title: Potential effectiveness of three different treatment approaches to improve minimal to moderate arm and hand function after stroke--a pilot randomized clinical trial.
abstract: OBJECTIVE
  To test a study design and explore the feasibility and potential effects of conventional neurological therapy, constraint induced therapy and therapeutic climbing to improve minimal to moderate arm and hand function in patients after a stroke.
  
  
  METHODS
  A pilot study with six-month follow-up in patients after stroke with minimal to moderate arm and hand function admitted for inpatient rehabilitation was performed. Participants were randomly allocated to one of three treatment approaches. Main outcomes were improvement of arm and hand function and adverse effects.
  
  
  RESULTS
  283 patients with stroke were screened for inclusion over a two-year period, out of which fourtyfour were included. All patients could be treated according to the protocol. Improvement of arm and hand function was significantly higher in conventional neurological therapy and constraint induced therapy compared with therapeutic climbing at discharge, and at six months follow-up (P < 0.05, effect size = 0.56-0.76). No significant differences in arm and hand function were observed between constraint induced therapy and conventional neurological therapy. Constraint induced therapy participants were significantly less at risk of developing shoulder pain at six months follow-up compared with the other participants (P < 0.05, effect size = 0.82 and 1.79, respectively).
  
  
  CONCLUSIONS
  The study design needs adaptation to accommodate the stringent inclusion criteria leading to prolonged study duration. Constraint induced therapy seems to be the optimal approach to improve arm and hand function and minimize the risk of shoulder pain for patients with minimal to moderate arm hand function after stroke in the intermediate term.
authors.affiliation: Department of Neurology and Neurorehabilitation, Rehabilitation Center Valens, Switzerland. christine.meier.khan@enzyklop.info
authors.forename: Christine Meier
authors.initials: CM
authors.lastname: Khan
authors.forename: Peter R
authors.initials: PR
authors.lastname: Oesch
authors.forename: Urs N
authors.initials: UN
authors.lastname: Gamper
authors.forename: Jan P
authors.initials: JP
authors.lastname: Kool
authors.forename: Serafin
authors.initials: S
authors.lastname: Beer
mesh_terms: D001132:Arm / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006225:Hand / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D020127:Recovery of Function / Q000502:physiology*; D012149:Restraint, Physical / Q000009:adverse effects / Q000379:methods; D020069:Shoulder Pain / Q000209:etiology; D018709:Statistics, Nonparametric; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation