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987; 2: 206–208.

13.

Morris

van Wijck

Joice

. A comparison of bilateral and unilateral upper limb task training in early post-stroke rehabilitation: a randomized controlled trial. Arch Phys Med Rehabil 2008; 89: 1237–1245.

14.

Minns Lowe

Wilson

Sackley

. Blind outcome assessment: the development and use of procedures to maintain and describe blinding in a pragmatic physiotherapy rehabilitation trial. Clin Rehabil 2011; 25: 264–274.

15.

Platz

Pinkowski

van Wijck

Johnson

GRJ

. ARM: Arm Rehabilitation Measurement. Manual for performance and scoring of the Fugl-Meyer test (arm section), Action Research Arm test and the Box-and-Block test. Baden-Baden: Deutscher Wissenschafts-Verlag (DWV) 2005.

16.

Platz

Pinkowski

van Wijck

. Reliability and validity of arm function assessment with standardised guidelines for the Fugl-Meyer Test, Action Research Arm test and Box and Blocks Test: a multi-centre study. Clin Rehabil 2005; 19: 452–462

17.

Wolf

Catlin

Ellis

. Assessing Wolf Motor Function Test as outcome measure for research in patients after stroke. Stroke 2001; 32: 1635–1639

18.

Morris

Uswatte

Crago

. The reliability of the Wolf Motor Function Test for assessing upper extremity function after stroke. Arch Phys Med Rehabil 2001; 82: 750–755.

19.

Uswatte

Taub

Morris

. The Motor Activity Log-28: assessing daily use of the hemiparetic arm after stroke. Neurology 2006; 67: 1189–1194.

20.

Duncan

Wallace

Lai

. The Stroke Impact Scale version 2.0: evaluation of reliability, validity and sensitivity to change. Stroke 1999; 30: 2131–2140.

21.

Robinson

. Validation of a caregiver strain index. J Gerontol 1983; 38: 344–348.

22.

Hoffmann

Glasziou

Boutron

. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014; 348: g1687.

23.

Donaldson

Tallis

Pomeroy

. A treatment schedule of conventional physical therapy provided to enhance upper limb sensorimotor recovery after stroke: Expert criterion validity and intra-rater reliability Physiotherapy 2009; 95: 110–119.

24.

Lancaster

Dodd

Williamson

. Design and analysis of pilot studies: recommendations for good practice. J Eval Clin Pract 2004; 10: 307–312

25.

Lang

Thompson

Wolf

. The EXCITE Trial: Reacquiring Upper-Extremity Task Performance With Early Versus Late Delivery of Constraint Therapy, Neurorehabil Neural Repair 2013; 27: 654–663.

26.

Wolf

McJunkin

Swanson

. The Wolf Motor Function Test: Normative data for able-bodied participants. Arch Phys Med Rehabil 2006; 87: 443–445.

27.

Wolf

Winstein

Miller

. Effect of Constraint-Induced Movement Therapy on upper limb function 3 to 9 months after stroke: the EXCITE randomised controlled trial. JAMA 2006; 296 : 2095–2104.

28.

Thomas

Plant

Woodward-Nutt

. Health care professionals’ views of the factors influencing the decision to refer patients to a stroke rehabilitation trial. Trials 2015; 16: 577.

29.

Tyson

Thomas

Vail

. Recruiting to inpatient-based rehabilitation trials: lessons learned, Trials 2015; 16: 75.

30.

Duncan

Studenski

Richards

., Randomized clinical trial of therapeutic exercise in subacute stroke. Stroke 2003; 34: 2173–2180.

31.

Winstein

Rose

Tan

. A randomized controlled comparison of upper-extremity rehabilitation strategies in acute stroke: A pilot study of immediate and long-term outcomes. Arch Phys Med Rehabil 2004; 85: 620–628

32.

Bollen

Dean

Siegert

. A systematic review of measures of self-reported adherence to unsupervised home-based rehabilitation exercise programmes, and their psychometric properties. BMJ Open 2014; doi:10.1136/bmjopen-2014–005044.

33.

Hayward

Eng

Boyd

. Exploring the role of accelerometers in the measurement of real world upper-limb use after stroke. Brain Impairment 2016; 17: 16–33.

34.

Remple

Bruneau

VandenBerg

. Sensitivity of cortical movement representations to motor experience: evidence that skill learning but not strength training induces cortical reorganization. Behav Brain Res 2001; 123: 133–41.

35.

Carey

Kimberley

Lewis

. Analysis of fMRI and finger tracking training in subjects with chronic stroke. Brain 2002; 125: 773–788.

36.

Calautti

Baron

. Functional Neuroimaging Studies of Motor Recovery After Stroke in Adults: A Review. Stroke 2003; 34: 1553–1566.

37.

van der Lee

Wagenaar

Lankhorst

. Forced use of the upper extremity in chronic stroke patients: results from a single- blind randomized clinical trial. Stroke 1999; 30: 2369–2375.

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Home-based Reach-to-Grasp training for people after stroke is feasible: a pilot randomised controlled trial

Abstract

Objective:

Design:

Participants:

Interventions:

Main Measures:

Results:

Conclusions:

Keywords

Get full access to this article

References

Supplementary Material