TY - JOUR
T1 - Dose response of task-specific upper limb training in people at least 6 months poststroke
T2 - A phase II, single-blind, randomized, controlled trial
AU - Lang, Catherine E.
AU - Strube, Michael J.
AU - Bland, Marghuretta D.
AU - Waddell, Kimberly J.
AU - Cherry-Allen, Kendra M.
AU - Nudo, Randolph J.
AU - Dromerick, Alexander W.
AU - Birkenmeier, Rebecca L.
N1 - Funding Information:
Funding was provided by NIH R01 HD068290. We thank Brittany Hill, Jill DeGeeter, Ryan Bailey, Michael Urbin, and Sydney Schafer for their invaluable assistance in running the trial.
Publisher Copyright:
© 2016 American Neurological Association
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Objective: The objectives of this work were to (1) determine whether higher doses of motor therapy in chronic poststroke hemiparesis result in better outcomes, compared to lower doses, and (2) evaluate potential modifiers of the dose-response relationship. Methods: Eighty-five adults with upper extremity paresis ≥6 months poststroke were randomized to one of four dose groups in this single-blind, parallel, randomized, control trial. The dosing parameter manipulated was amount of task-specific training, as indexed by the number of task repetitions. Groups received 3,200, 6,400, 9,600, or individualized maximum (IM) repetitions, during 1-hour sessions, 4 days/week for 8 weeks. The intervention was an individualized, progressive, task-specific upper-limb training program designed to improve upper-limb functional motor capacity. The primary outcome was the slope of the Action Research Arm Test (ARAT) during the intervention. Effects of dose and potential modifiers of the dose-response relationship were evaluated with hierarchical linear models. Results: ARAT scores for the 3,200, 9,600, and IM groups improved over time as indicated by slopes (ΔARAT/week, mean ± standard errors) of 0.40 ± 0.15, 0.31 ± 0.16, and 0.66 ± 0.14, respectively (p < 0.05). The slope of the 6,400 group was smaller (−0.05 ± 0.15) and significantly different from the 3,200 and IM groups (p < 0.001). Initial motor capacity, neglect, and other tested characteristics did not modify the dose-response relationship. Interpretation: Overall, treatment effects were small. There was no evidence of a dose-response effect of task-specific training on functional capacity in people with long-standing upper-limb paresis poststroke. Ann Neurol 2016;80:342–354.
AB - Objective: The objectives of this work were to (1) determine whether higher doses of motor therapy in chronic poststroke hemiparesis result in better outcomes, compared to lower doses, and (2) evaluate potential modifiers of the dose-response relationship. Methods: Eighty-five adults with upper extremity paresis ≥6 months poststroke were randomized to one of four dose groups in this single-blind, parallel, randomized, control trial. The dosing parameter manipulated was amount of task-specific training, as indexed by the number of task repetitions. Groups received 3,200, 6,400, 9,600, or individualized maximum (IM) repetitions, during 1-hour sessions, 4 days/week for 8 weeks. The intervention was an individualized, progressive, task-specific upper-limb training program designed to improve upper-limb functional motor capacity. The primary outcome was the slope of the Action Research Arm Test (ARAT) during the intervention. Effects of dose and potential modifiers of the dose-response relationship were evaluated with hierarchical linear models. Results: ARAT scores for the 3,200, 9,600, and IM groups improved over time as indicated by slopes (ΔARAT/week, mean ± standard errors) of 0.40 ± 0.15, 0.31 ± 0.16, and 0.66 ± 0.14, respectively (p < 0.05). The slope of the 6,400 group was smaller (−0.05 ± 0.15) and significantly different from the 3,200 and IM groups (p < 0.001). Initial motor capacity, neglect, and other tested characteristics did not modify the dose-response relationship. Interpretation: Overall, treatment effects were small. There was no evidence of a dose-response effect of task-specific training on functional capacity in people with long-standing upper-limb paresis poststroke. Ann Neurol 2016;80:342–354.
UR - http://www.scopus.com/inward/record.url?scp=84985953058&partnerID=8YFLogxK
U2 - 10.1002/ana.24734
DO - 10.1002/ana.24734
M3 - Article
C2 - 27447365
AN - SCOPUS:84985953058
SN - 0364-5134
VL - 80
SP - 342
EP - 354
JO - Annals of Neurology
JF - Annals of Neurology
IS - 3
ER -