Effects of forced use on arm function in the subacute phase after stroke: a randomized, clinical pilot study.
OBJECTIVE
Following stroke, it is common to exhibit motor impairments and decreased use of the upper limb. The objective of the present study was to evaluate forced use on arm function during the subacute phase after stroke.


METHODS
A comparison of standard rehabilitation only and standard rehabilitation together with a restraining sling was made through a randomized, nonblinded, clinical pilot trial with assessments before intervention, after intervention, and at 1- and 3-month follow-ups.


METHODS
The present study took place at the departments of rehabilitation medicine, geriatrics, and neurology at a university hospital.


METHODS
A convenience sample of 30 people 1 to 6 months (mean, 2.4 mo) after stroke was randomized into 2 groups (forced-use group and standard training group) of 15 people each. Twenty-six participants completed the 3-month follow-up.


METHODS
All participants received their standard rehabilitation program with training 5 days per week for 2 weeks as inpatients or outpatients. The forced-use group also wore a restraining sling on the nonparetic arm with a target of 6 hours per day.


METHODS
The Fugl-Meyer (FM) test, the Action Research Arm Test, the Motor Assessment Scale (MAS) (sum of scores for the upper limb), a 16-hole peg test (16HPT), a grip strength ratio (paretic hand to nonparetic hand), and the Modified Ashworth Scale were used to obtain measurements.


RESULTS
The changes in the forced-use group did not differ from the changes in the standard training group for any of the outcome measures. Both groups improved over time, with statistically significant changes in the FM test (mean score changed from 52 to 57), MAS (mean score changed from 10.1 to 12.4), 16HPT (mean time changed from >92 seconds to 60 seconds), and grip strength ratio (mean changed from 0.40 to 0.55).


CONCLUSIONS
The limitations of this pilot study include an extended study time, a nonblinded assessor, a lack of control of treatment content, and a small sample size.


CONCLUSIONS
The results of the present pilot study did not support forced use as a reinforcement of standard rehabilitation in the subacute phase after stroke. Forced use did not generate greater improvements with regard to motor impairment and capacity than standard rehabilitation alone. The findings of this effectiveness study will be used to help design future clinical trials with the aim of revealing a definitive conclusion regarding the clinical implementation of forced use for upper-limb rehabilitation.
Department of Rehabilitation Medicine, Orebro University Hospital, and School of Health and Medical Sciences, Orebro University, S-70185 Orebro, Sweden. ann.hammer@orebroll.se
Ann M
AM
Hammer
Birgitta
B
Lindmark
D000368:Aged; D000704:Analysis of Variance; D001132:Arm / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D013548:Sweden; D016896:Treatment Outcome