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Effect of forced use on arm function in the subacute phase after stoke - a randomized clinical pilote study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
2009 (English)In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 89, no 6, 526-539 p.Article in journal (Refereed) Published
Abstract [en]

Background and Objective. Following stroke, it is common to exhibit motor impairments and decreased use of the upper limb. The objective of the present study was to evaluate forced use on arm function during the subacute phase after stroke. Design. A comparison of standard rehabilitation only and standard  rehabilitation together with a restraining sling was made through a randomized, nonblinded, clinical pilot trial with assessments before   intervention, after intervention, and at 1-and 3-month follow-ups. Setting. The present study took place at the departments of   rehabilitation medicine, geriatrics, and neurology at a university   hospital.  Participants. A convenience sample of 30 people I to 6 months (mean,  2.4 mo) after stroke was randomized into 2 groups (forced-use group and   standard training group) of 15 people each. Twenty-six participants  completed the 3-month follow-up.   Intervention. All participants received their standard rehabilitation   program with training 5 days per week for 2 weeks as inpatients or outpatients. The forced-use group also wore a restraining sling on the  nonparetic arm with a target of 6 hours per day. Measurements. The  Fugl-Meyer (FM) test, the Action Research Arm Test, the Motor   Assessment Scale (MAS) (sum of scores for the upper limb), a 16-hole  peg test (16HPT), a grip strength ratio (paretic hand to nonparetic  hand), and the Modified Ashworth Scale were used to obtain measurements.  Results. The changes in the forced-Use group did not differ from the   changes in the standard training group for any Of the Outcome measures. Both groups improved over time, with statistically significant changes  in the FM test (mean score changed from 52 to 57), MAS (mean score changed from 10.1 to 12.4), 16HPT (mean time changed from >92 seconds   to 60 seconds), and grip strength ratio (mean changed from 0.40 to   0.55).   Limitations. The limitations of this pilot study include an extended   Study time, a nonblinded assessor, a lack of control of treatment  content, and a small sample size. Conclusions. The results of the present pilot study did not support  forced use as a reinforcement of standard rehabilitation in the  subacute phase after stroke. Forced use did not generate greater   improvements with regard to motor impairment and capacity than standard   rehabilitation alone. The findings of this effectiveness study will be  used to help design future clinical trials with the aim of revealing a definitive conclusion regarding the clinical implementation of forced use for upper-limb rehabilitation.

Place, publisher, year, edition, pages
2009. Vol. 89, no 6, 526-539 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-123994DOI: 10.2522/ptj.20080017ISI: 000266457500001PubMedID: 19372172OAI: oai:DiVA.org:uu-123994DiVA: diva2:317046
Available from: 2010-05-01 Created: 2010-05-01 Last updated: 2010-12-29Bibliographically approved

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