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Is forced use of the paretic upper limb beneficial?: A randomized pilot study during subacute post-stroke recovery
Örebro University, School of Health and Medical Sciences.
Uppsala Universitet.
2009 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 23, no 5, 424-433 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate the effect of two weeks of forced use of the paretic upper limb, as a supplement to the rehabilitation programme in the subacute phase after stroke, on self-rated use of that limb.

Design: A randomized, non-blind, parallel group, clinical, before-and-after trial. A forced use group and a conventional group were followed up one and three months after intervention.

Setting: In- and outpatient units of rehabilitation at a University Hospital.Subjects: Thirty patients were allocated to two groups, 15 in each, 1-6 months (mean 2.4) after stroke onset. Twenty-six patients completed the study.

Interventions: The patients of both groups participated in two weeks of daily training on weekdays. In addition, the forced use group wore a restraining sling on the non-paretic arm for up to 6 hours per weekday.

Main measure: The Motor Activity Log; patients scored 0-5 for 30 daily tasks concerning both amount of use and quality of movement.

Results: The forced use group tended to achieve larger improvements immediately post-intervention, but this was not clearly demonstrated. The small differences also levelled out up to the three-month follow-up, with both groups earning an approximately 1.0 score point on both scales of the Motor Activity Log.

Conclusions: This pilot study did not reveal any additional benefit of forced use on self-rated performance in daily use of the paretic upper limb. Both groups performed fairly extensive, active training with a similar duration, amount and content.

Place, publisher, year, edition, pages
London: Sage Publications, 2009. Vol. 23, no 5, 424-433 p.
National Category
Physiotherapy
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-7192DOI: 10.1177/0269215508101734ISI: 000266292300005PubMedID: 19321522Scopus ID: 2-s2.0-65549124035OAI: oai:DiVA.org:oru-7192DiVA: diva2:222534
Available from: 2009-06-09 Created: 2009-06-09 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Forced use on arm function after stroke: clinically rated and self-reported outcome and measurement during the sub-acute phase
Open this publication in new window or tab >>Forced use on arm function after stroke: clinically rated and self-reported outcome and measurement during the sub-acute phase
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
”Forced use” för armfunktion efter stroke : kliniskt bedömda och självrapporterade resultat samt mätmetoder i subakut fas
Abstract [en]

The overall aim was to evaluate the effectiveness of forced use on arm and hand recovery after stroke by applying a restraining sling on the non-affected arm and to investigate psychometric properties of selected upper limb measures.

Papers I and II reported a randomised trial with 1- and 3-month follow-ups. Thirty patients 1 to 6 months after stroke were included and received regular training for 2 weeks of intervention. The forced-use group had in addition a restraining sling on the non-paretic arm. Outcome measures were the Fugl-Meyer Assessment, the Modified Ashworth scale, the 16-hole peg test, grip force, the Action Research Arm test, and the Motor Assessment Scale (Paper I), and the Motor Activity Log (MAL) (Paper II). Results in Papers I and II showed no statistical difference in change between groups. Both groups improved over time.

Paper III assessed the responsiveness of the MAL and its cross-sectional and longitudinal validity. The MAL was responsive to change, with Standardised Response Means and Responsiveness Ratios larger than 1.0. Correlations between the MAL and the other measures were mostly close to 0.50.

Paper IV investigated test–retest intra-rater reliability of measuring grip force with Grippit, and assessed relationships between grip forces of both hands, and between sustained and peak grip force. The paretic hand needs to score a change of 10% or 50 N to exceed the measurement error. The mean ratio between sides was 0.66, and between sustained and peak grip force, 0.80–0.84.

In conclusion, this thesis provides preliminary evidence that forced use does not generate greater improvement on upper limb motor impairment, capacity, and performance of activity than regular rehabilitation. The findings indicate that the MAL is a responsive measure of daily hand use in patients with stroke. Correlations of construct validity indicated that daily hand use might need to be measured separately from body function and activity capacity. The coefficients calculated for repeatability and reproducibility were acceptable, and the Grippit instrument can be recommended.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2010. 101 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 39
Keyword
stroke, upper limb, reliability, validity, ICF, forced use, motor function, effectiveness, rehabilitation, physiotherapy, grip force
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-9601 (URN)978-91-7668-715-4 (ISBN)
Public defence
2010-03-19, Wilandersalen, Universitetssjukhuset Örebro, M-huset, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2010-02-09 Created: 2010-02-04 Last updated: 2017-10-18Bibliographically approved

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