Additional early active repetitive motor training did not prevent contracture in adults receiving task-specific upper limb training after stroke: a randomised trial.

Abstract

In adults undergoing rehabilitation after stroke, does 1 hour of additional active repetitive reaching per day prevent or reduce upper limb contracture? Multi-centre, randomised controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Fifty adults undergoing rehabilitation after stroke who were unable to actively extend the affected wrist past neutral or were unable to flex the affected shoulder to 90 deg. Three inpatient rehabilitation units in Australia. Both groups received usual upper limb therapy 5 days a week for 5 weeks. In addition, the experimental group received up to 1 hour a day of active, intensive, repetitive upper limb training using the SMART Arm device 5 days a week for 5 weeks. Measures were collected at baseline (Week 0), after intervention (Week 5) and at follow-up (Week 7). The primary outcomes were passive range of wrist extension, elbow extension, and shoulder flexion at Week 5. The secondary outcomes were: the three primary outcomes measured at Week 7; passive range of shoulder external rotation; arm function; and pain at rest, on movement and during sleep measured at Weeks 5 and 7. Following an average of 2310 reaching repetitions, the mean effect at Week 5 on passive range of wrist extension was 1 deg (95% CI -6 to 8), elbow extension -6 deg (95% CI -12 to -1), and shoulder flexion 5 deg (95% CI -8 to 17). There were no statistically significant or clinically important effects of the intervention on any secondary outcomes. In adults who are already receiving task-specific motor training for upper limb rehabilitation following stroke, 5 weeks of up to 1 hour of additional daily active repetitive motor training using the SMART Arm device did not prevent or reduce contracture in upper limb muscles. ACTRN12614001162606.