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).
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