Almhdawi Khader A, Mathiowetz Virgil G, White Matthew, delMas Robert C
Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan.
Department of Rehabilitation Science, University of Minnesota, Minneapolis, MN, USA.
Occup Ther Int. 2016 Dec;23(4):444-456. doi: 10.1002/oti.1447. Epub 2016 Oct 20.
There is a need for more effective rehabilitation methods for individuals post-stroke. Occupational Therapy Task-Oriented (TO) approach has not been evaluated in a randomized clinical trial. The purpose of this study was to evaluate functional and impairment efficacies of TO approach on the more-affected Upper Extremity (UE) of persons post-stroke. A randomized single-blinded cross-over trial recruited 20 participants post-stroke (mean chronicity = 62 months) who demonstrated at least 10° active more-affected shoulder flexion and abduction and elbow flexion-extension. Participants were randomized into immediate (n = 10) and delayed intervention (n = 10) groups. Immediate group had 6 weeks of 3 hr/week TO intervention followed by 6 weeks of no-intervention control. Delayed intervention group underwent the reversed order. Functional measures included Canadian Occupational Performance Measure (COPM), Motor Activity Log (MAL), and Wolf Motor Function Test (WMFT). Impairment measures included UE Active Range of Motion (AROM) and handheld dynamometry strength. Measurements were obtained at baseline, cross over, and end of the study. TO intervention showed statistically higher functional change scores. COPM performance and satisfaction scores were 2.83 and 3.46 units greater respectively (p < .001), MAL amount of use and quality of use scores were 1.1 and 0.87 units greater, respectively (p < .001), WMFT time was 8.35 seconds faster (p = .009). TO impairment outcomes were not significantly larger than control ones. TO approach appears to be an effective UE post-stroke rehabilitation approach inducing clinically meaningful functional improvements. More studies are needed with larger samples and specific stroke chronicity and severity. Copyright © 2016 John Wiley & Sons, Ltd.
中风后的个体需要更有效的康复方法。面向任务的职业治疗（TO）方法尚未在随机临床试验中得到评估。本研究的目的是评估TO方法对中风后患者受影响更严重的上肢（UE）的功能和损伤疗效。一项随机单盲交叉试验招募了20名中风后患者（平均病程=62个月），这些患者表现出至少10°的受影响更严重的肩部前屈和外展以及肘部屈伸。参与者被随机分为立即干预组（n = 10）和延迟干预组（n = 10）。立即干预组接受为期6周、每周3小时的TO干预，随后是6周的无干预对照。延迟干预组则采用相反的顺序。功能测量包括加拿大职业表现测量（COPM）、运动活动日志（MAL）和沃尔夫运动功能测试（WMFT）。损伤测量包括UE主动活动范围（AROM）和手持测力计力量。在基线、交叉点和研究结束时进行测量。TO干预显示出统计学上更高的功能变化分数。COPM表现和满意度分数分别高出2.83和3.46个单位（p <.001），MAL使用量和使用质量分数分别高出1.1和0.87个单位（p <.001），WMFT时间快8.35秒（p =.009）。TO损伤结果并不显著大于对照组。TO方法似乎是一种有效的中风后UE康复方法，可带来具有临床意义的功能改善。需要更多针对更大样本、特定中风病程和严重程度的研究。版权所有© 2016约翰威立父子有限公司。
