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Is forced use of the paretic upper limb beneficial? A randomized pilot study during subacute post-stroke recovery

Department of Rehabilitation Medicine, Örebro University Hospital, School of Health and Medical Sciences, Örebro University, Örebro, ann.hammer{at}orebroll.se,

Birgitta Lindmark

Department of Neuroscience, Section of Physiotherapy, Uppsala University, Uppsala, Sweden

Objective: To evaluate the effect of two weeks of forced use of the paretic upper limb, as a supplement to the rehabilitation programme in the subacute phase after stroke, on self-rated use of that limb.

Design: A randomized, non-blind, parallel group, clinical, before-and-after trial. A forced use group and a conventional group were followed up one and three months after intervention.

Setting: In- and outpatient units of rehabilitation at a University Hospital.

Subjects: Thirty patients were allocated to two groups, 15 in each, 1—6 months (mean 2.4) after stroke onset. Twenty-six patients completed the study.

Interventions: The patients of both groups participated in two weeks of daily training on weekdays. In addition, the forced use group wore a restraining sling on the non-paretic arm for up to 6 hours per weekday.

Main measure: The Motor Activity Log; patients scored 0—5 for 30 daily tasks concerning both amount of use and quality of movement.

Results: The forced use group tended to achieve larger improvements immediately post-intervention, but this was not clearly demonstrated. The small differences also levelled out up to the three-month follow-up, with both groups earning an approximately 1.0 score point on both scales of the Motor Activity Log.

Conclusions: This pilot study did not reveal any additional benefit of forced use on self-rated performance in daily use of the paretic upper limb. Both groups performed fairly extensive, active training with a similar duration, amount and content.

This version was published on May 1, 2009

Clinical Rehabilitation, Vol. 23, No. 5, 424-433 (2009)
DOI: 10.1177/0269215508101734


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