title: Effects of Unilateral Upper Limb Training in Two Distinct Prognostic Groups Early After Stroke: The EXPLICIT-Stroke Randomized Clinical Trial.
abstract: Background and Objective Favorable prognosis of the upper limb depends on preservation or return of voluntary finger extension (FE) early after stroke. The present study aimed to determine the effects of modified constraint-induced movement therapy (mCIMT) and electromyography-triggered neuromuscular stimulation (EMG-NMS) on upper limb capacity early poststroke. Methods A total of 159 ischemic stroke patients were included: 58 patients with a favorable prognosis (>10° of FE) were randomly allocated to 3 weeks of mCIMT or usual care only; 101 patients with an unfavorable prognosis were allocated to 3-week EMG-NMS or usual care only. Both interventions started within 14 days poststroke, lasted up until 5 weeks, focused at preservation or return of FE. Results Upper limb capacity was measured with the Action Research Arm Test (ARAT), assessed weekly within the first 5 weeks poststroke and at postassessments at 8, 12, and 26 weeks. Clinically relevant differences in ARAT in favor of mCIMT were found after 5, 8, and 12 weeks poststroke (respectively, 6, 7, and 7 points; P < .05), but not after 26 weeks. We did not find statistically significant differences between mCIMT and usual care on impairment measures, such as the Fugl-Meyer assessment of the arm (FMA-UE). EMG-NMS did not result in significant differences. Conclusions Three weeks of early mCIMT is superior to usual care in terms of regaining upper limb capacity in patients with a favorable prognosis; 3 weeks of EMG-NMS in patients with an unfavorable prognosis is not beneficial. Despite meaningful improvements in upper limb capacity, no evidence was found that the time-dependent neurological improvements early poststroke are significantly influenced by either mCIMT or EMG-NMS.
authors.affiliation: Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands.
authors.forename: Gert
authors.initials: G
authors.lastname: Kwakkel
authors.affiliation: Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Caroline
authors.initials: C
authors.lastname: Winters
authors.affiliation: Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands e.vanwegen@vumc.nl.
authors.forename: Erwin E H
authors.initials: EE
authors.lastname: van Wegen
authors.affiliation: Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands.
authors.forename: Rinske H M
authors.initials: RH
authors.lastname: Nijland
authors.affiliation: Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Annette A A
authors.initials: AA
authors.lastname: van Kuijk
authors.affiliation: Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Anne
authors.initials: A
authors.lastname: Visser-Meily
authors.affiliation: Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jurriaan
authors.initials: J
authors.lastname: de Groot
authors.affiliation: Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Delft, The Netherlands.
authors.forename: Erwin
authors.initials: E
authors.lastname: de Vlugt
authors.affiliation: Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: J Hans
authors.initials: JH
authors.lastname: Arendzen
authors.affiliation: Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Alexander C H
authors.initials: AC
authors.lastname: Geurts
authors.affiliation: Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Carel G M
authors.initials: CG
authors.lastname: Meskers
mesh_terms: D000328:Adult; D000368:Aged; D001132:Arm / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058765:Neurofeedback / Q000379:methods*; D026741:Physical Therapy Modalities; D011379:Prognosis; D012149:Restraint, Physical / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016037:Single-Blind Method; D020521:Stroke; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D034941:Upper Extremity / Q000502:physiology*
keywords: constraint-induced movement therapy (CIMT); electromyography-triggered neuromuscular stimulation (EMG-NMS); randomized controlled trial (RCT); stroke; upper limb