Article

While recent clinical trials involving robot-assisted therapy have
failed to show clinically significant improvement versus conventional therapy, it
is possible that a broader strategy of intensive therapy-to include
robot-assisted rehabilitation-may yield clinically meaningful outcomes. Objective
To test the immediate and sustained effects of intensive therapy (robot-assisted
therapy plus intensive conventional therapy) on outcomes in a chronic stroke
population. Methods A multivariate mixed-effects model adjusted for important
covariates was established to measure the effect of intensive therapy versus
usual care. A total of 127 chronic stroke patients from 4 Veterans Affairs
medical centers were randomized to either robot-assisted therapy (n = 49),
intensive comparison therapy (n = 50), or usual care (n = 28), in the VA-ROBOTICS
randomized clinical trial.
Patients were at least 6 months poststroke, of
moderate-to-severe upper limb impairment. The primary outcome measure was the
Fugl-Meyer Assessment at 12 and 36 weeks. Results There was significant benefit
of intensive therapy over usual care on the Fugl-Meyer Assessment at 12 weeks
with a mean difference of 4.0 points (95% CI = 1.3-6.7); P = .005; however, by 36
weeks, the benefit was attenuated (mean difference 3.4; 95% CI = -0.02 to 6.9; P
= .05). Subgroup analyses showed significant interactions between treatment and
age, treatment and time since stroke. Conclusions Motor benefits from intensive
therapy compared with usual care were observed at 12 and 36 weeks posttherapy;
however, this difference was attenuated at 36 weeks. Subgroups analysis showed
that younger age, and a shorter time since stroke were associated with greater
immediate and long-term improvement of motor function.
CI - (c) The Author(s) 2015.

Langue : ANGLAIS