A self-administered Graded Repetitive Arm Supplementary Program (GRASP) improves arm function during inpatient stroke rehabilitation: a multi-site randomized controlled trial.
OBJECTIVE
More than 70% of individuals who have a stroke experience upper limb deficits that impact daily activities. Increased amount of upper limb therapy has positive effects; however, practical and inexpensive methods of therapy are needed to deliver this increase in therapy.


METHODS
This was a multi-site single blind randomized controlled trial to determine the effectiveness of a 4-week self-administered graded repetitive upper limb supplementary program (GRASP) on arm recovery in stroke. 103 inpatients with stroke were randomized to the experimental group (GRASP group, n=53) or the control group (education protocol, n=50). The primary outcome measure was the Chedoke Arm and Hand Activity Inventory (CAHAI), a measure of upper limb function in activities of daily living. Secondary measures were used to evaluate grip strength and paretic upper limb use outside of therapy time. Intention-to-treat analysis was performed. Group differences were tested using analysis of covariance.


RESULTS
At the end of the 4-week intervention (approximately 7 weeks poststroke), the GRASP group showed greater improvement in upper limb function (CAHAI) compared to the control group (mean difference 6.2; 95% CI: 3.4 to 9.0; P<0.001). The GRASP group maintained this significant gain at 5 months poststroke. Significant differences were also found in favor of the GRASP protocol for grip strength and paretic upper limb use. No serious adverse effects were experienced.


CONCLUSIONS
A self-administered homework exercise program provides a cost-, time-, and treatment-effective delivery model for improving upper limb recovery in subacute stroke.
Harris
Jocelyn E
JE
Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, British Columbia, Canada.
Eng
Janice J
JJ
Miller
William C
WC
Dawson
Andrew S
AS
D000203:Activities of Daily Living; D000368:Aged; D000704:Analysis of Variance; D001132:Arm / Q000502:physiology*; D005081:Exercise Therapy; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008297:Male; D053580:Muscle Strength / Q000502:physiology; D010865:Pilot Projects; D016037:Single-Blind Method; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome