Very Early Constraint-Induced Movement during Stroke Rehabilitation (VECTORS) A single-center RCT
Very Early Constraint-Induced Movement during Stroke Rehabilitation (VECTORS) A single-center RCT
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DOI：
10.1212/wnl.0b013e3181ab2b27
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发表时间：
2009-07-21
期刊：
影响因子：
9.9
通讯作者：
Edwards, D. F.
中科院分区：
文献类型：
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作者：
Dromerick, A. W.;Lang, C. E.;Edwards, D. F.
背景：约束诱导运动疗法 (CIMT) 是最先进的上肢 (UE) 运动恢复训练方法之一。方法：中风康复期间的早期约束诱导运动 (VECTORS) 是急性住院患者康复期间 CIMT 的单盲 II 期试验，将传统 UE 疗法与剂量匹配和高强度 CIMT 方案进行比较。参与者在康复入院时被适应性随机化，并接受为期两周的研究相关治疗。主要终点是中风发作后 90 天受影响较严重一侧的总行动研究手臂测试 (ARAT) 得分。进行了混合模型分析。结果：共有 52 名参与者（平均年龄 63.9 +/- 14 岁）在发病后 9.65 +/- 4.5 天被随机分组。 NIHSS 平均为 5.3 +/- 1.8； ARAT 平均总分为 22.5 +/- 15.6； 77% 患有缺血性中风。各组在所有随机化变量的基线上都是等效的。正如预期的那样，随着时间的推移，所有组的 ARAT 总分都有所提高。存在显着的时间 x 组交互作用（F = 3.1，p < 0.01），因此高强度 CIT 组在第 90 天时的改善显着较小。在第 90 天，剂量匹配的 CIMT 和对照组之间没有发现显着差异。子样本的 MRI 显示没有活动依赖性病变扩大的证据。结论：约束诱导运动疗法（CIMT）同样有效，但并不优于等剂量的 CIMT。 住院中风康复期间的传统疗法。较高强度的 CIMT 导致 90 天时运动改善较少，表明剂量-反应呈反比关系。运动干预试验应控制剂量，并且不能认为较高剂量的运动训练更有益，尤其是中风后早期。神经病学（R）2009； 73：195-201
Background: Constraint-induced movement therapy (CIMT) is among the most developed training approaches for motor restoration of the upper extremity (UE).Methods: Very Early Constraint-Induced Movement during Stroke Rehabilitation (VECTORS) was a single-blind phase II trial of CIMT during acute inpatient rehabilitation comparing traditional UE therapy with dose-matched and high-intensity CIMT protocols. Participants were adaptively randomized on rehabilitation admission, and received 2 weeks of study-related treatments. The primary endpoint was the total Action Research Arm Test (ARAT) score on the more affected side at 90 days after stroke onset. A mixed model analysis was performed.Results: A total of 52 participants (mean age 63.9 +/- 14 years) were randomized 9.65 +/- 4.5 days after onset. Mean NIHSS was 5.3 +/- 1.8; mean total ARAT score was 22.5 +/- 15.6; 77% had ischemic stroke. Groups were equivalent at baseline on all randomization variables. As expected, all groups improved with time on the total ARAT score. There was a significant time x group interaction (F = 3.1, p < 0.01), such that the high intensity CIT group had significantly less improvement at day 90. No significant differences were found between the dose-matched CIMT and control groups at day 90. MRI of a subsample showed no evidence of activity-dependent lesion enlargement.Conclusion: Constraint-induced movement therapy (CIMT) was equally as effective but not superior to an equal dose of traditional therapy during inpatient stroke rehabilitation. Higher intensity CIMT resulted in less motor improvement at 90 days, indicating an inverse dose-response relationship. Motor intervention trials should control for dose, and higher doses of motor training cannot be assumed to be more beneficial, particularly early after stroke. Neurology (R) 2009; 73: 195-201