Unilateral vs Bilateral Hybrid Approaches for Upper Limb Rehabilitation in Chronic Stroke: A Randomized Controlled Trial

Chung-Shan Hung; Keh-Chung Lin; Wan-Ying Chang; Wen-Chih Huang; Ya-Ju Chang; Chia-Ling Chen; Kaiping Grace Yao; Ya-Yun Lee

doi:10.1016/j.apmr.2019.06.021

Unilateral vs Bilateral Hybrid Approaches for Upper Limb Rehabilitation in Chronic Stroke: A Randomized Controlled Trial

Arch Phys Med Rehabil. 2019 Dec;100(12):2225-2232. doi: 10.1016/j.apmr.2019.06.021. Epub 2019 Aug 14.

Authors

Chung-Shan Hung¹, Keh-Chung Lin², Wan-Ying Chang³, Wen-Chih Huang⁴, Ya-Ju Chang⁵, Chia-Ling Chen⁶, Kaiping Grace Yao⁷, Ya-Yun Lee⁸

Affiliations

¹ Department of Community and Aging, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
² School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: kehchunglin@ntu.edu.tw.
³ Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.
⁴ Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, Miaoli General Hospital, Ministry of Health and Welfare, Miaoli, Taiwan.
⁵ Physical Therapy Department and Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan.
⁶ Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan; Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁷ Department of Psychology, College of Science, National Taiwan University, Taipei, Taiwan.
⁸ School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.

PMID: 31421096
DOI: 10.1016/j.apmr.2019.06.021

Abstract

Objective: To investigate the effects of unilateral hybrid therapy (UHT) and bilateral hybrid therapy (BHT) compared with robot-assisted therapy (RT) alone in patients with chronic stroke.

Design: A single-blind, randomized controlled trial.

Setting: Four hospitals.

Participants: Outpatients with chronic stroke and mild to moderate motor impairment (N=44).

Intervention: UHT combined unilateral RT (URT) and modified constraint-induced therapy. BHT combined bilateral RT (BRT) and bilateral arm training. The RT group received URT and BRT. The intervention frequency for the 3 groups was 90 min/d 3 d/wk for 6 weeks.

Main outcome measures: Fugl-Meyer Assessment (FMA, divided into the proximal and distal subscale) and Stroke Impact Scale (SIS) version 3.0 scores before, immediately after, and 3 months after treatment and Wolf Motor Function Test (WMFT) and Nottingham Extended Activities of Daily Living (NEADL) scale scores before and immediately after treatment.

Results: The results favored BHT over UHT on the FMA total score and distal score at the posttest (P=.03 and .04) and follow-up (P=.01 and .047) assessment and BHT over RT on the follow-up FMA distal scores (P=.03). At the posttest assessment, the WMFT and SIS scores of the 3 groups improved significantly without between-group differences, and the RT group showed significantly greater improvement in the mobility domain of NEADL compared with the BHT group (P<.01).

Conclusions: BHT was more effective for improving upper extremity motor function, particularly distal motor function at follow-up, and individuals in the RT group demonstrated improved functional ambulation post intervention.

Trial registration: ClinicalTrials.gov NCT02451280.

Keywords: Randomized controlled trial; Rehabilitation; Robotics; Stroke; Therapy.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living
Adult
Aged
Biomechanical Phenomena
Chronic Disease
Disability Evaluation
Exercise Therapy / methods*
Female
Humans
Male
Middle Aged
Range of Motion, Articular
Recovery of Function
Robotics*
Single-Blind Method
Stroke Rehabilitation / methods*
Upper Extremity / physiopathology*

Associated data

ClinicalTrials.gov/NCT02451280

Abstract

Publication types

MeSH terms

Associated data

Grants and funding