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Neurorehabil Neural Repair. 2016 Jul;30(6):583-90. doi: 10.1177/1545968315608448. Epub 2015 Oct 8.

Long-term Effectiveness of Intensive Therapy in Chronic Stroke.

Author information

1
Yale University, New Haven, CT, USA VA Connecticut Healthcare System, West Haven, CT, USA.
2
VA RRD Center of Excellence for Neurorestoration and Neurotechnology, Providence, RI, USA Brown University, Providence, RI, USA.
3
Yale University, New Haven, CT, USA VA Connecticut Healthcare System, West Haven, CT, USA University of Hartford, West Hartford, CT, USA michael.wininger@va.gov.

Abstract

Background While recent clinical trials involving robot-assisted therapy have failed to show clinically significant improvement versus conventional therapy, it is possible that a broader strategy of intensive therapy-to include robot-assisted rehabilitation-may yield clinically meaningful outcomes. Objective To test the immediate and sustained effects of intensive therapy (robot-assisted therapy plus intensive conventional therapy) on outcomes in a chronic stroke population. Methods A multivariate mixed-effects model adjusted for important covariates was established to measure the effect of intensive therapy versus usual care. A total of 127 chronic stroke patients from 4 Veterans Affairs medical centers were randomized to either robot-assisted therapy (n = 49), intensive comparison therapy (n = 50), or usual care (n = 28), in the VA-ROBOTICS randomized clinical trial. Patients were at least 6 months poststroke, of moderate-to-severe upper limb impairment. The primary outcome measure was the Fugl-Meyer Assessment at 12 and 36 weeks. Results There was significant benefit of intensive therapy over usual care on the Fugl-Meyer Assessment at 12 weeks with a mean difference of 4.0 points (95% CI = 1.3-6.7); P = .005; however, by 36 weeks, the benefit was attenuated (mean difference 3.4; 95% CI = -0.02 to 6.9; P = .05). Subgroup analyses showed significant interactions between treatment and age, treatment and time since stroke. Conclusions Motor benefits from intensive therapy compared with usual care were observed at 12 and 36 weeks posttherapy; however, this difference was attenuated at 36 weeks. Subgroups analysis showed that younger age, and a shorter time since stroke were associated with greater immediate and long-term improvement of motor function.

KEYWORDS:

robot; therapy; upper limb

PMID:
26450442
DOI:
10.1177/1545968315608448
[Indexed for MEDLINE]

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