title: Home-based Reach-to-Grasp training for people after stroke is feasible: a pilot randomised controlled trial.
abstract: OBJECTIVE
  To determine feasibility of a randomised controlled trial (RCT) of home-based Reach-to-Grasp training after stroke.
  
  
  METHODS
  single-blind parallel group RCT.
  
  
  METHODS
  Residual arm deficit less than 12 months post-stroke.
  
  
  METHODS
  Reach-to-Grasp training in 14 one-hour therapist's visits over 6 weeks, plus one hour self-practice per day (total 56 hours).
  
  
  METHODS
  Usual care.
  
  
  METHODS
  Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), pre-randomisation, 7, 12, 24 weeks post-randomisation.
  
  
  RESULTS
  Forty-seven participants (Reach-to-Grasp=24, usual care=23) were randomised over 17 months. Reach-to-Grasp participants received a median (IQR) 14 (13,14) visits, and performed 157 (96,211) repetitions per visit; plus 30 minutes (22,45) self-practice per day. Usual care participants received 10.5 (5,14) therapist visits, comprising 38.6 (30,45) minutes of arm therapy with 16 (6,24) repetitions of functional tasks per visit. Median ARAT scores in the reach-to-grasp group were 8.5 (3.0,24.0) at baseline and 14.5 (3.5,26.0) at 24 weeks compared to median of 4 at both time points (IQR: baseline (3.0,14.0), 24 weeks (3.0,30.0)) in the usual-care group. Median WMFT tasks completed at baseline and 24 weeks were 6 (3.0,11.5) and 8.5 (4.5,13.5) respectively in the reach-to-grasp group and 4 (3.0,10.0), 6 (3.0,14.0) in the usual care group. Incidence of arm pain was similar between groups. The study was stopped before 11 patients reached the 24 weeks assessment.
  
  
  CONCLUSIONS
  An RCT of home-based Reach-to-Grasp training after stroke is feasible and safe. With ARAT being our preferred measure it is estimated that 240 participants will be needed for a future two armed trial.
authors.affiliation: 1 Department of Allied Health Professions, University of the West of England, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Turton
authors.affiliation: 1 Department of Allied Health Professions, University of the West of England, UK.
authors.forename: P
authors.initials: P
authors.lastname: Cunningham
authors.affiliation: 2 Institute for Applied Health Research and School of Health and Life Sciences, Glasgow Caledonian University, UK.
authors.forename: F
authors.initials: F
authors.lastname: van Wijck
authors.affiliation: 3 Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, UK.
authors.forename: Hjm
authors.initials: H
authors.lastname: Smartt
authors.affiliation: 3 Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, UK.
authors.forename: C A
authors.initials: CA
authors.lastname: Rogers
authors.affiliation: 4 Institute of Health and Social Care Research, King's College London, UK.
authors.forename: C M
authors.initials: CM
authors.lastname: Sackley
authors.affiliation: 5 School of Health and Population Sciences, University of Birmingham, UK.
authors.forename: S
authors.initials: S
authors.lastname: Jowett
authors.affiliation: 6 Emory Rehabilitation Hospital, Emory University, Atlanta, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Wolf
authors.affiliation: 7 Institute of Cancer and Genomic Sciences, University of Birmingham, UK.
authors.forename: K
authors.initials: K
authors.lastname: Wheatley
authors.affiliation: 8 School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Australia, and Hunter Medical Research Institute, UK.
authors.forename: P
authors.initials: P
authors.lastname: van Vliet
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D018570:Risk Assessment; D016037:Single-Blind Method; D020521:Stroke / Q000175:diagnosis*; D000071939:Stroke Rehabilitation / Q000379:methods*; D016896:Treatment Outcome
keywords: Stroke; hand function; home rehabilitation; randomized controlled trial; upper extremity (arm)