Using a bimanual lever-driven wheelchair for arm movement practice early after stroke: A pilot, randomized, controlled, single-blind trial.
Brendan W Smith, Joan Lobo-Prat, Daniel K Zondervan and 7 others
PMID 34027703WHAT IT FOUND
Adding 30 minutes of daily bimanual lever-wheelchair training did not significantly improve arm recovery compared to standard exercises.
The primary outcome showed no difference, though feasibility data suggests it can increase movement volume without increasing pain or tone.
Key findings
01The primary outcome, change in Upper Extremity Fugl-Meyer score, showed no statistically significant difference between the lever-wheelchair group and the conventional exercise group.
02No secondary clinical outcomes, including shoulder pain and muscle tone, showed significant differences between groups.
03Only 25% of participants in the lever-wheelchair group achieved skillful overground ambulation, though all could use the stationary gaming mode.
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 was underpowered because it stopped before reaching the target sample size of 44 participants. Participants received a lower dose of training than planned (mean 5.7 sessions for LARA vs 6.3 for control), limiting the ability to detect an effect. The yoked hand clutching mechanism was cognitively and coordinatively demanding, preventing the majority of participants from achieving overground mobility. The study could not separate the benefits of the stationary gaming mode from the overground ambulation mode.
Declared interests
Two authors are co-founders of and hold equity in Flint Rehabilitation Devices, the company commercializing the technology. One author is currently employed by the company, and another has received consulting payments from it. The study was funded by an NIH grant.
The easy way to misread this
Do not interpret the post-hoc power analysis predicting a large effect size as evidence that the treatment works. This was a null trial with a small sample, and the predicted benefit is an estimate for future research, not a confirmed clinical outcome.