The University of Southampton
University of Southampton Institutional Repository

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
1-24
Hunter, Susan M.
d4040b16-ebb2-45db-8337-4b5a1ed704c6
Johansen-Berg, Heidi
28e65bcc-5807-485a-b3d8-5a14ec464d54
Ward, Nick
7cf86ed6-2373-4470-840d-9d140a940277
Kennedy, Niamh C.
661daff7-724c-41a6-aa74-51a4186f7511
Chandler, Elizabeth
032466d4-98d6-41a7-b1a6-99603773ed88
Weir, Christopher John
a18afc76-ca8f-467d-8d71-7d81b198436f
Rothwell, John
fbb90cf5-88aa-4516-a693-935fd36b4f06
Wing, Alan M
2de28c53-81fc-4bd1-a9f0-8a7dda7c1466
Grey, Michael J.
212c85a0-e47b-4691-9b01-7ab8465bdbf4
Barton, Garry
a93f5218-d26f-4e4f-ba79-4ed63c22182a
Malachy Leavey, Nick
c2b0e56e-d060-460e-80d6-7b00d9d6c88c
Havis, Claire
68ad7c1a-0285-4d21-8962-bbe5be47ba2a
Lemon, Roger N.
b1bff74a-af36-4b2c-aa68-a9737793d5f2
Burridge, Jane
0110e9ea-0884-4982-a003-cb6307f38f64
Dymond, Amy
9db8382f-349b-42cb-a2b5-5669ae5c9987
Pomeroy, Valerie M.
d2abb394-ab10-49d3-ade9-e920dc74c253
Hunter, Susan M.
d4040b16-ebb2-45db-8337-4b5a1ed704c6
Johansen-Berg, Heidi
28e65bcc-5807-485a-b3d8-5a14ec464d54
Ward, Nick
7cf86ed6-2373-4470-840d-9d140a940277
Kennedy, Niamh C.
661daff7-724c-41a6-aa74-51a4186f7511
Chandler, Elizabeth
032466d4-98d6-41a7-b1a6-99603773ed88
Weir, Christopher John
a18afc76-ca8f-467d-8d71-7d81b198436f
Rothwell, John
fbb90cf5-88aa-4516-a693-935fd36b4f06
Wing, Alan M
2de28c53-81fc-4bd1-a9f0-8a7dda7c1466
Grey, Michael J.
212c85a0-e47b-4691-9b01-7ab8465bdbf4
Barton, Garry
a93f5218-d26f-4e4f-ba79-4ed63c22182a
Malachy Leavey, Nick
c2b0e56e-d060-460e-80d6-7b00d9d6c88c
Havis, Claire
68ad7c1a-0285-4d21-8962-bbe5be47ba2a
Lemon, Roger N.
b1bff74a-af36-4b2c-aa68-a9737793d5f2
Burridge, Jane
0110e9ea-0884-4982-a003-cb6307f38f64
Dymond, Amy
9db8382f-349b-42cb-a2b5-5669ae5c9987
Pomeroy, Valerie M.
d2abb394-ab10-49d3-ade9-e920dc74c253

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.

Text
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
Available under License Creative Commons Attribution.
Download (1MB)

More information

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

Catalogue record

Date deposited: 15 Feb 2018 17:30
Last modified: 16 Mar 2024 02:57

Export record

Altmetrics

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

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×