Sage Journals: Discover world-class research

Abstract

Objective:

To establish feasibility of initiating electrical stimulation treatment of wrist extensors and flexors in patients early after stroke to prevent muscle contractures and pain.

Design:

Feasibility randomized controlled trial with economic evaluation.

Setting:

A specialist stroke unit in Nottinghamshire.

Subjects:

A total of 40 patients recruited within 72 hours post-stroke with arm hemiparesis.

Interventions:

Participants were randomized to receive usual care or usual care and electrical stimulation to wrist flexors and extensors for 30 minutes, twice a day, five days a week for three months. Initial treatment was delivered by an occupational therapist or physiotherapist who trained participants to self-manage subsequent treatments.

Measures:

Measures of feasibility included recruitment and attrition rates, completion of treatment, and successful data collection. Outcome data on wrist range of motion, pain, arm function, independence, quality of life, and resource use were measured at 3-, 6-, and 12-months post-randomization.

Results:

A total of 40 participants (of 215 potentially eligible) were recruited in 15 months (20 men; mean age: 72 (SD: 13.0)). Half the participants lacked mental capacity and were recruited by consultee consent. Attrition at three-month follow-up was 12.5% (death (n = 2), end-of-life care (n = 2), and unable to contact (n = 1)). Compliance varied (mean: 65 (SD: 53)) and ranged from 10 to 166 treatments per patient (target dosage was 120). Data for a valid economic analysis can be adequately collected.

Conclusion:

Early initiation of electrical stimulation was acceptable and feasible. Data collection methods used were feasible and acceptable to participants. A large definitive study is needed to determine if electrical stimulation is efficacious and cost effective.

Keywords

Stroke upper extremity (arm)muscle contractures pain electric stimulation therapy

Get full access to this article

View all access options for this article.

References

Intercollegiate Stroke Working Party. National clinical guidelines for stroke. 5th ed. London: Royal College of Physicians, 2016.

National Audit Office. Progress in improving stroke care. London: The Stationery Office, 2010.

Malhotra

Pandyan

Rosewilliam

et al. Spasticity and contractures at the wrist after stroke: time course of development and their association with functional recovery of the upper limb. Clin Rehabil 2011; 25(2): 184–191.

Sackley

Brittle

Patel

et al. The prevalence of joint contractures, pressure sores, painful shoulder, other pain, falls, and depression in the year after a severely disabling stroke. Stroke 2008; 39(12): 3329–3334.

NICE. Stroke rehabilitation: long term rehabilitation after stroke, clinical guideline 162. London: National Clinical Guideline Centre, 2013.

Intercollegiate Stroke Working Party. National sentinel stroke clinical audit 2010, round 7: public report for England, Wales and Northern Ireland. London: Royal College of Physicians, 2012.

Kaur

English

Hillier

How physically active are people with stroke in physiotherapy sessions aimed at improving motor function? A systematic review. Stroke Res Treat 2012; 2012: 820673.

Biernaskie

Chernenko

Corbett

Efficacy of rehabilitative experience declines with time after focal ischemic brain injury. J Neurosci 2004; 24(5): 1245–1254.

Kwakkel

Kollen

Twisk

Impact of time on improvement of outcome after stroke. Stroke 2006; 37(9): 2348–2353.

10.

Bernhardt

Indredavik

Langhorne

When should rehabilitation begin after stroke?

Int J Stroke 2013; 8(1): 5–7.

11.

Bernhardt

Godecke

Johnson

et al. Early rehabilitation after stroke. Curr Opin Neurol 2017; 30(1): 48–54.

12.

Kwakkel

Kollen

Van der Grond

et al. Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Stroke 2003; 34(9): 2181–2186.

13.

The AVERT Trial Collaboration Group. Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet 2015; 386(9988): 46–55.

14.

Church

Price

Pandyan

et al. Randomized controlled trial to evaluate the effect of surface neuromuscular electrical stimulation to the shoulder after acute stroke. Stroke 2006; 37(12): 2995–3001.

15.

Dimitrijević

Soroker

Mesh-glove. 2. Modulation of residual upper limb motor control after stroke with whole-hand electric stimulation. Scand J Rehabil Med 1994; 26(4): 187–190.

16.

Malhotra

Rosewilliam

Hermens

et al. A randomized controlled trial of surface neuromuscular electrical stimulation applied early after acute stroke: effects on wrist pain, spasticity and contractures. Clin Rehabil 2013; 27(7): 579–590.

17.

Rosewilliam

Malhotra

Roffe

et al. Can surface neuromuscular electrical stimulation of the wrist and hand combined with routine therapy facilitate recovery of arm function in patients with stroke? Arch Phys Med Rehabil 2012; 93(10): 1715–1721.e1.

18.

Pandyan

Granat

Stott

DJ.

Effects of electrical stimulation on flexion contractures in the hemiplegic wrist. Clin Rehabil 1997; 11(2): 123–130.

19.

Fletcher-Smith

Walker

Sprigg

et al. ESCAPS study protocol: a feasibility randomised controlled trial of ‘early electrical stimulation to the wrist extensors and wrist flexors to prevent the post-stroke complications of pain and contractures in the paretic arm’. BMJ Open 2016; 6(1): e010079.

20.

Brott

Adams

Jr Olinger

et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989; 20(7): 864–870.

21.

Baker

Wederich

McNeal

et al. Neuromuscular electrical stimulation: a practical guide. 4th ed. Downey, CA: Los Amigos Research and Education Institute,2000.

22.

Nasreddine

Phillips

Bédirian

et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53(4): 695–699.

23.

Nouri

Lincoln

NB.

An extended activities of daily living scale for stroke patients. Clin Rehabil 1987; 1(4): 301–305.

24.

Collin

Wade

Davies

et al. The Barthel ADL index: a reliability study. Int Disabil Stud 1988; 10(2): 61–63.

25.

Rankin

. Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J 1957; 2: 200–215.

26.

Bonita

Beaglehole

Modification of Rankin Scale: recovery of motor function after stroke. Stroke 1988; 19(12): 1497–1500.

27.

Jackson

Horn

Kersten

et al. Development of a pictorial scale of pain intensity for patients with communication impairments: initial validation in a general population. Clin Med 2006; 6(6): 580–585.

28.

Hsieh

C-L

Hsueh

I-P

Chiang

F-M

et al. Inter-rater reliability and validity of the action research arm test in stroke patients. Age Ageing 1998; 27(2): 107–113.

29.

Williams

Weinberger

Harris

et al. Devel-opment of a stroke-specific quality of life scale. Stroke 1999; 30(7): 1362–1369.

30.

Oppe

Rabin

De Charro

EQ-5D user guide version 1.0. Rotterdam: EuroQOL Group, 2007.

31.

Robinson

BC.

Validation of a Caregiver Strain Index. J Gerontol 1983; 38(3): 344–348.

32.

Her Majesty’s Treasury. The Green Book: appraisal and evaluation in Central Government, 2013, GOV.UK, 2017, https://www.gov.uk/government/publications/the-green-book-appraisal-and-evaluation-in-central-governent (accessed 12 December 2017).

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.27 MB

The ESCAPS study: a feasibility randomized controlled trial of early electrical stimulation to the wrist extensors and flexors to prevent post-stroke complications of pain and contractures in the paretic arm

Abstract

Objective:

Design:

Setting:

Subjects:

Interventions:

Measures:

Results:

Conclusion:

Keywords

Get full access to this article

References

Supplementary Material