Authors: (including presenting author): :
Chim HT(1), Wong HL(1),Bryan Chung PH(1), Leo Cheung CT(1)
Affiliation: :
(1) Physiotherapy Department, Tai Po Hospital
Keyword 2: :
Upper Extremity
Introduction: :
Providing suitable interventions to people with stroke according to their upper extremity deficits is important. Traditionally, intervention selection to people with stroke varied by personal background and experience of therapists, which in turn affecting rehabilitation outcomes. A standardized stroke rehabilitation program may minimize the influence of therapists’ experience and bias.
Objectives: :
The objective of the program was to investigate the effectiveness of this standardized stroke upper extremity rehabilitation program in the domains of upper extremity motor function.
Methodology: :
A new standardized stroke upper extremity rehabilitation program was designed on the basis of Shortened Fugl-Meyer Assessment (S-FM) stratification. S-FM consisted of six items examining upper extremity movements (shoulder elevation, shoulder flexion 90° to 180°, elbow extension, elbow 90°pronation/supination, elbow 90° wrist flexion/extension and grasp, adduct thumb). Each item was scored with an ordinal scale of 0-2 with total score 12. It was found to be comparable with the 33-item upper extremity subscale of original FMA. In clinical settings, S-FM was suggested to be able to distinguish clinically important changes that 1-point change was expected to exceed the error range. Participants were classified into 3 categories based on their level of upper extremity impairment reflected by the baseline S-FM score (severe 0-4, moderate 5-8, and mild 9-12). Upper extremity training, with standardized treatment choices preset with expert opinions, was provided accordingly. Treatment choices included stretching exercise and positioning, mobilization exercise, strengthening exercise, hand function training, mirror therapy, electrical therapy and acupuncture. Treatments were classified with progression of difficulties indifferent parts of upper extremity to match the S-FM scale. For the control group, participants received conventional training prescribed based on the corporate stroke rehabilitation protocol of Hong Kong Hospital Authority. The protocol introduced different treatments without classification of upper extremity impairment level and progression. It allowed variations in clinical practice and ultimate decision about a particular clinical treatment depended on each individual patient’s condition and clinical judgment of individual therapists. Both groups received training by physiotherapists for 5 days per week. The duration of each physiotherapy session was 60 to 90 minutes depended on participants’ tolerance and motivation. The number of training sessions was 5 to 20 depended on participants’ length of stay. 39 participants were analyzed.
Result & Outcome: :
Of the total 44 participants, 39 completed the program and 5 dropped out. Outcomes of 19 participants of the experimental group and 20 participants of the control group were analyzed. S-FM was used to evaluate upper extremity motor function gain. Both experimental and control group showed improvements in S-FM. Though the improvements were slightly higher in the experimental group, there were no statistically significant interactions between the groups and time on S-FM (F(1,37)=0.38, p=0.54). The change of functional outcomes with participants categorized into mild (baseline S-FM=9-12),moderate (baseline S-FM=5-8), and severe (baseline S-FM=0-4)upper extremity impairment. There were no statistically significant interactions between the groups, upper extremity impairment levels and time on S-FM (F(2, 33)=0.49, p=0.62,partial η2=0.029). In participants with severe upper extremity impairment, the experimental group showed greater improvements in S-FM compared to the control group, with the change in S-FM exceeding the minimal clinically important difference (MCID). However, these differences were small (partialη²=0.052-0.064) and did not reach statistical significance(p>0.25). The statistically insignificant improvements may be explained by the small sample size, especially for the category of mild and moderate upper extremity impairment, where there were only a few participants in the experimental and control group. Generalizability and statistical power were limited with the small sample size.
