A low cost virtual reality system for home based rehabilitation of the arm following stroke: a randomised controlled feasibility trial.
P J Standen, K Threapleton, A Richardson and 5 others
PMID 27029939WHAT IT FOUND
The home glove system, with usual care, therapist setup and support, did not significantly improve the primary arm function test after eight weeks.
Recruitment was so low that a definitive trial would need many more participants, and the system required substantial therapist support.
Key findings
01The primary outcome, Wolf Motor Function Test, did not show a significant difference at the final assessment.
02Significant improvements in the intervention group were reported only for Wolf Grip strength at midpoint, Motor Activity Log amount of use at final and Motor Activity Log number of activities attempted at final.
03A definitive trial would need 114 randomised patients and approximately 63 months at the observed recruitment rate, while the intervention required a median of 4 research-team visits per patient.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Only 27 patients were randomised (17 intervention, 10 control), so the study was a feasibility trial and could not show whether the glove works. Recruitment was very low: 47 referrals in 15 months, 29 consented, and 2 withdrew before randomisation. Retention at final outcome measures was 67%, and dropout was higher in the intervention group. Reasons for dropout included physical ill health, absence from home and competing commitments, which may affect any unsupervised home-based intervention. The intervention group had a longer time since stroke than the control group at baseline. Midpoint assessments were not always blind because the equipment or patient comments could reveal allocation. The glove required median 4 research-team visits per patient and 92 hours 45 minutes of researcher contact time, including training and technical troubleshooting. The system was a prototype, so the support burden and technical issues may not reflect a finished product.
Declared interests
The authors declared no potential conflicts of interest. The research was funded by the National Institute for Health Research.
The easy way to misread this
Do not conclude that the home glove system, with its therapist support, improves arm function. The significant results were only grip strength at midpoint and Motor Activity Log amount of use and number of activities attempted at final; the primary Wolf Motor Function Test outcome was not significant at final, and this small feasibility trial could not test effectiveness.