A community-based upper-extremity group exercise program improves motor function and performance of functional activities in chronic stroke: a randomized controlled trial.
OBJECTIVE
To assess the effects of a community-based exercise program on motor recovery and functional abilities of the paretic upper extremity in persons with chronic stroke.


METHODS
Randomized controlled trial.


METHODS
Rehabilitation research laboratory and a community hall.


METHODS
A sample of 63 people (> or =50y) with chronic deficits resulting from stroke (onset > or =1y).


METHODS
The arm group underwent an exercise program designed to improve upper-extremity function (1h/session, 3 sessions/wk for 19wk). The leg group underwent a lower-extremity exercise program.


METHODS
The Wolf Motor Function Test (WMFT), Fugl-Meyer Assessment (FMA), hand-held dynamometry (grip strength), and the Motor Activity Log.


RESULTS
Multivariate analysis showed a significant group by time interaction (Wilks lambda=.726, P=.017), indicating that overall, the arm group had significantly more improvement than the leg group. Post hoc analysis demonstrated that gains in WMFT (functional ability) (P=.001) and FMA (P=.001) scores were significantly higher in the arm group. The amount of improvement was comparable to other novel treatment approaches such as constraint-induced movement therapy or robot-aided exercise training previously reported in chronic stroke. Participants with moderate arm impairment benefited more from the program.


CONCLUSIONS
The pilot study showed that a community-based exercise program can improve upper-extremity function in persons with chronic stroke. This outcome justifies a larger clinical trial to further assess efficacy and cost effectiveness.
Pang
Marco Y
MY
School of Rehabilitation Sciences, University of British Columbia, Rehabilitation Research Laboratory, GF Strong Centre, Vancouver, BC, Canada.
Harris
Jocelyn E
JE
Eng
Janice J
JJ
D000367:Age Factors; D000368:Aged; D002908:Chronic Disease; D003153:Community Health Services; D006233:Persons with Disabilities / Q000534:rehabilitation; D015444:Exercise / Q000502:physiology*; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D009788:Occupational Therapy / Q000379:methods; D010349:Patient Compliance; D010865:Pilot Projects; D011379:Prognosis; D020127:Recovery of Function; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D016037:Single-Blind Method; D020521:Stroke / Q000175:diagnosis*; D000071939:Stroke Rehabilitation; D034941:Upper Extremity