Effects of functional and analytical strength training on upper-extremity activity after stroke: a randomized controlled trial.
Patrícia Graef, Stella M Michaelsen, Maria L R Dadalt and 3 others
PMID 27683837WHAT IT FOUND
Five weeks of home-based functional reaching-and-grasping practice improved arm activity more than analytical dumbbell lifting in chronic stroke, and the difference was still seen at 10 months.
Strength, range of motion, motor control, and tone did not differ between groups.
Key findings
01Functional strengthening produced better unilateral task analysis immediately after treatment and better combined unilateral and bilateral arm activity at 10 months than analytical strengthening.
02Arm activity scores improved in both groups after treatment and at follow-up.
03No between-group differences were found for shoulder flexion strength, handgrip strength, active shoulder range of motion, Fugl-Meyer motor score, or muscle tone.
STILL TO COME
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What it does not show
The study did not reach its planned sample size: 27 were randomized instead of 32 patients per group. Six participants could not be reassessed at 10 months because of death, unwillingness to participate, or relocation. There was no control group that received neither functional nor analytical strengthening, so both active programs could have improved outcomes. Participants had chronic stroke with mild/moderate impairment and were excluded for severe tone, pain, contractures, or severe shoulder weakness, so results do not apply to more severe or complicated cases. Both groups received the same dose and intensity, so the trial mainly compares task specificity, not amount of training.
The easy way to misread this
Do not conclude that functional strengthening is proven better than usual care or that either program is required. There was no no-treatment control, the study did not reach its planned sample size, and both groups improved.