AUTHOR=Hunter Susan M. , Johansen-Berg Heidi , Ward Nick , Kennedy Niamh C. , Chandler Elizabeth , Weir Christopher John , Rothwell John , Wing Alan M. , Grey Michael J. , Barton Garry , Leavey Nick Malachy , Havis Claire , Lemon Roger N. , Burridge Jane , Dymond Amy , Pomeroy Valerie M. 

TITLE=Functional Strength Training and Movement Performance Therapy for Upper Limb Recovery Early Poststroke—Efficacy, Neural Correlates, Predictive Markers, and Cost-Effectiveness: FAST-INdiCATE Trial

JOURNAL=Frontiers in Neurology

VOLUME=8

YEAR=2018

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2017.00733

DOI=10.3389/fneur.2017.00733

ISSN=1664-2295

ABSTRACT=<sec id="ST1"><title>Background</title><p>Variation in physiological deficits underlying upper limb paresis after stroke could influence how people recover and to which physical therapy they best respond.</p></sec><sec id="ST2"><title>Objectives</title><p>To determine whether functional strength training (FST) improves upper limb recovery more than movement performance therapy (MPT). To identify: (a) neural correlates of response and (b) whether pre-intervention neural characteristics predict response.</p></sec><sec id="ST3"><title>Design</title><p>Explanatory investigations within a randomised, controlled, observer-blind, and multicentre trial. Randomisation was computer-generated and concealed by an independent facility until baseline measures were completed. Primary time point was outcome, after the 6-week intervention phase. Follow-up was at 6 months after stroke.</p></sec><sec id="ST4"><title>Participants</title><p>With some voluntary muscle contraction in the paretic upper limb, not full dexterity, when recruited up to 60 days after an anterior cerebral circulation territory stroke.</p></sec><sec id="ST5"><title>Interventions</title><p>Conventional physical therapy (CPT) plus either MPT or FST for up to 90 min-a-day, 5 days-a-week for 6 weeks. FST was “hands-off” progressive resistive exercise cemented into functional task training. MPT was “hands-on” sensory/facilitation techniques for smooth and accurate movement.</p></sec><sec id="ST6"><title>Outcomes</title><p>The primary efficacy measure was the Action Research Arm Test (ARAT). Neural measures: fractional anisotropy (FA) corpus callosum midline; asymmetry of corticospinal tracts FA; and resting motor threshold (RMT) of motor-evoked potentials.</p></sec><sec id="ST7"><title>Analysis</title><p>Covariance models tested ARAT change from baseline. At outcome: correlation coefficients assessed relationship between change in ARAT and neural measures; an interaction term assessed whether baseline neural characteristics predicted response.</p></sec><sec id="ST8"><title>Results</title><p>288 Participants had: mean age of 72.2 (SD 12.5) years and mean ARAT 25.5 (18.2). For 240 participants with ARAT at baseline and outcome the mean change was 9.70 (11.72) for FST + CPT and 7.90 (9.18) for MPT + CPT, which did not differ statistically (<italic>p</italic> = 0.298). Correlations between ARAT change scores and baseline neural values were between 0.199, <italic>p</italic> = 0.320 for MPT + CPT RMT (<italic>n</italic> = 27) and −0.147, <italic>p</italic> = 0.385 for asymmetry of corticospinal tracts FA (<italic>n</italic> = 37). Interaction effects between neural values and ARAT change between baseline and outcome were not statistically significant.</p></sec><sec id="ST9"><title>Conclusions</title><p>There was no significant difference in upper limb improvement between FST and MPT. Baseline neural measures did not correlate with upper limb recovery or predict therapy response.</p></sec><sec id="ST10"><title>Trial registration</title><p>Current Controlled Trials: ISRCT 19090862, <uri xlink:href="http://www.controlled-trials.com" xmlns:xlink="http://www.w3.org/1999/xlink">http://www.controlled-trials.com</uri></p></sec>