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No extra benefit from task-orientated stroke rehabilitation programmes

Nor did increasing therapy time offer additional improvement in motor function

Lousie Prime

Wednesday, 10 February 2016

Task-orientated stroke rehabilitation programmes offer no additional benefits over standard stroke rehabilitation programmes for people with moderate upper extremity impairment, in terms of either motor function or recovery after 12 months, according to US research* published today in JAMA. The authors of the study said their results – which also showed that doubling the ‘dose’ of therapy made no meaningful difference to outcomes – would help those commissioning care to spend limited funds wisely.

Some earlier clinical trials had suggested that task-orientated training, in higher doses, could be better than current clinical practice for people with upper extremity limb deficits following stroke. US researchers designed a study to find out more.

They randomly assigned 361 people (average age 61 years) from various centres in the US, who were suffering moderate motor impairment following a stroke, to one of three groups for outpatient treatment. The groups were: structured, task-oriented upper extremity training (119 people); dose-equivalent occupational therapy (DEUCC), involving 30 one-hour sessions over 10 weeks (120 people); or to monitoring-only occupational therapy (usual clinical care UCC, 122 people).

After 12 months, they compared recovery and motor function between the groups; 304 participants took part in this assessment.

They found that upper extremity motor performance did not differ significantly between the groups – the structured, task-orientated motor therapy was non-superior to UCC for the same number of hours, which they said showed there was no additional benefit for an evidence-based, intensive restorative therapy programme. Nor was providing more than twice the average dose of therapy (mean 27 hours) associated with any greater restoration of motor function than providing the average of 11 hours’ therapy in the UCC group, showing no additional benefit from providing substantially more therapy time.

The study authors said: “These findings do not support superiority of this task-oriented rehabilitation programme for patients with motor stroke and moderate upper extremity impairment.

“With payer pressures on reducing inpatient rehabilitation, outpatient rehabilitation may be of greater importance for patients with stroke. The findings from this study provide important new guidance to clinicians who must choose the best treatment for patients with stroke. The results suggest that usual and customary community-based therapy, provided during the typical outpatient rehabilitation time window by licensed therapists, improves upper extremity motor function and that more than doubling the dose of therapy does not lead to meaningful differences in motor outcomes.”

They added: “The data pertaining to dose of rehabilitation therapy may be important to policy makers and may be useful to estimate the cost and expected effect of aftercare in the outpatient setting.”

* Winstein CJ, Wolf SL, Dromerick AW et al. Effect of a task-oriented rehabilitation program on upper extremity recovery following motor stroke: the ICARE randomized clinical trial. JAMA. 2016; 315(6): 571-581. doi:10.1001/jama.2016.0276.

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