SMART arm training with outcome-triggered electrical stimulation in subacute stroke survivors with severe arm disability: a randomized controlled trial

Barker, Ruth N., Hayward, Kathryn S., Carson, Richard G., Lloyd, David, and Brauer, Sandra G. (2017) SMART arm training with outcome-triggered electrical stimulation in subacute stroke survivors with severe arm disability: a randomized controlled trial. Neurorehabilitation and Neural Repair, 31 (12). pp. 1005-1016.

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DOI: 10.1177/1545968317744276

View at Publisher Website: https://doi.org/10.1177/1545968317744276

Abstract

Background: Stroke survivors with severe upper limb disability need opportunities to engage in task-oriented practice to achieve meaningful recovery. Objective. To compare the effect of SMART Arm training, with or without outcome-triggered electrical stimulation to usual therapy, on arm function for stroke survivors with severe upper limb disability undergoing inpatient rehabilitation.

Methods: A prospective, multicenter, randomized controlled trial was conducted with 3 parallel groups, concealed allocation, assessor blinding and intention-to-treat analysis. Fifty inpatients within 4 months of stroke with severe upper limb disability were randomly allocated to 60 min/d, 5 days a week for 4 weeks of (1) SMART Arm with outcome-triggered electrical stimulation and usual therapy, (2) SMART Arm alone and usual therapy, or (3) usual therapy. Assessment occurred at baseline (0 weeks), posttraining (4 weeks), and follow-up (26 and 52 weeks). The primary outcome measure was Motor Assessment Scale item 6 (MAS6) at posttraining.

Results: All groups demonstrated a statistically (P < .001) and clinically significant improvement in arm function at posttraining (MAS6 change >= 1 point) and at 52 weeks (MAS6 change >= 2 points). There were no differences in improvement in arm function between groups (P = .367). There were greater odds of a higher MAS6 score in SMART Arm groups as compared with usual therapy alone posttraining (SMART Arm stimulation generalized odds ratio [GenOR] = 1.47, 95%CI = 1.23-1.71) and at 26 weeks (SMART Arm alone GenOR = 1.31, 95% CI = 1.05-1.57).

Conclusion: SMART Arm training supported a clinically significant improvement in arm function, which was similar to usual therapy. All groups maintained gains at 12 months.


Item ID:	51937
Item Type:	Article (Research - C1)
ISSN:	1545-6844
Keywords:	training, rehabilitation, physiotherapy, occupational therapy, electrical stimulation
Funders:	National Health and Medical Research Council (NHMRC), National Heart Foundation of Australia (NHF), National Stroke Foundation of Australia (NSFA)
Projects and Grants:	NHMRC 511241, NSFA PB 09B 4847
Date Deposited:	10 Jan 2018 07:36
FoR Codes:	32 BIOMEDICAL AND CLINICAL SCIENCES > 3209 Neurosciences > 320905 Neurology and neuromuscular diseases @ 40% 42 HEALTH SCIENCES > 4201 Allied health and rehabilitation science > 420106 Physiotherapy @ 30% 42 HEALTH SCIENCES > 4207 Sports science and exercise > 420703 Motor control @ 30%
SEO Codes:	92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920111 Nervous System and Disorders @ 20% 92 HEALTH > 9202 Health and Support Services > 920201 Allied Health Therapies (excl. Mental Health Services) @ 40% 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920403 Disability and Functional Capacity @ 40%
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