Accelerating Stroke Recovery: Body Structures and Functions, Activities, Participation, and Quality of Life Outcomes From a Large Rehabilitation Trial

You will notice that your doctor has absolutely nothing to do here to help your recovery. Their time frame for action was in the first week by stopping the 5 causes of the neuronal cascade of death. But they did nothing then.
http://journals.sagepub.com/doi/abs/10.1177/1545968318760726

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Rebecca Lewthwaite, PhD¹²*

Rebecca Lewthwaite

1University of Southern California, Los Angeles, CA, USA2Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
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, Carolee J. Winstein, PhD¹*

Carolee J. Winstein

1University of Southern California, Los Angeles, CA, USA
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, Christianne J. Lane, PhD¹

Christianne J. Lane

1University of Southern California, Los Angeles, CA, USA
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Sarah Blanton, DPT³

Sarah Blanton

3Emory University, Atlanta, GA, USA
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, Burl R. Wagenheim, PhD²

Burl R. Wagenheim

2Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
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, Monica A. Nelsen, DPT¹

Monica A. Nelsen

1University of Southern California, Los Angeles, CA, USA
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, Alexander W. Dromerick, MD⁴⁵⁶*

Alexander W. Dromerick

4Georgetown University, Washington, DC, USA5MedStar National Rehabilitation Hospital, Washington, DC, USA6VA Medical Center, Washington, DC, USA
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, Steven L. Wolf, PhD³⁷*

Steven L. Wolf

3Emory University, Atlanta, GA, USA7VA Center on Visual and Neurocognitive Rehabilitation, Decatur, GA, USA
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First Published March 19, 2018 Research Article

https://doi.org/10.1177/1545968318760726

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Article Information

Volume: 32 issue: 2, page(s): 150-165

Article first published online: March 19, 2018; Issue published: February 1, 2018

https://doi.org/10.1177/1545968318760726

Rebecca Lewthwaite, PhD^{1, 2}*, Carolee J. Winstein, PhD¹*, Christianne J. Lane, PhD¹, Sarah Blanton, DPT³, Burl R. Wagenheim, PhD², Monica A. Nelsen, DPT¹, Alexander W. Dromerick, MD^{4, 5, 6}*, Steven L. Wolf, PhD^{3, 7}*

¹University of Southern California, Los Angeles, CA, USA

²Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA

³Emory University, Atlanta, GA, USA

⁴Georgetown University, Washington, DC, USA

⁵MedStar National Rehabilitation Hospital, Washington, DC, USA

⁶VA Medical Center, Washington, DC, USA

⁷VA Center on Visual and Neurocognitive Rehabilitation, Decatur, GA, USA

Corresponding Author:

*These authors are a member of The American Society of Neurorehabilitation.

Rebecca Lewthwaite, PhD, Physical Therapy Department, HB 223, Rancho Los Amigos National Rehabilitation Center, 7601 East Imperial Highway, Downey, CA 90242, USA. Email: rlewthwaite@dhs.lacounty.gov

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Abstract

Background. Task-oriented therapies have been developed to address significant upper extremity disability that persists after stroke. Yet, the extent of and approach to rehabilitation and recovery remains unsatisfactory to many.  
Objective. To compare a skill-directed investigational intervention with usual care treatment for body functions and structures, activities, participation, and quality of life outcomes. Methods. On average, 46 days poststroke, 361 patients were randomized to 1 of 3 outpatient therapy groups: a patient-centered Accelerated Skill Acquisition Program (ASAP), dose-equivalent usual occupational therapy (DEUCC), or usual therapy (UCC). Outcomes were taken at baseline, posttreatment, 6 months, and 1 year after randomization. Longitudinal mixed effect models compared group differences in poststroke improvement during treatment and follow-up phases.
Results. Across all groups, most improvement occurred during the treatment phase, followed by change more slowly during follow-up. Compared with DEUCC and UCC, ASAP group gains were greater during treatment for Stroke Impact Scale Hand, Strength, Mobility, Physical Function, and Participation scores, self-efficacy, perceived health, reintegration, patient-centeredness, and quality of life outcomes. ASAP participants reported higher Motor Activity Log–28 Quality of Movement than UCC posttreatment and perceived greater study-related improvements in quality of life. By end of study, all groups reached similar levels with only limited group differences.
Conclusions. Customized task-oriented training can be implemented to accelerate gains across a full spectrum of patient-reported outcomes. While group differences for most outcomes disappeared at 1 year, ASAP participants achieved these outcomes on average 8 months earlier (ClinicalTrials.gov: Interdisciplinary Comprehensive Arm Rehabilitation Evaluation [ICARE] Stroke Initiative, at www.ClinicalTrials.gov/ClinicalTrials.gov. Identifier: NCT00871715).