The ESCAPS study: a feasibility randomised controlled trial of early electrical stimulation to the wrist extensors and flexors to prevent post-stroke complications of pain and contractures in the paretic arm

Abstract

Objective: to establish feasibility of initiating electrical stimulation treatment of
wrist extensors and flexors in patients early after stroke to prevent muscle
contractures and pain.

Design: feasibility randomised controlled trial with economic evaluation.

Setting: a specialist stroke unit in Nottinghamshire.

Subjects: forty patients recruited within 72 hours post-stroke with arm
hemiparesis.

Interventions: participants were randomised to receive usual care or usual
care and electrical stimulation to wrist flexors and extensors for 30 minutes,
twice a day, five days a week for three months. Initial treatment was delivered
by an occupational therapist or physiotherapist who trained participants to selfmanage subsequent treatments.

Measures: measures of feasibility included recruitment and attrition rates,
completion of treatment, successful data collection. Outcome data on wrist
range of motion, pain, arm function, independence, quality of life and resource
use were measured at 3, 6- and 12-months post-randomisation.

Results: forty participants (of 215 potentially eligible) were recruited in 15
months [20 men; mean age 72(SD 13.0)]. Half the participants lacked mental
capacity and were recruited by consultee consent. Attrition at three-month
follow-up was 12.5% [death (n=2), end-of-life care (n=2), unable to contact
(n=1)]. Compliance varied [mean 65 (SD 53)] and ranged from 10 to 166
treatments per patient (target dosage was 120). Data for a valid economic
analysis can be adequately collected.

Conclusion: early initiation of electrical Stimulation was acceptable and
feasible. Data collection methods used were feasible and acceptable to
participants. A large definitive study is needed to determine if electrical
stimulation is efficacious and cost effective.

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Identifiers

ORCID for Dawn-Marie Walker: orcid.org/0000-0003-2135-1363

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