SMART Arm Training With Outcome-Triggered Electrical Stimulation in Subacute Stroke Survivors With Severe Arm Disability: A Randomized Controlled Trial

Look at that! An email address for your doctor to use to get the protocol for this. Does your doctor have enough sense to ask for this before you request it?
http://journals.sagepub.com/doi/abs/10.1177/1545968317744276

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Ruth N. Barker, PhD¹

Ruth N. Barker

1James Cook University, Cairns, Queensland, Australia
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, Kathryn S. Hayward, PhD²³

Kathryn S. Hayward

2The University of Queensland, Brisbane, Queensland, Australia3James Cook University, Mount Isa, Queensland, Australia
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, Richard G. Carson, PhD²⁴⁵

Richard G. Carson

2The University of Queensland, Brisbane, Queensland, Australia4Trinity College Dublin, Dublin, Ireland5Queen’s University Belfast, Belfast, UK
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David Lloyd, PhD²

David Lloyd

2The University of Queensland, Brisbane, Queensland, Australia
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, Sandra G. Brauer, PhD²

Sandra G. Brauer

2The University of Queensland, Brisbane, Queensland, Australia
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First Published December 4, 2017 Research Article

https://doi.org/10.1177/1545968317744276

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Article Information

Volume: 31 issue: 12, page(s): 1005-1016

Article first published online: December 4, 2017; Issue published: December 1, 2017

https://doi.org/10.1177/1545968317744276

Ruth N. Barker, PhD¹, Kathryn S. Hayward, PhD^{2, 3}, Richard G. Carson, PhD^{2, 4, 5}, David Lloyd, PhD², Sandra G. Brauer, PhD²

¹James Cook University, Cairns, Queensland, Australia

²The University of Queensland, Brisbane, Queensland, Australia

³James Cook University, Mount Isa, Queensland, Australia

⁴Trinity College Dublin, Dublin, Ireland

⁵Queen’s University Belfast, Belfast, UK

Corresponding Author: Ruth N. Barker, College of Healthcare Sciences, James Cook University, Cairns, Queensland 4870, Australia. Email: ruth.barker@jcu.edu.au

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Abstract

Background. Stroke survivors with severe upper limb disability need opportunities to engage in task-oriented practice to achieve meaningful recovery.
Objective. To compare the effect of SMART Arm training, with or without outcome-triggered electrical stimulation to usual therapy, on arm function for stroke survivors with severe upper limb disability undergoing inpatient rehabilitation.
Methods. A prospective, multicenter, randomized controlled trial was conducted with 3 parallel groups, concealed allocation, assessor blinding and intention-to-treat analysis. Fifty inpatients within 4 months of stroke with severe upper limb disability were randomly allocated to 60 min/d, 5 days a week for 4 weeks of (1) SMART Arm with outcome-triggered electrical stimulation and usual therapy, (2) SMART Arm alone and usual therapy, or (3) usual therapy. Assessment occurred at baseline (0 weeks), posttraining (4 weeks), and follow-up (26 and 52 weeks). The primary outcome measure was Motor Assessment Scale item 6 (MAS6) at posttraining.
Results. All groups demonstrated a statistically (P < .001) and clinically significant improvement in arm function at posttraining (MAS6 change ≥1 point) and at 52 weeks (MAS6 change ≥2 points). There were no differences in improvement in arm function between groups (P = .367). There were greater odds of a higher MAS6 score in SMART Arm groups as compared with usual therapy alone posttraining (SMART Arm stimulation generalized odds ratio [GenOR] = 1.47, 95%CI = 1.23-1.71) and at 26 weeks (SMART Arm alone GenOR = 1.31, 95% CI = 1.05-1.57).
Conclusion. SMART Arm training supported a clinically significant improvement in arm function, which was similar to usual therapy. All groups maintained gains at 12 months.