Article

Objective: To test a study design and explore the feasibility and potential
effects of conventional neurological therapy, constraint induced therapy and
therapeutic climbing to improve minimal to moderate arm and hand function in
patients after a stroke. Method: A pilot study with six-month follow-up in
patients after stroke with minimal to moderate arm and hand function admitted for
inpatient rehabilitation was performed. Participants were randomly allocated to
one of three treatment approaches. Main outcomes were improvement of arm and hand
function and adverse effects. Results: 283 patients with stroke were screened for
inclusion over a two-year period, out of which fourtyfour were included. All
patients could be treated according to the protocol. Improvement of arm and hand
function was significantly higher in conventional neurological therapy and
constraint induced therapy compared with therapeutic climbing at discharge, and
at six months follow-up (P < 0.05, effect size = 0.56-0.76). No significant
differences in arm and hand function were observed between constraint induced
therapy and conventional neurological therapy. Constraint induced therapy
participants were significantly less at risk of developing shoulder pain at six
months follow-up compared with the other participants (P < 0.05, effect size =
0.82 and 1.79, respectively). Conclusions: The study design needs adaptation to
accommodate the stringent inclusion criteria leading to prolonged study duration.
Constraint induced therapy seems to be the optimal approach to improve arm and
hand function and minimize the risk of shoulder pain for patients with minimal to
moderate arm hand function after stroke in the intermediate term.

Langue : ANGLAIS