Hejazi-Shirmard Mahnaz, Taghizadeh Ghorban, Rassafiani Mehdi, Cheraghifard Moslem, Yousefi Mahin, Hosseini Seyed Hossein, Askary Kachoosangy Reihaneh, Lajevardi Laleh
Department of Occupational Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Geriatric Mental Health Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
Disabil Rehabil. 2025 Apr;47(7):1807-1816. doi: 10.1080/09638288.2024.2384622. Epub 2024 Jul 30.
The present study aimed to compare the effectiveness of Top-down and Bottom-up approaches on levels of the International Classification of Functioning, Disability and Health Framework (ICF), including impairments, activities, and participation.
Thirty-nine chronic stroke survivors were recruited for this single-blinded randomized clinical trial. Participants were assigned to Top-down, Bottom-up interventions, or control group, and received a 6-week intervention. They were assessed before/after treatments and at follow-up (6 weeks later). Impairments were measured through kinematic analysis, Trail Making Tests (TMT), and Fugl-Meyer Assessment (FMA). Activity and participation were evaluated Box and Block Test, Motor Activity Log (MAL), and Canadian Occupational Performance Measure (COPM), respectively.
We found significant improvements in impairment (FMA) and participation (COPM) in all groups, however, COPM scores improved beyond the MCID only in the Top-down, and FMA scores exceeded the MCID in Top-down and Bottom-up groups. Use of the upper limb in daily activities (MAL) enhanced in the Top-down group, although was not clinically significant.
In most of the outcome measures, no significant difference was observed between groups. It seems that Top-down, Bottom-up, and traditional interventions have relatively comparable effectiveness in chronic stroke survivors.
IRCT20150721023277N2.
本研究旨在比较自上而下和自下而上方法对国际功能、残疾和健康分类框架（ICF）各层面的有效性，包括损伤、活动和参与。
39名慢性卒中幸存者被纳入这项单盲随机临床试验。参与者被分配到自上而下、自下而上干预组或对照组，并接受为期6周的干预。在治疗前/后以及随访时（6周后）对他们进行评估。通过运动学分析、连线测验（TMT）和Fugl-Meyer评估（FMA）来测量损伤。分别使用箱块测试、运动活动日志（MAL）和加拿大职业表现测量量表（COPM）来评估活动和参与情况。
我们发现所有组在损伤（FMA）和参与（COPM）方面均有显著改善，然而，仅自上而下组的COPM评分改善超过了最小临床重要差异（MCID），自上而下组和自下而上组的FMA评分均超过了MCID。自上而下组在日常活动中上肢的使用（MAL）有所增强，尽管在临床上无显著意义。
在大多数结局指标中，各小组之间未观察到显著差异。似乎自上而下、自下而上和传统干预措施在慢性卒中幸存者中具有相对可比的有效性。
IRCT20150721023277N2。
