Improving arm function after stroke using task-specific training

85% of the 15 million people in the world annually who have a stroke cannot use their arm for basic tasks like eating and toileting. With usual health care services, 60% of stroke survivors still have non-functional arms 6 months after stroke. More effective treatments are needed.

We will conduct a large, Phase III, two-arm, multicentre randomised controlled trial (RCT), to determine if a 6-week task-specific home-based training program is more effective than current practice in improving arm function and amount of arm use. Our pilot RCT (48 participants) established the feasibility of the Phase III trial and produced proof-of-concept support for our hypotheses. We also developed a detailed task-specific training manual (122 exercises) to be used in this trial.

Large Phase III trials in stroke rehabilitation are uncommon. This trial is novel because it is the first Phase III two-arm, multicentre RCT of task-specific training. We expect participants themselves, who rate upper limb rehabilitation as one of the top 10 stroke research priorities, to reap significant benefit from our findings. The therapy suits participants with all levels of movement impairment, does not require special equipment, and can be practised independently. This makes it suitable for delivery to almost all participants, unlike other treatments. 83% participants in the feasibility trial said task-specific training made a difference to use of their arm – e.g. ‘I have more movement. More confidence to try things in my life.’, ‘Improvement on grasping things – I find it easier. Stronger arm’ – and 96% said it was worth the effort.

Our trial includes investigating the cost-effectiveness of task-specific training, compared to current practice, and identifying potential barriers to implementation and possible solutions.