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Clin Rehabil. 2003 Sep;17(6):579-89.

Does an early increased-intensity interdisciplinary upper limb therapy programme following acute stroke improve outcome?

Author information

1
School of Clinical Medical Sciences, University of Newcastle upon Tyne and North Tyneside General Hospital, Northumbria Healthcare Trust, Newcastle upon Tyne, UK. helen.rodgers@ncl.ac.uk

Abstract

OBJECTIVE:

To determine whether an early increased-intensity upper limb therapy programme following acute stroke improves outcome.

DESIGN:

A randomized controlled trial.

SETTING:

A stroke unit which provides acute care and rehabilitation for all stroke admissions.

SUBJECTS:

One hundred and twenty-three patients who had had a stroke causing upper limb impairment within the previous 10 days.

INTERVENTION:

The intervention group received stroke unit care plus enhanced upper limb rehabilitation provided jointly by a physiotherapist and occupational therapist, commencing within 10 days of stroke, and available up to 30 minutes/day, five days/week for six weeks. The control group received stroke unit care.

MAIN OUTCOME MEASURES:

The primary outcome measure was the Action Research Arm Test (ARAT) three months after stroke.

SECONDARY OUTCOME MEASURES:

Motricity Index; Frenchay Arm Test; upper limb pain; Barthel ADL Index; Nottingham E-ADL Scale; and costs to health and social services at three and six months after stroke.

RESULTS:

There were no differences in outcomes between the intervention and control groups three and six months after stroke. During the intervention period the intervention group received a median of 29 minutes of enhanced upper limb therapy per working day as inpatients. The total amount of inpatient physiotherapy and occupational therapy received by the intervention group was a median of 52 minutes per working day during the intervention period and 38 minutes per working day for the control group (p = 0.001). There were no differences in service costs.

CONCLUSIONS:

An early increased-intensity interdisciplinary upper limb therapy programme jointly provided by a physiotherapist and occupational therapist did not improve outcome after stroke. The actual difference in the amount of therapy received by intervention and control groups was less than planned due to a competitive therapy bias.

PMID:
12971702
DOI:
10.1191/0269215503cr652oa
[Indexed for MEDLINE]

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