http://journals.sagepub.com/doi/abs/10.1177/1545968317744276
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Ruth N. Barker, PhD 1
, Kathryn S. Hayward, PhD 23
, Richard G. Carson, PhD 245
,
1James Cook University, Cairns, Queensland, Australia
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2The University of Queensland, Brisbane, Queensland, Australia3James Cook University, Mount Isa, Queensland, Australia
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2The University of Queensland, Brisbane, Queensland, Australia4Trinity College Dublin, Dublin, Ireland5Queen’s University Belfast, Belfast, UK
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David Lloyd, PhD 2
, Sandra G. Brauer, PhD 2
...
2The University of Queensland, Brisbane, Queensland, Australia
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2The University of Queensland, Brisbane, Queensland, Australia
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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, PhD 1, Kathryn S. Hayward, PhD 2, 3, Richard G. Carson, PhD 2, 4, 5, David Lloyd, PhD 2, Sandra G. Brauer, PhD 2
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.
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.
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.
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