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A Self-Empowered Upper Limb Repetitive Engagement Program to Improve Upper Limb Recovery Early Post-Stroke: Phase II Pilot Randomized Controlled Trial
Neurorehabilitation and Neural Repair ( IF 4.2 ) Pub Date : 2021-07-19 , DOI: 10.1177/15459683211032967
Lay Fong Chin 1, 2 , Kathryn S Hayward 2, 3, 4, 5 , Audrey Lik Ming Chai 1 , Sandra G Brauer 2
Affiliation  

Background. Time outside therapy provides an opportunity to increase upper limb (UL) use during post-stroke hospitalization. Objective. To determine if a self-directed UL program outside therapy (Self-Empowered UL Repetitive Engagement, SURE) was feasible and to explore the potential effect of the SURE program on UL use and recovery. Methods. Twenty-three patients from an inpatient rehabilitation center who were ≤21 days post-stroke and had a Fugl Meyer UL (FMUL) score ≤50 and a positive motor evoked potential (MEP+) response were randomized (stratified by impairment) to either experimental group (SURE: individualized, UL self-exercise and use outside therapy for 6 hours/week for 4 weeks) or control group (education booklet). Feasibility was evaluated by program adherence, dropout rate, adverse events, and satisfaction. Potential effect was measured by paretic UL use via accelerometry weekly during the intervention, FMUL and Action Research Arm Test (ARAT) at baseline (Week 0), post-intervention (Week 4), and follow-up (Week 8 and Week 16). Results. Adherence to SURE was high: 87% program completion (mean 313±75 repetitions/day). There were no dropouts, no adverse events related to SURE, and patient satisfaction averaged 7.8/10. Experimental participants achieved an additional hour of UL use daily (range: .3–1.2 hours/day) compared to control. Significant improvements in FMUL and ARAT were observed in both groups from Week 0 to Week 4 and to Week 8 (P ≤ .002), which were maintained to Week 16. There were no differences between groups (P ≥ .119). Conclusions. SURE was a feasible self-directed program that increased UL use in MEP+ individuals with moderate-severe impairment early post-stroke. Further studies with larger sample sizes and potentially higher dose are required to determine efficacy.



中文翻译:

一项自我授权的上肢重复参与计划,以改善中风后早期的上肢恢复:II 期试点随机对照试验

背景。治疗之外的时间提供了在中风后住院期间增加上肢 (UL) 使用的机会。客观的。确定治疗之外的自我指导的 UL 计划(Self-Empowered UL Repetitive Engagement,SURE)是否可行,并探索 SURE 计划对 UL 使用和恢复的潜在影响。方法。来自住院康复中心的 23 名卒中后≤21 天且 Fugl Meyer UL (FMUL) 评分≤50 且运动诱发电位 (MEP+) 阳性反应的患者被随机分配(按损伤分层)到任一实验组(当然:个性化、UL 自我锻炼和使用外部疗法,每周 6 小时,持续 4 周)或对照组(教育手册)。通过项目依从性、辍学率、不良事件和满意度来评估可行性。通过干预期间每周通过加速度计、FMUL 和行动研究臂测试 (ARAT) 在基线(第 0 周)、干预后(第 4 周)和随访(第 8 周和第 16 周)通过使用麻痹性 UL 来测量潜在影响. 结果。对 SURE 的依从性很高:87% 的计划完成(平均 313±75 次重复/天)。没有辍学,没有与 SURE 相关的不良事件,患者满意度平均为 7.8/10。与对照组相比,实验参与者每天额外使用 UL 一个小时(范围:0.3–1.2 小时/天)。从第 0 周到第 4 周和第 8 周,两组的 FMUL 和 ARAT 均有显着改善(P ≤ .002),并维持到第 16 周。组间没有差异(P ≥ .119)。结论。SURE 是一个可行的自主计划,可增加中风后早期中重度损伤的 MEP+ 个体的 UL 使用。需要更大样本量和潜在更高剂量的进一步研究来确定疗效。

更新日期:2021-07-20
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