Home-based reach-to-grasp training for people after stroke: a feasibility randomised controlled trial

Abstract

Background: Arm rehabilitation after stroke is a top research priority. Specifically, there is an urgent need for trials on task-specific training to improve arm function for people discharged home post stroke. Aim: To determine the feasibility of a Phase III randomized controlled trial of home-based reach-to-grasp (RtG) training after stroke. Methods: Design: multicenter, assessor-blinded feasibility RCT. • Intervention group (RtG): task-specific reach-to-grasp training. Dose 56 hours: 14 therapist visits over 6-weeks plus 1 hour self-practice per day. • Control group (CG): usual care. • Participants: less than 12 months post-stroke, discharged home. • Data collection: recruitment, adherence, treatment fidelity, acceptability, adverse events. Outcomes: Action Research Arm Test (ARAT, primary outcome), Wolf Motor Function Test (WMFT), Motor Activity Log, Stroke Impact Scale. Time points: pre-randomization and 7, 12 and 24 weeks post-randomization. Results: 47 participants (RtG = 24, UC = 23) were recruited over 17 months, two withdrew. 94% of scheduled treatment visits were completed. RtG participants performed a median of 157 repetitions per visit plus 52 repetitions of self practice per day. 96% participants rated training acceptable, 71% rated 1 hour of independent practice/day acceptable and 83% reported it improved arm function. There were no serious adverse events. The ARAT score in the RtG group improved beyond the MCID, whilst it did not change in the CG (Table 1). Conclusions: Findings indicate that a Phase III RCT of home-based RtG training after stroke is warranted and feasible. (Table Presented).