[WEB SITE] Intensive Task-Oriented Rehabilitation Not Found More Effective Than Conventional Occupational Therapy for Stroke Recovery – Neurology Today

Researchers found that a structured, task-oriented rehabilitation program for patients with motor stroke and primarily moderate upper extremity impairment did not significantly improve motor function or recovery, compared with either an equivalent or lower dose of usual and customary occupational therapy.

 

A new study testing the benefits of a task-oriented rehabilitation program to strengthen hand and arm weakness on the heels of a stroke challenges the idea that more training is more effective.

Patients who received intensive upper body training — 30 one-hour sessions over a 10-week period — fared no better than individuals who received a more standard type of rehabilitation and those who received significantly fewer hours, according to a study published in the February 9 issue of the Journal of the American Medical Association.

In the past 10 years, several large studies have tested whether a program that is more challenging (in the tasks and the length of rehabilitation) is more beneficial than standard outpatient rehabilitation. The results have been mixed.

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[WEB SITE] Post-Stroke Rehabilitation: More is Not Always Better, According to New Study – Neurology Today

Thursday, February 11, 2016

​BY JAMIE TALAN

A new study testing the benefits of a task-oriented rehabilitation program to strengthen hand and arm weakness on the heels of a stroke has called into question the belief that more hours of such an intensive training protocol is better than usual occupational therapy. Patients who received intensive upper-body training — 30 one-hour sessions over a 10-week period — fared no better than those who received a more standard type of rehabilitation, or the usual therapy with significantly fewer hours.

Results of the study were published in the February 9 issue of the Journal of the American Medical Association.

Scientists at the University of Southern California in Los Angeles led the study, recruiting 361 stroke patients from seven hospitals around the country. The patients were randomly assigned to receive either one-hour intensive, structured upper-extremity training three times a week during the 10-week study; 30 hours of usual occupational therapy; or occupational therapy that was monitored but with no prescribed amount of hours. The rehabilitation services were delivered in an outpatient setting.

Carolee J. Winstein, PhD, a professor of biokinesiology and physical therapy and her colleagues at the University of Southern California, measured upper-extremity motor function and recovery for a year. They reported in the JAMA study that there were no group differences in upper extremity motor performance. The intensive, task-oriented rehabilitation did not result in any significant benefits compared with the usual occupational therapy or monitored-only standard rehabilitation practice, whether the control patient received 11 hours or the equivalent 30 hours of treatment. In other words, a more intensive treatment protocol wasn’t any better at restoring motor performance.

“These findings do not support superiority of this task-oriented rehabilitation program for patients with motor stroke and moderate upper extremity impairment,” the study authors wrote.

The study counters other recent research that has suggested that higher doses of task-oriented upper-extremity training is better for stroke patients than standard occupational and physical therapy. The researchers acknowledged that changing practices among physical and occupational therapists could have accounted for the similar motor outcome identified in the study. Also, the variability in the hours of rehabilitation that patients received in the control arm of the study could have skewed the results, they said.

Still, the researchers concluded: “The findings from this study provide important new guidance to clinicians who must choose the best treatment for patients with stroke. The results suggest that usual and customary community-based therapy, provided during the typical outpatient rehabilitation time window by licensed therapists, improves upper extremity motor function and that more than doubling the dose of therapy does not lead to meaningful differences in motor outcomes.”​

Look for more in-depth coverage and independent analysis of this study in an upcoming issue ofNeurology Today.

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• Winstein CJ, Wolf SL, Dromerick AW, et al, for the Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) Investigative Team. Effect of a task-oriented rehabilitation program on upper extremity recovery following motor stroke: The ICARE randomized clinical trial. JAMA 2016; 315(6):571-581.
• Neurology Today archive on stroke rehabilitation: http://bit.ly/NT-srokerehab

Source: Neurology Today