Forced use of the upper extremity in chronic stroke patients -: Results from a single-blind randomized clinical trial
Forced use of the upper extremity in chronic stroke patients -: Results from a single-blind randomized clinical trial
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DOI：
10.1161/01.str.30.11.2369
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发表时间：
1999-11-01
期刊：
影响因子：
8.3
通讯作者：
Bouter, LM
中科院分区：
文献类型：
--
作者：
van der Lee, JH;Wagenaar, RC;Bouter, LM
背景和目的-在所有中风幸存者中，30%到66%的人不能使用他们的患臂进行日常生活活动。虽然强迫使用疗法似乎可以改善慢性中风患者的手臂功能，但没有确凿的证据。本研究评估的有效性，强迫使用therapy. Methods，在一个双盲随机临床试验中，66例慢性中风患者被分配到强迫使用疗法（固定的未受影响的手臂结合强化训练）或参考治疗的同等强度双手训练，神经发育治疗的基础上，为期2周。根据康复活动概况（活动）、行动研究臂（ARA）测试（灵活性）、Fugl-Meyer评估量表的上肢部分、运动活动日志（MAL）和问题评分对结果进行评价。最小临床重要差异（MCID）在研究开始时确定。结果-最后一次治疗后一周，与双手组相比，强迫使用组的有效性有显著差异（校正基线差异）发现ARA评分（3.0分; 95% CI，1.3 - 3.8; MCID，5：7分）和MAL使用量评分（0.52分; 95% CI，0.11 - 0.93; MCID，0.50）。其他参数显示无显著差异效应，仅ARA观察到1年随访效应。ARA和MAL的使用量分数的治疗效果的差异是临床相关的感觉障碍和hemineastheneurs. Conclusions患者，本研究显示了一个小的，但持久的影响，强迫使用治疗的灵巧性受影响的手臂（ARA）和临时的临床相关影响的日常生活活动中受影响的手臂的使用量（MAL的使用量）。强迫使用治疗的效果分别在感觉障碍和偏侧运动障碍患者亚组中具有临床相关性。
Background and Purpose-Of all stroke survivors, 30% to 66% are unable to use their affected arm in performing activities of daily living. Although forced use therapy appears to improve arm function in chronic stroke patients, there is no conclusive evidence. This study evaluates the effectiveness of forced use therapy.Methods-In an observer-blinded randomized clinical trial, 66 chronic stroke patients were allocated to either forced use therapy (immobilization of the unaffected arm combined with intensive training)or a reference therapy of equally intensive bimanual training, based on Neuro-Developmental Treatment, for a period of 2 weeks. Outcomes were evaluated on the basis of the Rehabilitation Activities Profile (activities), the Action Research Arm (ARA) test (dexterity), the upper extremity section of the Fugl-Meyer Assessment scale, the Motor Activity Log (MAL), and a Problem Score. The minimal clinically important difference (MCID) was determined at the onset of the study.Results-One week after the last treatment session, a significant difference in effectiveness in favor of the forced use group compared with the bimanual group (corrected for baseline differences) was found for the ARA score (3.0 points; 95% CI, 1.3 to 3.8; MCID, 5:7 points) and the MAL amount of use score (0.52 points; 95% CI, 0.11 to 0.93; MCID, 0.50). The other parameters revealed no significant differential effects, One-year follow-up effects were observed only for the ARA. The differences in treatment effect for the ARA and the MAL amount of use scores were clinically relevant for patients with sensory disorders and hemineglect, respectively.Conclusions-The present study showed a small but lasting effect of forced use therapy on the dexterity of the affected arm (ARA) and a temporary clinically relevant effect on the amount of use of the affected arm during activities of daily living (MAL amount of use). The effect of forced use therapy was clinically relevant in the subgroups of patients with sensory disorders and hemineglect, respectively.