Dose response of task-specific upper limb training in people at least 6 months poststroke: A phase II, single-blind, randomized, controlled trial.

MedStar author(s):
Citation: Annals of Neurology. 80(3):342-54, 2016 SepPMID: 27447365Institution: MedStar National Rehabilitation NetworkForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Exercise Therapy/mt [Methods] | *Outcome and Process Assessment (Health Care) | *Paresis/rh [Rehabilitation] | *Stroke Rehabilitation/mt [Methods] | *Stroke/th [Therapy] | *Upper Extremity/pp [Physiopathology] | Aged | Female | Humans | Male | Middle Aged | Paresis/et [Etiology] | Single-Blind Method | Stroke/co [Complications] | Time FactorsYear: 2016Local holdings: Available online from MWHC library: 1996 - presentISSN:
  • 0364-5134
Name of journal: Annals of neurologyAbstract: Copyright � 2016 American Neurological Association.INTERPRETATION: Overall, treatment effects were small. There was no evidence of a dose-response effect of task-specific training on functional capacity in people with long-standing upper-limb paresis poststroke. Ann Neurol 2016;80:342-354.METHODS: Eighty-five adults with upper extremity paresis >6 months poststroke were randomized to one of four dose groups in this single-blind, parallel, randomized, control trial. The dosing parameter manipulated was amount of task-specific training, as indexed by the number of task repetitions. Groups received 3,200, 6,400, 9,600, or individualized maximum (IM) repetitions, during 1-hour sessions, 4 days/week for 8 weeks. The intervention was an individualized, progressive, task-specific upper-limb training program designed to improve upper-limb functional motor capacity. The primary outcome was the slope of the Action Research Arm Test (ARAT) during the intervention. Effects of dose and potential modifiers of the dose-response relationship were evaluated with hierarchical linear models.OBJECTIVE: The objectives of this work were to (1) determine whether higher doses of motor therapy in chronic poststroke hemiparesis result in better outcomes, compared to lower doses, and (2) evaluate potential modifiers of the dose-response relationship.RESULTS: ARAT scores for the 3,200, 9,600, and IM groups improved over time as indicated by slopes (DELTAARAT/week, mean+/-standard errors) of 0.40+/-0.15, 0.31+/-0.16, and 0.66+/-0.14, respectively (p<0.05). The slope of the 6,400 group was smaller (-0.05+/-0.15) and significantly different from the 3,200 and IM groups (p<0.001). Initial motor capacity, neglect, and other tested characteristics did not modify the dose-response relationship.All authors: Birkenmeier RL, Bland MD, Cherry-Allen KM, Dromerick AW, Lang CE, Nudo RJ, Strube MJ, Waddell KJFiscal year: FY2017Digital Object Identifier: Date added to catalog: 2017-05-24
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 27447365 Available 27447365

Available online from MWHC library: 1996 - present

Copyright � 2016 American Neurological Association.

INTERPRETATION: Overall, treatment effects were small. There was no evidence of a dose-response effect of task-specific training on functional capacity in people with long-standing upper-limb paresis poststroke. Ann Neurol 2016;80:342-354.

METHODS: Eighty-five adults with upper extremity paresis >6 months poststroke were randomized to one of four dose groups in this single-blind, parallel, randomized, control trial. The dosing parameter manipulated was amount of task-specific training, as indexed by the number of task repetitions. Groups received 3,200, 6,400, 9,600, or individualized maximum (IM) repetitions, during 1-hour sessions, 4 days/week for 8 weeks. The intervention was an individualized, progressive, task-specific upper-limb training program designed to improve upper-limb functional motor capacity. The primary outcome was the slope of the Action Research Arm Test (ARAT) during the intervention. Effects of dose and potential modifiers of the dose-response relationship were evaluated with hierarchical linear models.

OBJECTIVE: The objectives of this work were to (1) determine whether higher doses of motor therapy in chronic poststroke hemiparesis result in better outcomes, compared to lower doses, and (2) evaluate potential modifiers of the dose-response relationship.

RESULTS: ARAT scores for the 3,200, 9,600, and IM groups improved over time as indicated by slopes (DELTAARAT/week, mean+/-standard errors) of 0.40+/-0.15, 0.31+/-0.16, and 0.66+/-0.14, respectively (p<0.05). The slope of the 6,400 group was smaller (-0.05+/-0.15) and significantly different from the 3,200 and IM groups (p<0.001). Initial motor capacity, neglect, and other tested characteristics did not modify the dose-response relationship.

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