Robot-assisted and conventional therapies produce distinct rehabilitative trends in stroke survivors
Year: 2016
Type: article
Abstract: BACKGROUND: Comparing the efficacy of alternative therapeutic strategies for the rehabilitation of motor function in chronically impaired individuals is often inconclusive. For example, a recent randomized clinical trial (RCT) compared robot-assisted vs. conventional therapy in 77 patients who had had chronic motor impairment after a cerebrovascular accident. While patients assigned to robotic therapy had greater improvements in the primary outcome measure (change in score on the upper extremity section of the Fugl-Meyer assessment), the absolute difference between therapies was small, which left the clinical relevance in question. METHODS: Here we revisit that study to test whether the multidimensional rehabilitative response of these patients can better distinguish between treatment outcomes. We used principal components analysis to find the correlation of changes across seven outcome measures between the start and end of 8 weeks of therapy. Permutation tests verified the robustness of the principal components found. RESULTS: Each therapy in fact produces different rehabilitative trends of recovery across the clinical, functional, and quality of life domains. A rehabilitative trend is a principal component that quantifies the correlations among changes in outcomes with each therapy. CONCLUSIONS: These findings challenge the traditional emphasis of RCTs on using a single primary outcome measure to compare rehabilitative responses that are naturally multidimensional. This alternative approach to, and interpretation of, the results of RCTs may will lead to more effective therapies targeted for the multidimensional mechanisms of recovery. TRIAL REGISTRATION: ClinicalTrials.gov number NCT00719433 . Registered July 17, 2008.
Language: English
Subfield: Rehabilitation
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,990
Funders: National Science Foundation, Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung, Eidgenössische Technische Hochschule Zürich, National Institutes of Health, National Institute on Disability and Rehabilitation Research, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Division of Emerging Frontiers in Research and Innovation
Awards: G3625451693, Control of finger movement and force for precision pinch, Functional recovery in stroke patients with task-specific robot-aided arm therapy, G5298371816, Structure and function of the fingers tendinous apparatus, EFRI-COPN: Reverse-engineering the Human Brain's Ability to Control the Hand
OpenAlex ID: W2529985333