Background:Although Constraint-Induced Movement therapy (CIMT) has been deemed efficacious for adults with persistent, mild-to-moderate, post-stroke upper-extremity hemiparesis, CIMT is not available on a widespread clinical basis. Impediments include its cost and travel to multiple therapy appointments. To overcome these barriers, we developed an automated, tele-health form of CIMT. Objective:Determine whether in-home, tele-health CIMT has outcomes as good as in-clinic, face-to-face CIMT in adults ≥1-year post-stroke with mild-to-moderate upper-extremity hemiparesis. Methods:Twenty-four stroke patients with chronic upper-arm extremity hemiparesis were randomly assigned to tele-health CIMT (Tele-AutoCITE) or in-lab CIMT. All received 35 hours of treatment. In the tele-health group, an automated, upper-extremity workstation with built-in sensors and video cameras was set-up in participants’ homes. Internet-based audio-visual and data links permitted supervision of treatment by a trainer in the lab. Results:Ten patients in each group completed treatment. All twenty, on average, showed very large improvements immediately afterwards in everyday use of the more-affected arm (mean change on Motor Activity Log Arm Use scale = 2.5 points, p < 0.001, d’ = 3.1). After one-year, a large improvement from baseline was still present (mean change = 1.8, p < 0.001, d’ = 2). Post-treatment outcomes in the tele-health group were not inferior to those in the in-lab group. Neither were participants’ perceptions of satisfaction with and difficulty of the interventions. Although everyday arm use was similar in the two groups after one-year (mean difference = –0.1, 95%CI = –1.3–1.0), reductions in the precision of the estimates of this parameter due to drop-out over follow-up did not permit ruling out that the tele-health group had an inferior long-term outcome. Conclusions:This proof-of-concept study suggests that Tele-AutoCITE produces immediate benefits that are equivalent to those after in-lab CIMT in stroke survivors with chronic upper-arm extremity hemiparesis. Cost savings possible with this tele-health approach remain to be evaluated.

中文翻译：

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中风后上肢偏瘫的远程康复：家庭约束诱导运动疗法的概念验证随机对照试验

背景：尽管约束诱导运动疗法 (CIMT) 被认为对患有持续性、轻度至中度、卒中后上肢偏瘫的成年人有效，但 CIMT 并不能在广泛的临床基础上使用。障碍包括其成本和前往多个治疗预约的旅行。为了克服这些障碍，我们开发了一种自动化的远程医疗形式的 CIMT。目的：确定在家中远程医疗 CIMT 在中风后 1 年以上患有轻度至中度上肢偏瘫的成人中是否具有与诊所内面对面 CIMT 一样好的结果。方法：将 24 名患有慢性上臂肢体偏瘫的卒中患者随机分配到远程医疗 CIMT (Tele-AutoCITE) 或实验室 CIMT。所有人都接受了35小时的治疗。在远程医疗组中，一个自动化的、在参与者家中设置了带有内置传感器和摄像机的上肢工作站。基于互联网的视听和数据链接允许实验室的培训师监督治疗。结果：每组10例患者完成治疗。平均而言，所有 20 只手臂在日常使用受影响较大的手臂后立即显示出非常大的改善（运动活动日志手臂使用量表的平均变化 = 2.5 分，p < 0.001，d' = 3.1）。一年后，与基线相比仍有很大改善（平均变化 = 1.8，p < 0.001，d' = 2）。远程医疗组的治疗后结果并不逊于实验室组。参与者对干预的满意度和难度的看法也没有。尽管一年后两组的日常手臂使用情况相似（平均差 = –0.1, 95%CI = –1.3–1.0），但由于随访期间的退出导致该参数的估计精度降低不允许排除远程医疗组的长期结果较差。结论：这项概念验证研究表明，Tele-AutoCITE 对患有慢性上臂肢体偏瘫的中风幸存者产生的直接益处与实验室内 CIMT 后的益处相当。这种远程医疗方法可能节省的成本仍有待评估。这项概念验证研究表明，Tele-AutoCITE 对患有慢性上臂肢体偏瘫的中风幸存者产生的直接益处与实验室内 CIMT 后的效果相当。这种远程医疗方法可能节省的成本仍有待评估。这项概念验证研究表明，Tele-AutoCITE 对患有慢性上臂肢体偏瘫的中风幸存者产生的直接益处与实验室内 CIMT 后的效果相当。这种远程医疗方法可能节省的成本仍有待评估。