Poststroke Virtual Movement Therapy No Better Than Standard Care

 Survivors don't care about 'care'; they want RECOVERY! Are you that blitheringly stupid? Yes, I guess you are! The mentors and senior researchers need to be fired for approving such crapola!

Poststroke Virtual Movement Therapy No Better Than Standard Care

TOPLINE:

High-dose, high-intensity virtual exploratory movement therapy initiated within 2 weeks of a stroke showed no advantage over conventional therapy for improvements in hand and arm recovery at 3 months in a new phase 2a trial.

METHODOLOGY:

• The ESPRESSO phase 2a biomarker-guided stroke rehabilitation trial was conducted in New Zealand between 2021 and 2024 and included 64 adults with weakness in the upper limbs and a positive motor evoked potential status indicating a functionally intact corticospinal tract — a key biomarker linked to the potential for hand and arm recovery.
• Within 2 weeks of an ischemic or hemorrhagic stroke, patients were randomly assigned to receive virtual exploratory movement therapy using an immersive video game-based platform (median age, 74 years; 61% men) or time-matched conventional therapy based on upper-extremity task-specific training principles (median age, 66 years; 54.5% men). Both groups also received 90 minutes per weekday for 3 weeks of therapist time for intensive upper limb therapy in addition to their usual care.
• The primary endpoint was the change in score on the Action Research Arm Test (ARAT) between baseline and 3 months post-stroke. Secondary outcomes included changes in ARAT scores at 1 and 6 months; changes in Fugl-Meyer Upper Extremity (FM-UE) scores at 1, 3, and 6 months; and recovery of manual dexterity.
• Intention-to-treat (ITT) analysis included all 64 patients; a per-protocol (PP) analysis included 54 patients who met the weekly target of active therapy minutes.

TAKEAWAY:

• In the ITT analysis, ARAT scores were higher immediately post-intervention for all participants (P < .0001), increasing further between 1 and 3 months (P < .0001) and again from 3 to 6 months (P = .01), with similar findings for the PP analysis. However, the primary endpoint did not differ significantly between the treatment groups, with recovery over time observed in both.
• The PP analysis showed an increase of 18.1 points in estimated FM-UE scores immediately post-intervention (P < .0001) for all participants, with a further increase of 3.1 points between 1 and 3 months (P < .001), but there were no significant differences between the treatment groups.
• Other secondary outcomes at 6 months were similar between groups for both the ITT and PP analyses.
• When both treatment groups were compared with a matched historical cohort that received usual care only, there were no differences in ARAT or FM-UE scores, despite the former groups completing more than three times the amount of upper limb therapy (mean, 901.6 minutes vs 249.3 minutes; P < .0001).

IN PRACTICE:

“Our findings suggest that early recovery after stroke is dominated by powerful biological repair processes, and increasing therapy dose over and above standard care very early after stroke may not enhance those processes,” lead study investigator Winston D. Byblow, PhD, School of Exercise, Sport, and Rehabilitation Sciences, University of Auckland, Auckland, New Zealand, said in a press release.

SOURCE:

The study was published online on March 28 in Brain Communications.