http://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-016-0199-5#Abs1
- Francisco J. Valero-CuevasEmail author,
- Verena Klamroth-Marganska,
- Carolee J. Winstein and
- Robert Riener
Journal of NeuroEngineering and Rehabilitation201613:92
DOI: 10.1186/s12984-016-0199-5
© The Author(s). 2016
Received: 11 May 2016
Accepted: 1 October 2016
Published: 11 October 2016
Abstract
Background
Comparing the efficacy of
alternative therapeutic strategies for the rehabilitation of motor
function in chronically impaired individuals is often inconclusive. For
example, a recent randomized clinical trial (RCT) compared
robot-assisted vs. conventional therapy in 77 patients who had had
chronic motor impairment after a cerebrovascular accident. While
patients assigned to robotic therapy had greater improvements in the
primary outcome measure (change in score on the upper extremity section
of the Fugl-Meyer assessment), the absolute difference between therapies
was small, which left the clinical relevance in question.
Methods
Here we revisit that study to
test whether the multidimensional rehabilitative response of these
patients can better distinguish between treatment outcomes. We used
principal components analysis to find the correlation of changes across
seven outcome measures between the start and end of 8 weeks of therapy.
Permutation tests verified the robustness of the principal components
found.
Results
Each therapy in fact produces
different rehabilitative trends of recovery across the clinical,
functional, and quality of life domains. A rehabilitative trend is a
principal component that quantifies the correlations among changes in
outcomes with each therapy.
Conclusions
These findings challenge the
traditional emphasis of RCTs on using a single primary outcome measure
to compare rehabilitative responses that are naturally multidimensional.
This alternative approach to, and interpretation of, the results of
RCTs may will lead to more effective therapies targeted for the
multidimensional mechanisms of recovery.
Trial registration
ClinicalTrials.gov number NCT00719433. Registered July 17, 2008.
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