Improved quality of life following constraint-induced movement therapy is associated with gains in arm use, but not motor improvement.
Kristina M Kelly, Alexandra L Borstad, David Kline and 1 others
PMID 30246613WHAT IT FOUND
After constraint-induced movement therapy, better daily use of the weaker arm tracked with better quality of life.
Objective motor test gains did not track the same way, so carry-over into everyday tasks may matter more than test scores alone.
Key findings
01Participants improved in daily arm use, motor function, and quality of life. The mean changes were 1.07 points for the Motor Activity Log, 7.08 seconds for the Wolf Motor Function Test, 2.41 points for the Action Research Arm Test, and 16.60 points for the Stroke Specific Quality of Life Scale.
02Daily arm use was the only motor-related outcome significantly associated with quality of life. The correlation was 0.74 (95% credible interval 0.48, 0.89), and a one-point increase in arm-use score was associated with a 33.19-point quality-of-life change (95% credible interval 17.13, 49.34).
03The Action Research Arm Test and Wolf Motor Function Test scores were not significantly associated with quality of life: correlations were -0.09 (95% credible interval -0.63, 0.50) and -0.27 (95% credible interval -0.72, 0.32).
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
The analysis was correlational, so direct causal relationships cannot be confirmed. The sample size was small and some data were missing, though a complete-case analysis reached the same conclusions. Participants had chronic stroke and had to have some preserved movement and a daily-use deficit, so results may not apply to people with more severe or more mild upper-extremity impairment. The analysis combined data from two cohorts that differed in age and treatment delivery, and the model adjusted for cohort. The study was a retrospective correlational analysis of treated participants, not a randomized controlled trial.
Declared interests
The supplied metadata lists research support from NIH extramural and non-U.S. government sources. Authors Borstad and Gauthier were shareholders in Games That Move You, PBC, a company that commercialized the technology used in the gaming cohort. The University had conflict management plans in place. Kelly and Kline reported no conflicts of interest.
The easy way to misread this
Do not conclude that improving motor test scores alone will improve quality of life. The association was significant only for daily arm use, and the study was correlational, so it cannot prove that any component caused the quality of life gains.