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Home-based reach-to-grasp training for people after stroke is feasible: A pilot randomised controlled trial

Turton, A. J.; Cunningham, P.; Van Wijck, F.; Smartt, H. J. M.; Rogers, C. A.; Sackley, C. M.; Jowett, S.; Wolf, S. L.; Wheatley, K.; Van Vliet, P.

Authors

Ailie Turton Ailie.Turton@uwe.ac.uk
Senior Lecturer in Occupational Therapy

Paul Cunningham Paul6.Cunningham@uwe.ac.uk
Senior Lecturer in Neuro Rehab Physio Therapy

F. Van Wijck

H. J. M. Smartt

C. A. Rogers

C. M. Sackley

S. Jowett

S. L. Wolf

K. Wheatley

P. Van Vliet



Abstract

Objective: To determine feasibility of a randomised controlled trial (RCT) of home-based Reach-to-Grasp training after stroke.

Design: single-blind parallel group RCT.

Participants: Residual arm deficit less than 12 months post-stroke.

Interventions: Reach-to-Grasp training in 14 one-hour therapist’s visits over 6 weeks, plus one hour self-practice per day (total 56 hours). Control: Usual care.

Main Measures: Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), pre-randomisation, 7, 12, 24 weeks post-randomisation.

Results: 47 participants (Reach-to-Grasp=24, usual care=23) were randomised over 17 months. Reach-to-Grasp participants received a median (IQR) 14 (13,14) visits, and performed 157 (96,211) repetitions per visit; plus 30 minutes (22,45) self-practice per day. Usual care participants received 10.5 (5,14) therapist visits, comprising 38.6 (30,45) minutes of arm therapy with 16 (6,24) repetitions of functional tasks per visit. Median ARAT scores in the reach-to-grasp group were 8.5 (3.0,24.0) at baseline and 14.5 (3.5,26.0) at 24 weeks compared to median of 4 at both time points (IQR: baseline (3.0,14.0), 24 weeks (3.0,30.0)) in the usual-care group. Median WMFT tasks completed at baseline and 24 weeks were 6 (3.0,11.5) and 8.5 (4.5,13.5) respectively in the reach-to-grasp group and 4 (3.0,10.0), 6 (3.0,14.0) in the usual care group. Incidence of arm pain was similar between groups. The study was stopped before 11 patients reached the 24 weeks assessment.

Conclusions: An RCT of home-based Reach-to-Grasp training after stroke is feasible and safe. With ARAT being our preferred measure it is estimated that 240 participants will be needed for a future two armed trial.

Journal Article Type Article
Publication Date Jan 1, 2017
Journal Clinical Rehabilitation
Print ISSN 0269-2155
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Volume 31
Issue 7
Pages 891-903
APA6 Citation Turton, A., Cunningham, P., van Wijck, F., Smartt, H., & Rogers, C. (2017). Home-based reach-to-grasp training for people after stroke is feasible: A pilot randomised controlled trial. Clinical Rehabilitation, 31(7), 891-903. https://doi.org/10.1177/0269215516661751
DOI https://doi.org/10.1177/0269215516661751
Keywords stroke, arm, hand, rehabilitation, reach to grasp, randomised controlled trial
Publisher URL http://dx.doi.org/10.1177/0269215516661751
Additional Information Additional Information : The dataset for this study is available from the UWE Research Data Repository: http://researchdata.uwe.ac.uk/178/

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