PMID- 10548673
OWN - NLM
STAT- MEDLINE
DCOM- 19991123
LR  - 20220408
IS  - 0039-2499 (Print)
IS  - 0039-2499 (Linking)
VI  - 30
IP  - 11
DP  - 1999 Nov
TI  - Forced use of the upper extremity in chronic stroke patients: results from a 
      single-blind randomized clinical trial.
PG  - 2369-75
AB  - BACKGROUND AND PURPOSE: Of all stroke survivors, 30% to 66% are unable to use 
      their affected arm in performing activities of daily living. Although forced use 
      therapy appears to improve arm function in chronic stroke patients, there is no 
      conclusive evidence. This study evaluates the effectiveness of forced use 
      therapy. METHODS: In an observer-blinded randomized clinical trial, 66 chronic 
      stroke patients were allocated to either forced use therapy (immobilization of 
      the unaffected arm combined with intensive training) or a reference therapy of 
      equally intensive bimanual training, based on Neuro-Developmental Treatment, for 
      a period of 2 weeks. Outcomes were evaluated on the basis of the Rehabilitation 
      Activities Profile (activities), the Action Research Arm (ARA) test (dexterity), 
      the upper extremity section of the Fugl-Meyer Assessment scale, the Motor 
      Activity Log (MAL), and a Problem Score. The minimal clinically important 
      difference (MCID) was determined at the onset of the study. RESULTS: One week 
      after the last treatment session, a significant difference in effectiveness in 
      favor of the forced use group compared with the bimanual group (corrected for 
      baseline differences) was found for the ARA score (3.0 points; 95% CI, 1.3 to 
      4.8; MCID, 5.7 points) and the MAL amount of use score (0.52 points; 95% CI, 0.11 
      to 0.93; MCID, 0.50). The other parameters revealed no significant differential 
      effects. One-year follow-up effects were observed only for the ARA. The 
      differences in treatment effect for the ARA and the MAL amount of use scores were 
      clinically relevant for patients with sensory disorders and hemineglect, 
      respectively. CONCLUSIONS: The present study showed a small but lasting effect of 
      forced use therapy on the dexterity of the affected arm (ARA) and a temporary 
      clinically relevant effect on the amount of use of the affected arm during 
      activities of daily living (MAL amount of use). The effect of forced use therapy 
      was clinically relevant in the subgroups of patients with sensory disorders and 
      hemineglect, respectively.
FAU - van der Lee, J H
AU  - van der Lee JH
AD  - Department of Rehabilitation Medicine, University Hospital Vrije Universiteit, 
      and Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, 
      The Netherlands. jh.vandelee@azvu.nl
FAU - Wagenaar, R C
AU  - Wagenaar RC
FAU - Lankhorst, G J
AU  - Lankhorst GJ
FAU - Vogelaar, T W
AU  - Vogelaar TW
FAU - Deville, W L
AU  - Deville WL
FAU - Bouter, L M
AU  - Bouter LM
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Stroke
JT  - Stroke
JID - 0235266
SB  - IM
CIN - Stroke. 2000 Apr;31(4):986-8. PMID: 10754013
MH  - Activities of Daily Living
MH  - Aged
MH  - Arm/*physiology
MH  - Chronic Disease
MH  - Female
MH  - Follow-Up Studies
MH  - Hemiplegia/rehabilitation
MH  - Humans
MH  - Immobilization
MH  - Male
MH  - Middle Aged
MH  - Motor Activity/physiology
MH  - Motor Skills/physiology
MH  - Movement
MH  - *Physical Therapy Modalities
MH  - Sensation Disorders/rehabilitation
MH  - Single-Blind Method
MH  - *Stroke Rehabilitation
MH  - Treatment Outcome
EDAT- 1999/11/05 08:00
MHDA- 2000/05/29 09:00
CRDT- 1999/11/05 08:00
PHST- 1999/11/05 08:00 [pubmed]
PHST- 2000/05/29 09:00 [medline]
PHST- 1999/11/05 08:00 [entrez]
AID - 10.1161/01.str.30.11.2369 [doi]
PST - ppublish
SO  - Stroke. 1999 Nov;30(11):2369-75. doi: 10.1161/01.str.30.11.2369.