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Dose response of task‐specific upper limb training in people at least 6 months poststroke: A phase II, single‐blind, randomized, controlled trial
Author(s) -
Lang Catherine E.,
Strube Michael J.,
Bland Marghuretta D.,
Waddell Kimberly J.,
CherryAllen Kendra M.,
Nudo Randolph J.,
Dromerick Alexander W.,
Birkenmeier Rebecca L.
Publication year - 2016
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.24734
Subject(s) - randomized controlled trial , hemiparesis , medicine , physical medicine and rehabilitation , paresis , physical therapy , upper limb , stroke (engine) , rehabilitation , psychology , surgery , mechanical engineering , lesion , engineering
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. 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. Results ARAT scores for the 3,200, 9,600, and IM groups improved over time as indicated by slopes (ΔARAT/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. 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