The Efficiency, Efficacy, and Retention of Task Practice in Chronic Stroke.
Chunji Wang, Carolee Winstein, David Z D'Argenio and 1 others
PMID 32830617WHAT IT FOUND
More practice hours improved perceived arm movement quality in chronic stroke, but extra hours gave smaller gains and larger doses faded faster.
The authors suggest shorter, spread-out practice and encouraging daily arm use to retain gains.
Key findings
01Higher practice dose increased the MAL score during training, mainly due to the 60-hour dose.
02The gain per hour fell as dose rose, and the gain per week fell as practice continued.
03After training, larger doses showed more decay, but average post-training movement quality above about 3.4 was linked to continued increase.
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 outcome was self-reported movement quality, not a direct measure of impairment, function, or the choice to use the arm. Only 41 participants were analyzed, and dose groups were not balanced at baseline; the 30-hour group started with higher MAL, which may have reduced apparent gains. The trial did not vary the number of practice weeks, so the effect of a third week on later retention could not be tested. The 0-hour group may have received practice through assessments, because the WMFT and BART included many arm and hand movements. It is unclear whether the results apply to acute or sub-acute stroke. The analysis assumed forgetting was smaller than learning during practice, and model fit was poor for one participant.
Declared interests
The authors declare no conflict of interest. The article is listed as supported by NIH and non-U.S. government research sources.
The easy way to misread this
Do not read the higher immediate MAL gains in the 60-hour group as proof that more supervised hours give better long-term arm function. The model showed less gain per hour at higher dose, more decay after larger dose, and no difference across dose groups from initial to final MAL.