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Hunter SM, Johansen-Berg H, Ward N, et al. Functional Strength Training and Movement Performance Therapy for Upper Limb Recovery Early Poststroke-Efficacy, Neural Correlates, Predictive Markers, and Cost-Effectiveness: FAST-INdiCATE Trial. Front Neurol. 2018;8:733doi: 10.3389/fneur.2017.00733.
Hunter, S. M., Johansen-Berg, H., Ward, N., Kennedy, N. C., Chandler, E., Weir, C. J., Rothwell, J., Wing, A. M., Grey, M. J., Barton, G., Leavey, N. M., Havis, C., Lemon, R. N., Burridge, J., Dymond, A., & Pomeroy, V. M. (2017). Functional Strength Training and Movement Performance Therapy for Upper Limb Recovery Early Poststroke-Efficacy, Neural Correlates, Predictive Markers, and Cost-Effectiveness: FAST-INdiCATE Trial. Frontiers in neurology, 8733. https://doi.org/10.3389/fneur.2017.00733
Hunter, Susan M, et al. "Functional Strength Training and Movement Performance Therapy for Upper Limb Recovery Early Poststroke-Efficacy, Neural Correlates, Predictive Markers, and Cost-Effectiveness: FAST-INdiCATE Trial." Frontiers in neurology vol. 8 (2017): 733. doi: https://doi.org/10.3389/fneur.2017.00733
Hunter SM, Johansen-Berg H, Ward N, Kennedy NC, Chandler E, Weir CJ, Rothwell J, Wing AM, Grey MJ, Barton G, Leavey NM, Havis C, Lemon RN, Burridge J, Dymond A, Pomeroy VM. Functional Strength Training and Movement Performance Therapy for Upper Limb Recovery Early Poststroke-Efficacy, Neural Correlates, Predictive Markers, and Cost-Effectiveness: FAST-INdiCATE Trial. Front Neurol. 2018 Jan 25;8:733. doi: 10.3389/fneur.2017.00733. eCollection 2017. PMID: 29472884; PMCID: PMC5810279.
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Front Neurol. 2018 Jan 25;8:733. doi: 10.3389/fneur.2017.00733. eCollection 2017.

Functional Strength Training and Movement Performance Therapy for Upper Limb Recovery Early Poststroke-Efficacy, Neural Correlates, Predictive Markers, and Cost-Effectiveness: FAST-INdiCATE Trial.

Frontiers in neurology

Susan M Hunter, Heidi Johansen-Berg, Nick Ward, Niamh C Kennedy, Elizabeth Chandler, Christopher John Weir, John Rothwell, Alan M Wing, Michael J Grey, Garry Barton, Nick Malachy Leavey, Claire Havis, Roger N Lemon, Jane Burridge, Amy Dymond, Valerie M Pomeroy

Affiliations

  1. School of Health and Rehabilitation, Institute for Applied Clinical Sciences, Keele University, Keele, United Kingdom.
  2. Wellcome Centre for Integrative Neuroimaging, Functional MRI of the Brain (FMRIB), University of Oxford, Nuffield Department of Clinical neurosciences, John Radcliffe Hospital, Oxford, United Kingdom.
  3. Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom.
  4. School of Psychology, Ulster University, Coleraine, United Kingdom.
  5. Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom.
  6. Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom.
  7. School of Psychology, University of Birmingham, Birmingham, United Kingdom.
  8. Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom.

PMID: 29472884 PMCID: PMC5810279 DOI: 10.3389/fneur.2017.00733

Abstract

BACKGROUND: Variation in physiological deficits underlying upper limb paresis after stroke could influence how people recover and to which physical therapy they best respond.

OBJECTIVES: To determine whether functional strength training (FST) improves upper limb recovery more than movement performance therapy (MPT). To identify: (a) neural correlates of response and (b) whether pre-intervention neural characteristics predict response.

DESIGN: Explanatory investigations within a randomised, controlled, observer-blind, and multicentre trial. Randomisation was computer-generated and concealed by an independent facility until baseline measures were completed. Primary time point was outcome, after the 6-week intervention phase. Follow-up was at 6 months after stroke.

PARTICIPANTS: With some voluntary muscle contraction in the paretic upper limb, not full dexterity, when recruited up to 60 days after an anterior cerebral circulation territory stroke.

INTERVENTIONS: Conventional physical therapy (CPT) plus either MPT or FST for up to 90 min-a-day, 5 days-a-week for 6 weeks. FST was "hands-off" progressive resistive exercise cemented into functional task training. MPT was "hands-on" sensory/facilitation techniques for smooth and accurate movement.

OUTCOMES: The primary efficacy measure was the Action Research Arm Test (ARAT). Neural measures: fractional anisotropy (FA) corpus callosum midline; asymmetry of corticospinal tracts FA; and resting motor threshold (RMT) of motor-evoked potentials.

ANALYSIS: Covariance models tested ARAT change from baseline. At outcome: correlation coefficients assessed relationship between change in ARAT and neural measures; an interaction term assessed whether baseline neural characteristics predicted response.

RESULTS: 288 Participants had: mean age of 72.2 (SD 12.5) years and mean ARAT 25.5 (18.2). For 240 participants with ARAT at baseline and outcome the mean change was 9.70 (11.72) for FST + CPT and 7.90 (9.18) for MPT + CPT, which did not differ statistically (

CONCLUSIONS: There was no significant difference in upper limb improvement between FST and MPT. Baseline neural measures did not correlate with upper limb recovery or predict therapy response.

TRIAL REGISTRATION: Current Controlled Trials: ISRCT 19090862, http://www.controlled-trials.com.

Keywords: magnetic resonance imaging; physical therapy; rehabilitation; stroke; transcranial magnetic stimulation; upper limb; prediction

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