Functional Strength Training and Movement Performance Therapy for upper limb recovery early post-stroke – efficacy, neural correlates, predictive markers and cost-effectiveness: FAST-INdiCATE trial

Hunter, Susan M., Johansen-Berg, Heidi, Ward, Nick, Kennedy, Niamh C., Chandler, Elizabeth, Weir, Christopher John, Rothwell, John, Wing, Alan M., Grey, Michael J. ORCID: https://orcid.org/0000-0002-3216-3272, Barton, Garry, Leavey, Nick Malachy, Havis, Claire, Lemon, Roger N., Burridge, Jane, Dymond, Amy and Pomeroy, Valerie M. ORCID: https://orcid.org/0000-0003-4487-823X (2018) Functional Strength Training and Movement Performance Therapy for upper limb recovery early post-stroke – efficacy, neural correlates, predictive markers and cost-effectiveness: FAST-INdiCATE trial. Frontiers in Neurology, 8. ISSN 1664-2295

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Abstract

Background: Variation in physiological deficits underlying upper limb paresis after stroke could influence how people recover and to which physical therapy they best respond. Objectives: To determine whether functional strength training (FST) improves upper limb recovery more than movement performance therapy (MPT). To identify: (a) neural correlates of response and (b) whether pre-intervention neural characteristics predict response. Design: Explanatory investigations within a randomised, controlled, observer-blind, and multicentre trial. Randomisation was computer-generated and concealed by an independent facility until baseline measures were completed. Primary time point was outcome, after the 6-week intervention phase. Follow-up was at 6 months after stroke. Participants: With some voluntary muscle contraction in the paretic upper limb, not full dexterity, when recruited up to 60 days after an anterior cerebral circulation territory stroke. Interventions: Conventional physical therapy (CPT) plus either MPT or FST for up to 90 min-a-day, 5 days-a-week for 6 weeks. FST was “hands-off” progressive resistive exercise cemented into functional task training. MPT was “hands-on” sensory/facilitation techniques for smooth and accurate movement. Outcomes: The primary efficacy measure was the Action Research Arm Test (ARAT). Neural measures: fractional anisotropy (FA) corpus callosum midline; asymmetry of corticospinal tracts FA; and resting motor threshold (RMT) of motor-evoked potentials. Analysis: Covariance models tested ARAT change from baseline. At outcome: correlation coefficients assessed relationship between change in ARAT and neural measures; an interaction term assessed whether baseline neural characteristics predicted response. Results: 288 Participants had: mean age of 72.2 (SD 12.5) years and mean ARAT 25.5 (18.2). For 240 participants with ARAT at baseline and outcome the mean change was 9.70 (11.72) for FST + CPT and 7.90 (9.18) for MPT + CPT, which did not differ statistically (p = 0.298). Correlations between ARAT change scores and baseline neural values were between 0.199, p = 0.320 for MPT + CPT RMT (n = 27) and −0.147, p = 0.385 for asymmetry of corticospinal tracts FA (n = 37). Interaction effects between neural values and ARAT change between baseline and outcome were not statistically significant. Conclusions: There was no significant difference in upper limb improvement between FST and MPT. Baseline neural measures did not correlate with upper limb recovery or predict therapy response. Trial registration: Current Controlled Trials: ISRCT 19090862, http://www.controlled-trials.com

Item Type: Article
Faculty \ School: Faculty of Medicine and Health Sciences > School of Health Sciences
Faculty of Medicine and Health Sciences > Norwich Medical School
Faculty of Medicine and Health Sciences > School of Rehabilitation Sciences
Depositing User: Pure Connector
Date Deposited: 20 Dec 2017 06:07
Last Modified: 15 Aug 2022 01:37
URI: https://ueaeprints.uea.ac.uk/id/eprint/65784
DOI: 10.3389/fneur.2017.00733

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