Research
Additional early active repetitive motor training did not prevent contracture in adults receiving task-specific upper limb training after stroke: a randomised trial

https://doi.org/10.1016/j.jphys.2019.02.005Get rights and content
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Abstract

Question

In adults undergoing rehabilitation after stroke, does 1 hour of additional active repetitive reaching per day prevent or reduce upper limb contracture?

Design

Multi-centre, randomised controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis.

Participants

Fifty adults undergoing rehabilitation after stroke who were unable to actively extend the affected wrist past neutral or were unable to flex the affected shoulder to 90 deg.

Setting

Three inpatient rehabilitation units in Australia.

Intervention

Both groups received usual upper limb therapy 5 days a week for 5 weeks. In addition, the experimental group received up to 1 hour a day of active, intensive, repetitive upper limb training using the SMART Arm device 5 days a week for 5 weeks.

Outcome measures

Measures were collected at baseline (Week 0), after intervention (Week 5) and at follow-up (Week 7). The primary outcomes were passive range of wrist extension, elbow extension, and shoulder flexion at Week 5. The secondary outcomes were: the three primary outcomes measured at Week 7; passive range of shoulder external rotation; arm function; and pain at rest, on movement and during sleep measured at Weeks 5 and 7.

Results

Following an average of 2310 reaching repetitions, the mean effect at Week 5 on passive range of wrist extension was 1 deg (95% CI –6 to 8), elbow extension –6 deg (95% CI –12 to –1), and shoulder flexion 5 deg (95% CI –8 to 17). There were no statistically significant or clinically important effects of the intervention on any secondary outcomes.

Conclusion

In adults who are already receiving task-specific motor training for upper limb rehabilitation following stroke, 5 weeks of up to 1 hour of additional daily active repetitive motor training using the SMART Arm device did not prevent or reduce contracture in upper limb muscles.

Trial registration

ACTRN12614001162606.

Key words

Randomised controlled trial
Stroke
Contracture
Upper extremity
Active motor training

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Footnotes: a Acumar, Lafayette Instrument Company, Lafayette, USA.

eAddenda: Table 4 and Appendices 1, 2 and 3 can be found online at DOI: https://doi.org/10.1016/j.jphys.2019.02.005.

Ethics approval: Townsville Hospital and Health Service Human Research Ethics Committee approved the study protocol (HREC reference number: HREC/14/QTHS/124). All participants gave written informed consent before data collection began.

Competing interests: KS Hayward is a research consultant for SMART Arm Pty Ltd.

Source(s) of support: Funding for the conduct of this trial was provided by the Sunshine Coast Health Foundation Wishlist Research Grant Scheme.