van der Lee J H, Wagenaar R C, Lankhorst G J, Vogelaar T W, Devillé W L, Bouter L M
Department of Rehabilitation Medicine, University Hospital Vrije Universiteit, and Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, The Netherlands.
Stroke. 1999 Nov;30(11):2369-75. doi: 10.1161/01.str.30.11.2369.
Of all stroke survivors, 30% to 66% are unable to use their affected arm in performing activities of daily living. Although forced use therapy appears to improve arm function in chronic stroke patients, there is no conclusive evidence. This study evaluates the effectiveness of forced use therapy.
In an observer-blinded randomized clinical trial, 66 chronic stroke patients were allocated to either forced use therapy (immobilization of the unaffected arm combined with intensive training) or a reference therapy of equally intensive bimanual training, based on Neuro-Developmental Treatment, for a period of 2 weeks. Outcomes were evaluated on the basis of the Rehabilitation Activities Profile (activities), the Action Research Arm (ARA) test (dexterity), the upper extremity section of the Fugl-Meyer Assessment scale, the Motor Activity Log (MAL), and a Problem Score. The minimal clinically important difference (MCID) was determined at the onset of the study.
One week after the last treatment session, a significant difference in effectiveness in favor of the forced use group compared with the bimanual group (corrected for baseline differences) was found for the ARA score (3.0 points; 95% CI, 1.3 to 4.8; MCID, 5.7 points) and the MAL amount of use score (0.52 points; 95% CI, 0.11 to 0.93; MCID, 0.50). The other parameters revealed no significant differential effects. One-year follow-up effects were observed only for the ARA. The differences in treatment effect for the ARA and the MAL amount of use scores were clinically relevant for patients with sensory disorders and hemineglect, respectively.
The present study showed a small but lasting effect of forced use therapy on the dexterity of the affected arm (ARA) and a temporary clinically relevant effect on the amount of use of the affected arm during activities of daily living (MAL amount of use). The effect of forced use therapy was clinically relevant in the subgroups of patients with sensory disorders and hemineglect, respectively.
在所有中风幸存者中，30%至66%的人无法在日常生活活动中使用其患侧手臂。尽管强制使用疗法似乎能改善慢性中风患者的手臂功能，但尚无确凿证据。本研究评估强制使用疗法的有效性。
在一项观察者盲法随机临床试验中，66名慢性中风患者被分配至强制使用疗法组（健侧手臂固定并结合强化训练）或基于神经发育疗法的同等强度双手训练参考疗法组，为期2周。基于康复活动量表（活动）、动作研究臂（ARA）测试（灵活性）、Fugl-Meyer评估量表上肢部分、运动活动日志（MAL）和问题评分来评估结果。在研究开始时确定最小临床重要差异（MCID）。
在最后一次治疗 session 后一周，与双手训练组相比，强制使用组在有效性方面存在显著差异（校正基线差异后），ARA 评分（3.0分；95%CI，1.3至4.8；MCID，5.7分）和 MAL 使用量评分（0.52分；95%CI，0.11至0.93；MCID，0.50）。其他参数未显示出显著的差异效应。仅对ARA观察到了一年的随访效应。ARA和MAL使用量评分的治疗效果差异分别对感觉障碍和偏侧忽视患者具有临床相关性。
本研究表明，强制使用疗法对患侧手臂的灵活性（ARA）有微小但持久的影响，对日常生活活动中患侧手臂的使用量（MAL使用量）有暂时的临床相关影响。强制使用疗法的效果分别在感觉障碍和偏侧忽视患者亚组中具有临床相关性。
