Effect of a Task-Oriented Rehabilitation Program on Upper Extremity Recovery Following Motor Stroke

作者：Carolee J. Winstein, Steven L. Wolf, Alexander W. Dromerick, Christianne J. Lane, Monica A. Nelsen, Rebecca Lewthwaite, Steven Cen, Stanley P. Azen, for the Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) Investigative Team · 发表于：JAMA · 年份：2016 · DOI：10.1001/jama.2016.0276 · 被引用次数：353 · 研究领域：Stroke Rehabilitation and Recovery、Occupational Therapy Practice and Research、Cerebral Palsy and Movement Disorders

IMPORTANCE: Clinical trials suggest that higher doses of task-oriented training are superior to current clinical practice for patients with stroke with upper extremity motor deficits. OBJECTIVE: To compare the efficacy of a structured, task-oriented motor training program vs usual and customary occupational therapy (UCC) during stroke rehabilitation. DESIGN, SETTING, AND PARTICIPANTS: Phase 3, pragmatic, single-blind randomized trial among 361 participants with moderate motor impairment recruited from 7 US hospitals over 44 months, treated in the outpatient setting from June 2009 to March 2014. INTERVENTIONS: Structured, task-oriented upper extremity training (Accelerated Skill Acquisition Program [ASAP]; n = 119); dose-equivalent occupational therapy (DEUCC; n = 120); or monitoring-only occupational therapy (UCC; n = 122). The DEUCC group was prescribed 30 one-hour sessions over 10 weeks; the UCC group was only monitored, without specification of dose. MAIN OUTCOMES AND MEASURES: The primary outcome was 12-month change in log-transformed Wolf Motor Function Test time score (WMFT, consisting of a mean of 15 timed arm movements and hand dexterity tasks). Secondary outcomes were change in WMFT time score (minimal clinically important difference [MCID] = 19 seconds) and proportion of patients improving ≥25 points on the Stroke Impact Scale (SIS) hand function score (MCID = 17.8 points). RESULTS: Among the 361 randomized patients (mean age, 60.7 years; 56% men; 42% African Americ...