Nerve Stimulation Enhances Task-Oriented Training for Moderate-to-Severe Hemiparesis 3-12 Months After Stroke: A Randomized Trial.
Cheryl Carrico, Philip M Westgate, Elizabeth Salmon Powell and 4 others
PMID 29794530WHAT IT FOUND
Adding nerve stimulation to intensive arm training improved task-based hand performance more than sham stimulation with the same training at the end of treatment in adults with moderate-to-severe stroke arm weakness.
Key findings
01Active stimulation plus training was favored over sham stimulation plus training on the primary hand task measure at the end of treatment and on the arm function measure at the end of treatment, 1-month, and 4-month.
02The arm motor impairment measure did not separate the groups at any timepoint.
03Active stimulation plus training was associated with improvement on the hand task and arm function measures, while sham stimulation plus training was not.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The main hand task measure may be less useful when weakness is severe, because very impaired hands can hit the bottom of the scale. The motor impairment measure may be less sensitive to change in chronic severe impairment, which could hide group differences. The active and sham groups were not equal in size, and losses to follow-up at 1 month and 4 months reduced confidence in later results. The smallest change that matters clinically was not established for these measures in people with severe arm weakness, so the clinical meaning of the differences is unclear. The trial ended because funding was completed, not because a planned stopping point was reached.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that nerve stimulation alone restored arm use. Both groups received the same intensive task-oriented training, and the trial only tested adding stimulation to that training.