title: Efficacy of Occupational Therapy Task-oriented Approach in Upper Extremity Post-stroke Rehabilitation.
abstract: There is a need for more effective rehabilitation methods for individuals post-stroke. Occupational Therapy Task-Oriented (TO) approach has not been evaluated in a randomized clinical trial. The purpose of this study was to evaluate functional and impairment efficacies of TO approach on the more-affected Upper Extremity (UE) of persons post-stroke. A randomized single-blinded cross-over trial recruited 20 participants post-stroke (mean chronicity = 62 months) who demonstrated at least 10° active more-affected shoulder flexion and abduction and elbow flexion-extension. Participants were randomized into immediate (n = 10) and delayed intervention (n = 10) groups. Immediate group had 6 weeks of 3 hr/week TO intervention followed by 6 weeks of no-intervention control. Delayed intervention group underwent the reversed order. Functional measures included Canadian Occupational Performance Measure (COPM), Motor Activity Log (MAL), and Wolf Motor Function Test (WMFT). Impairment measures included UE Active Range of Motion (AROM) and handheld dynamometry strength. Measurements were obtained at baseline, cross over, and end of the study. TO intervention showed statistically higher functional change scores. COPM performance and satisfaction scores were 2.83 and 3.46 units greater respectively (p < .001), MAL amount of use and quality of use scores were 1.1 and 0.87 units greater, respectively (p < .001), WMFT time was 8.35 seconds faster (p = .009). TO impairment outcomes were not significantly larger than control ones. TO approach appears to be an effective UE post-stroke rehabilitation approach inducing clinically meaningful functional improvements. More studies are needed with larger samples and specific stroke chronicity and severity. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Khader A
authors.initials: KA
authors.lastname: Almhdawi
authors.affiliation: Department of Rehabilitation Science, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Virgil G
authors.initials: VG
authors.lastname: Mathiowetz
authors.affiliation: Abbott Northwestern Hospital, Courage Kenny Rehabilitation Institute, Minneapolis, MN, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: White
authors.affiliation: Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: delMas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018592:Cross-Over Studies; D004551:Elbow Joint / Q000503:physiopathology; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy / Q000379:methods*; D010291:Paresis / Q000534:rehabilitation; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012785:Shoulder Joint / Q000503:physiopathology; D016037:Single-Blind Method; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation / Q000379:methods*; D013647:Task Performance and Analysis; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*
keywords: functional; neurorehabilitation; occupational therapy; paretic upper extremity; stroke rehabilitation; task-oriented