Rodgers Helen, Mackintosh Joan, Price Christopher, Wood Ruth, McNamee Paul, Fearon Tracy, Marritt Anna, Curless Richard
School of Clinical Medical Sciences, University of Newcastle upon Tyne and North Tyneside General Hospital, Northumbria Healthcare Trust, Newcastle upon Tyne, UK.
Clin Rehabil. 2003 Sep;17(6):579-89. doi: 10.1191/0269215503cr652oa.
To determine whether an early increased-intensity upper limb therapy programme following acute stroke improves outcome.
A randomized controlled trial.
A stroke unit which provides acute care and rehabilitation for all stroke admissions.
One hundred and twenty-three patients who had had a stroke causing upper limb impairment within the previous 10 days.
The intervention group received stroke unit care plus enhanced upper limb rehabilitation provided jointly by a physiotherapist and occupational therapist, commencing within 10 days of stroke, and available up to 30 minutes/day, five days/week for six weeks. The control group received stroke unit care.
The primary outcome measure was the Action Research Arm Test (ARAT) three months after stroke.
Motricity Index; Frenchay Arm Test; upper limb pain; Barthel ADL Index; Nottingham E-ADL Scale; and costs to health and social services at three and six months after stroke.
There were no differences in outcomes between the intervention and control groups three and six months after stroke. During the intervention period the intervention group received a median of 29 minutes of enhanced upper limb therapy per working day as inpatients. The total amount of inpatient physiotherapy and occupational therapy received by the intervention group was a median of 52 minutes per working day during the intervention period and 38 minutes per working day for the control group (p = 0.001). There were no differences in service costs.
An early increased-intensity interdisciplinary upper limb therapy programme jointly provided by a physiotherapist and occupational therapist did not improve outcome after stroke. The actual difference in the amount of therapy received by intervention and control groups was less than planned due to a competitive therapy bias.
确定急性中风后早期强化上肢治疗方案是否能改善预后。
一项随机对照试验。
一个为所有中风患者提供急性护理和康复服务的中风单元。
123名在过去10天内发生中风并导致上肢功能障碍的患者。
干预组接受中风单元护理，外加由物理治疗师和职业治疗师联合提供的强化上肢康复治疗，在中风后10天内开始，每天最多30分钟，每周5天，持续6周。对照组接受中风单元护理。
中风后3个月的行动研究上肢测试（ARAT）。
运动指数；弗伦奇上肢测试；上肢疼痛；巴氏日常生活活动指数；诺丁汉电子日常生活活动量表；以及中风后3个月和6个月时的健康和社会服务成本。
中风后3个月和6个月时，干预组和对照组的预后无差异。在干预期间，干预组住院患者每个工作日接受强化上肢治疗的中位数为29分钟。干预组在干预期间接受的住院物理治疗和职业治疗总量为每个工作日中位数52分钟；对照组为每个工作日38分钟（p = 0.001）。服务成本无差异。
由物理治疗师和职业治疗师联合提供的早期强化跨学科上肢治疗方案并不能改善中风后的预后。由于竞争性治疗偏差，干预组和对照组实际接受的治疗量差异小于计划量。
