Implementation and Evaluation of the Virtual Graded Repetitive Arm Supplementary Program (GRASP) for Individuals With Stroke During the COVID-19 Pandemic and Beyond.
Chieh-Ling Yang, Seonaid Waterson, Janice J Eng
PMID 33682872WHAT IT FOUND
Nine stroke survivors completed a virtual upper-limb exercise program.
Self-reported hand function improved significantly, with six of nine reaching a clinically important change. Staff found the format workable, though webcam angles and audio interference posed technical challenges.
Key findings
01Significant improvements were found in self-reported hand function and recovery between baseline and follow-up, with six of nine participants reaching the minimal clinically important difference on the distribution-based estimate.
02Staff reported that the virtual format worked well, but noted difficulties observing upper-limb movements due to nonideal webcam setups and managing simultaneous speech, which was challenging for participants with aphasia.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The sample size was very small, with only nine participants included in the final analysis, which limits the generalizability of the findings. The study was underpowered, and no correction for multiple comparisons was applied. Participants who could not log into a videoconference were excluded, which may bias the results toward those with higher digital literacy. The study was conducted in a single setting with only two iterations. There were discrepancies between objective measures (ArmCAM) and patient-reported outcomes (SIS-Hand), with two participants showing decreased ArmCAM scores but improved SIS-Hand scores.
Declared interests
The funders played no role in the design, conduct, or reporting of this study. The study was supported by the Stroke Recovery Association of British Columbia (SRABC/MODC), a nonprofit organization.
The easy way to misread this
Do not interpret the significant improvements in self-reported hand function as proof of efficacy. The study had a very small sample size of nine participants, was underpowered, and lacked a control group, so it is impossible to determine if the virtual program caused these changes or if they occurred naturally or due to other factors.