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Improving arm function after stroke using task specific training

Despite currently available treatments, many people have not regained enough movement to use their affected arm easily in their daily life at 6 months after stroke. Task specific training may improve arm and hand function more than usual care. We are conducting a multicentre randomised controlled trial to test whether task-specific training is more effective than usual care.

Aims

To determine if a 6-week task-specific home-based training programme for stroke survivors is more effective than current practice in improving arm function and amount of arm use.

HYPOTHESES:
1. Upper limb function will achieve a ≥5 point improvement on the Action Research Arm Test in the task-specific training group compared to the current practice group.
2. Amount of upper limb use in everyday life will achieve a ≥1 point improvement on the Motor Activity Log in the task-specific training group compared to the current practice group.
Supplementary aims are to: (a) identify costs of both interventions; and (b) identify potential barriers and possible solutions to implementation of 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 programme 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 investigation of the cost-effectiveness of task-specific training, compared to current practice, and identification of potential barriers to implementation and possible solutions.

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