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Functional strength training and movement performance therapy for upper limb recovery early poststroke—efficacy, neural correlates, predictive markers, and cost-effectiveness: FAST-INdiCATE Trial

Functional strength training and movement performance therapy for upper limb recovery early poststroke—efficacy, neural correlates, predictive markers, and cost-effectiveness: FAST-INdiCATE Trial
Functional strength training and movement performance therapy for upper limb recovery early poststroke—efficacy, neural correlates, predictive markers, and cost-effectiveness: FAST-INdiCATE Trial
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 (p = 0.298). Correlations between ARAT change scores and baseline neural values were between 0.199, p = 0.320 for MPT + CPT RMT (n = 27) and −0.147, p = 0.385 for asymmetry of corticospinal tracts FA (n = 37). Interaction effects between neural values and ARAT change between baseline and outcome were not statistically significant.

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.
1664-2295
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Hunter, Susan M.
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Johansen-Berg, Heidi
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Ward, Nick
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Kennedy, Niamh C.
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Chandler, Elizabeth
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Weir, Christopher John
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Rothwell, John
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Wing, Alan M
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Grey, Michael J.
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Barton, Garry
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Malachy Leavey, Nick
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Havis, Claire
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Lemon, Roger N.
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Burridge, Jane
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Dymond, Amy
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Pomeroy, Valerie M.
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Hunter, Susan M.
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Johansen-Berg, Heidi
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Ward, Nick
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Kennedy, Niamh C.
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Chandler, Elizabeth
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Weir, Christopher John
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Rothwell, John
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Wing, Alan M
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Grey, Michael J.
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Barton, Garry
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Malachy Leavey, Nick
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Havis, Claire
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Lemon, Roger N.
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Burridge, Jane
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Dymond, Amy
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Pomeroy, Valerie M.
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Hunter, Susan M., Johansen-Berg, Heidi, Ward, Nick, Kennedy, Niamh C., Chandler, Elizabeth, Weir, Christopher John, Rothwell, John, Wing, Alan M, Grey, Michael J., Barton, Garry, Malachy Leavey, Nick, Havis, Claire, Lemon, Roger N., Burridge, Jane, Dymond, Amy and Pomeroy, Valerie M. (2018) 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, 8, 1-24, [733]. (doi:10.3389/fneur.2017.00733).

Record type: Article

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 (p = 0.298). Correlations between ARAT change scores and baseline neural values were between 0.199, p = 0.320 for MPT + CPT RMT (n = 27) and −0.147, p = 0.385 for asymmetry of corticospinal tracts FA (n = 37). Interaction effects between neural values and ARAT change between baseline and outcome were not statistically significant.

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.

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Functional strength Training and Movement Performance Therapy for Upper limb recovery early Poststroke—efficacy, neural correlates, Predictive Markers, and cost-effectiveness: FasT-indicaTe Trial - Version of Record
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Accepted/In Press date: 19 December 2017
e-pub ahead of print date: 25 January 2018
Published date: 25 January 2018

Identifiers

Local EPrints ID: 417847
URI: http://eprints.soton.ac.uk/id/eprint/417847
ISSN: 1664-2295
PURE UUID: 838cc3c4-caf7-447c-8ef6-73dfac8440c3
ORCID for Jane Burridge: ORCID iD orcid.org/0000-0003-3497-6725

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Date deposited: 15 Feb 2018 17:30
Last modified: 13 Nov 2021 02:38

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Contributors

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

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