http://nnr.sagepub.com/content/30/6/583?etoc
- Xiaotian Wu, MS1,2
- Peter Guarino, MPH, PhD1,2
- Albert C. Lo, MD PhD3,4
- Peter Peduzzi, PhD1,2
- Michael Wininger, PhD1,2,5⇑
- 1Yale University, New Haven, CT, USA
- 2VA Connecticut Healthcare System, West Haven, CT, USA
- 3VA RRD Center of Excellence for Neurorestoration and Neurotechnology, Providence, RI, USA
- 4Brown University, Providence, RI, USA
- 5University of Hartford, West Hartford, CT, USA
- Michael Wininger, PhD, Department of Veterans Affairs, VA Connecticut Healthcare System, Cooperative Studies Program, 950 Campbell Avenue, Building 35 (151-A), West Haven, CT 06516, USA. Email: michael.wininger@va.gov
Abstract
Background. While recent clinical
trials involving robot-assisted therapy have failed to show clinically
significant improvement versus
conventional therapy, it is possible that a broader
strategy of intensive therapy—to include robot-assisted
rehabilitation—may
yield clinically meaningful outcomes.
Objective. To test the immediate and sustained effects of intensive therapy (robot-assisted therapy plus intensive conventional therapy)
on outcomes in a chronic stroke population.
Methods.
A multivariate mixed-effects model adjusted for important covariates
was established to measure the effect of intensive
therapy versus usual care. A total of 127 chronic
stroke patients from 4 Veterans Affairs medical centers were randomized
to either robot-assisted therapy (n = 49),
intensive comparison therapy (n = 50), or usual care (n = 28), in the
VA-ROBOTICS
randomized clinical trial. Patients were at least 6
months poststroke, of moderate-to-severe upper limb impairment. The
primary
outcome measure was the Fugl-Meyer Assessment at 12
and 36 weeks. Results. There was significant benefit of intensive therapy over usual care on the Fugl-Meyer Assessment at 12 weeks with a mean
difference of 4.0 points (95% CI = 1.3-6.7); P = .005; however, by 36 weeks, the benefit was attenuated (mean difference 3.4; 95% CI = −0.02 to 6.9; P = .05). Subgroup analyses showed significant interactions between treatment and age, treatment and time since stroke.
Conclusions.
Motor benefits from intensive therapy compared with usual care were
observed at 12 and 36 weeks posttherapy; however, this
difference was attenuated at 36 weeks. Subgroups
analysis showed that younger age, and a shorter time since stroke were
associated
with greater immediate and long-term improvement of
motor function.
Fine, but I haver already lost enough because of the stroke, without being cursed with even MORE boring repetitive exercise, that only MAY. help, more like will exhaust and frustrate me
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