Long-Dose Intensive Therapy Is Necessary for Strong, Clinically Significant, Upper Limb Functional Gains and Retained Gains in Severe/Moderate Chronic Stroke.
Janis J Daly, Jessica P McCabe, John Holcomb and 3 others
PMID 31131743WHAT IT FOUND
Severe/moderate chronic stroke survivors who received 300 hours of intensive upper-limb therapy improved coordination and function.
Gains remained at 3 months, and functional task performance improved further.
Key findings
01Across the three combined treatment groups, Fugl-Meyer coordination improved 9.8 points from pre-treatment to post-treatment, double the minimum clinically important difference.
02There was no plateau at 150 hours; Fugl-Meyer coordination improved another 5.1 points from mid-treatment to post-treatment.
03Functional task performance continued to improve after treatment ended: AMAT-F increased 0.11 points and AMAT-T improved 109 points from post-treatment to 3-month follow-up.
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 study had no untreated or usual-care control group, so it cannot rule out effects from time, attention, or natural recovery. Follow-up data were available for 31 participants, and baseline data were reported for 36 participants. The most frequent reason for leaving was transportation difficulty. The sample was small and group sizes were unequal, with 10 in the proximal group, 8 in the distal group, and 18 in the whole arm group. The study was singleblind, and only the examiner was blinded. The therapy was very intensive, 5 hours per day, 5 days per week for 12 weeks, and may not be available in many services. The protocol combined motor learning, functional task practice, and technology-assisted movement support, so the effect of any single component cannot be separated. The same group developed the protocol and reported this as a replication of their prior work.
Declared interests
The authors declared no potential conflicts of interest. The study was funded by the Department of Veterans Affairs Rehabilitation Research and Development grant # B3709 and Career Scientist Award B5080S.
The easy way to misread this
Do not read this as proof that 300 hours is required for every patient or that FES or robotics alone caused the gains. The study had no untreated control group, all groups received 70% motor learning and functional task practice plus technology for 30% of time, and the three groups did not differ in response.