Does an early increased-intensity interdisciplinary upper limb therapy programme following acute stroke improve outcome?

OBJECTIVE

To determine whether an early increased-intensity upper limb therapy programme following acute stroke improves outcome.

DESIGN

A randomized controlled trial.

SETTING

A stroke unit which provides acute care and rehabilitation for all stroke admissions.

SUBJECTS

One hundred and twenty-three patients who had had a stroke causing upper limb impairment within the previous 10 days.

INTERVENTION

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.

MAIN OUTCOME MEASURES

The primary outcome measure was the Action Research Arm Test (ARAT) three months after stroke.

SECONDARY OUTCOME MEASURES

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.

RESULTS

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.

CONCLUSIONS

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.