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Does an early increased-intensity interdisciplinary upper limb therapy programme following acute stroke improve outcome?

School of Clinical Medical Sciences and School of Population and Health Sciences, University of Newcastle upon Tyne and North Tyneside General Hospital, Northumbria Healthcare Trust, Newcastle upon Tyne, UK

Joan Mackintosh

School of Clinical Medical Sciences and School of Population and Health Sciences, University of Newcastle upon Tyne, UK

Christopher Price

School of Clinical Medical Sciences, University of Newcastle upon Tyne and North Tyneside General Hospital, Northumbria Healthcare Trust, Newcastle upon Tyne, UK

Ruth Wood

Paul McNamee

School of Population and Health Sciences, University of Newcastle upon Tyne, UK

Tracy Fearon

Anna Marritt

North Tyneside General Hospital, Northumbria Healthcare Trust, Newcastle upon Tyne, UK

Richard Curless

School of Clinical Medical Sciences, University of Newcastle upon Tyne and North Tyneside General Hospital, Northumbria Healthcare Trust, Newcastle upon Tyne, UK

Objective: To determine whether an early increased-intensity upper limb therapy programme following acute stroke improves outcome.

Design: A randomized controlled trial.

Setting: A stroke unit which provides acute care and rehabilitation for all stroke admissions.

Subjects: One hundred and twenty-three patients who had had a stroke causing upper limb impairment within the previous 10 days.

Intervention: The intervention group received stroke unit care plus enhanced upper limb rehabilitation provided jointly by a physiotherapist and occupational therapist, commencing within 10 days of stroke, and available up to 30 minutes/day, five days/week for six weeks. The control group received stroke unit care.

Main outcome measures: The primary outcome measure was the Action Research Arm Test (ARAT) three months after stroke. Secondary outcome measures: Motricity Index; Frenchay Arm Test; upper limb pain; Barthel ADL Index; Nottingham E-ADL Scale; and costs to health and social services at three and six months after stroke.

Results: There were no differences in outcomes between the intervention and control groups three and six months after stroke. During the intervention period the intervention group received a median of 29 minutes of enhanced upper limb therapy per working day as inpatients. The total amount of inpatient physiotherapy and occupational therapy received by the intervention group was a median of 52 minutes per working day during the intervention period and 38 minutes per working day for the control group (p = 0.001). There were no differences in service costs.

Conclusions: An early increased-intensity interdisciplinary upper limb therapy programme jointly provided by a physiotherapist and occupational therapist did not improve outcome after stroke. The actual difference in the amount of therapy received by intervention and control groups was less than planned due to a competitive therapy bias.

Clinical Rehabilitation, Vol. 17, No. 6, 579-589 (2003)
DOI: 10.1191/0269215503cr652oa


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