Is forced use of the paretic upper limb beneficial? A randomized pilot study during subacute post-stroke recovery

Abstract

Objective: To evaluate the effect of two weeks of forced use of the paretic upper limb, as a supplement to the rehabilitation programme in the subacute phase after stroke, on self-rated use of that limb. Design: A randomized, non-blind, parallel group, clinical, before-and-after trial. A forced use group and a conventional group were followed up one and three months after intervention. Setting: In-and outpatient units of rehabilitation at a University Hospital. Subjects: Thirty patients were allocated to two groups, 15 in each, 1-6 months (mean 2.4) after stroke onset. Twenty-six patients completed the study. Interventions: The patients of both groups participated in two weeks of daily training on weekdays. In addition, the forced use group wore a restraining sling on the non-paretic arm for up to 6 hours per weekday. Main measure: The Motor Activity Log; patients scored 0-5 for 30 daily tasks concerning both amount of use and quality of movement. Results: The forced use group tended to achieve larger improvements immediately post-intervention, but this was not clearly demonstrated. The small differences also levelled out up to the three-month follow-up, with both groups earning an approximately 1.0 score point on both scales of the Motor Activity Log. Conclusions: This pilot study did not reveal any additional benefit of forced use on self-rated performance in daily use of the paretic upper limb. Both groups performed fairly extensive, active training with a similar duration, amount and content.

Responsiveness and validity of the Motor Activity Log in patients during the subacute phase after stroke

“…Consistent with other reports investigating responsiveness and correlations, data from all subjects were pooled, regardless of group assignment in the trial. Groups were equivalent at baseline on all randomization variables, and there was no group difference in change [25,39]. Both groups improved over study time on most physical function measures and the measure of daily use.…”

“…Treatment was daily training on weekdays in the 2 weeks of intervention, reaching a mean of *3 h per day [25,39]. Informed consent was obtained from all participants prior to inclusion, and ethical approval was granted from the research ethics committee at the study site (Ö rebro County Council approval 500:16, 844/98).…”

Constraint-induced movement therapy after stroke

“…(34, 45, 47, 49, 50, 52, 53, 56, 59, 66, 67, 69, 76, 78, 82) Panel 1 shows the used search strategy and selection criteria used for this systematic review of the literature. For details about the search strategy, methods and flow-chart, see supplementary web appendix 2 to 4.…”

“…Forced use therapy was investigated in 6 RCTs (N=165)(59, 60, 65, 67-69, 79) (see supplementary web appendix 5) and did not show an added value for self-reported amount of arm-hand use in daily life and self-reported quality of arm-hand movement in daily life (Figure 2) (see also supplementary web appendix 6). …”

“…References: (a) 33-35, 37, 38, 43, 45, 46, 49, 50, 57, 62, 64, 70, 71, 73, 80, 82; (b) 39, 42; (c) 55, 73; (d) 46, 82; (e) 46, 75; (f) 28; (g) 31, 33- 43, 45- 47, 51-56, 73, 75-78, 80-82; (h) 28; (i) 34, 37, 41, 43, 46, 52, 54, 55, 57, 61-64, 70-73, 75, 77, 78, 80-82; (j) 67, 69; (k) 28; (l) 34, 36, 37, 41, 43, 46, 49-52, 54, 55, 57, 61, 62, 64, 70-73, 75, 77, 78, 80-82; (m) 67, 69, 79; (n) 41, 47, 52, 54, 62-64, 66, 71; (o) 53, 81, 82; (p) 81, 82.…”