Functional Strength Training and Movement Performance Therapy for upper limb recovery early post-stroke – efficacy, neural correlates, predictive markers and cost-effectiveness: FAST-INdiCATE trial

Susan M. Hunter, Heidi Johansen-Berg, Nick Ward, Niamh C. Kennedy, Elizabeth Chandler, Christopher John Weir, John Rothwell, Alan M. Wing, Michael J. Grey, Garry Barton, Nick Malachy Leavey, Claire Havis, Roger N. Lemon, Jane Burridge, Amy Dymond, Valerie M. Pomeroy

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Abstract

Background: Variation in physiological deficits underlying upper limb paresis after stroke could influence how people recover and to which physical therapy they best respond.Objectives: To determine whether functional strength training (FST) improves upper limb recovery more than movement performance therapy (MPT). To identify: (a) neural correlates of response and (b) whether pre-intervention neural characteristics predict response.Design: Explanatory investigations within a randomised, controlled, observer-blind, and multicentre trial. Randomisation was computer-generated and concealed by an independent facility until baseline measures were completed. Primary time point was outcome, after the 6-week intervention phase. Follow-up was at 6 months after stroke.Participants: With some voluntary muscle contraction in the paretic upper limb, not full dexterity, when recruited up to 60 days after an anterior cerebral circulation territory stroke.Interventions: Conventional physical therapy (CPT) plus either MPT or FST for up to 90 min-a-day, 5 days-a-week for 6 weeks. FST was “hands-off” progressive resistive exercise cemented into functional task training. MPT was “hands-on” sensory/facilitation techniques for smooth and accurate movement.Outcomes: The primary efficacy measure was the Action Research Arm Test (ARAT). Neural measures: fractional anisotropy (FA) corpus callosum midline; asymmetry of corticospinal tracts FA; and resting motor threshold (RMT) of motor-evoked potentials.Analysis: Covariance models tested ARAT change from baseline. At outcome: correlation coefficients assessed relationship between change in ARAT and neural measures; an interaction term assessed whether baseline neural characteristics predicted response.Results: 288 Participants had: mean age of 72.2 (SD 12.5) years and mean ARAT 25.5 (18.2). For 240 participants with ARAT at baseline and outcome the mean change was 9.70 (11.72) for FST + CPT and 7.90 (9.18) for MPT + CPT, which did not differ statistically (p = 0.298). Correlations between ARAT change scores and baseline neural values were between 0.199, p = 0.320 for MPT + CPT RMT (n = 27) and −0.147, p = 0.385 for asymmetry of corticospinal tracts FA (n = 37). Interaction effects between neural values and ARAT change between baseline and outcome were not statistically significant.Conclusions: There was no significant difference in upper limb improvement between FST and MPT. Baseline neural measures did not correlate with upper limb recovery or predict therapy response.Trial registration: Current Controlled Trials: ISRCT 19090862, http://www.controlled-trials.com
LanguageEnglish
Pages1-24
Number of pages25
JournalFrontiers in Neurology
Volume8
Early online date25 Jan 2018
DOIs
Publication statusE-pub ahead of print - 25 Jan 2018

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Resistance Training
Upper Extremity
Cost-Benefit Analysis
Stroke
Health Services Research
Anisotropy
Therapeutics
Pyramidal Tracts
Cerebrovascular Circulation
Motor Evoked Potentials
Corpus Callosum
Paresis
Random Allocation
Muscle Contraction
Multicenter Studies
Skeletal Muscle
Hand

Keywords

  • stroke
  • rehabilitation
  • physical therapy
  • transcranial magnetic stimulation
  • magnetic resonance
  • imaging
  • upper limb
  • prediction

Cite this

Hunter, Susan M. ; Johansen-Berg, Heidi ; Ward, Nick ; Kennedy, Niamh C. ; Chandler, Elizabeth ; Weir, Christopher John ; Rothwell, John ; Wing, Alan M. ; Grey, Michael J. ; Barton, Garry ; Leavey, Nick Malachy ; Havis, Claire ; Lemon, Roger N. ; Burridge, Jane ; Dymond, Amy ; Pomeroy, Valerie M. / Functional Strength Training and Movement Performance Therapy for upper limb recovery early post-stroke – efficacy, neural correlates, predictive markers and cost-effectiveness: FAST-INdiCATE trial. In: Frontiers in Neurology. 2018 ; Vol. 8. pp. 1-24.
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title = "Functional Strength Training and Movement Performance Therapy for upper limb recovery early post-stroke – efficacy, neural correlates, predictive markers and cost-effectiveness: FAST-INdiCATE trial",
abstract = "Background: Variation in physiological deficits underlying upper limb paresis after stroke could influence how people recover and to which physical therapy they best respond.Objectives: To determine whether functional strength training (FST) improves upper limb recovery more than movement performance therapy (MPT). To identify: (a) neural correlates of response and (b) whether pre-intervention neural characteristics predict response.Design: Explanatory investigations within a randomised, controlled, observer-blind, and multicentre trial. Randomisation was computer-generated and concealed by an independent facility until baseline measures were completed. Primary time point was outcome, after the 6-week intervention phase. Follow-up was at 6 months after stroke.Participants: With some voluntary muscle contraction in the paretic upper limb, not full dexterity, when recruited up to 60 days after an anterior cerebral circulation territory stroke.Interventions: Conventional physical therapy (CPT) plus either MPT or FST for up to 90 min-a-day, 5 days-a-week for 6 weeks. FST was “hands-off” progressive resistive exercise cemented into functional task training. MPT was “hands-on” sensory/facilitation techniques for smooth and accurate movement.Outcomes: The primary efficacy measure was the Action Research Arm Test (ARAT). Neural measures: fractional anisotropy (FA) corpus callosum midline; asymmetry of corticospinal tracts FA; and resting motor threshold (RMT) of motor-evoked potentials.Analysis: Covariance models tested ARAT change from baseline. At outcome: correlation coefficients assessed relationship between change in ARAT and neural measures; an interaction term assessed whether baseline neural characteristics predicted response.Results: 288 Participants had: mean age of 72.2 (SD 12.5) years and mean ARAT 25.5 (18.2). For 240 participants with ARAT at baseline and outcome the mean change was 9.70 (11.72) for FST + CPT and 7.90 (9.18) for MPT + CPT, which did not differ statistically (p = 0.298). Correlations between ARAT change scores and baseline neural values were between 0.199, p = 0.320 for MPT + CPT RMT (n = 27) and −0.147, p = 0.385 for asymmetry of corticospinal tracts FA (n = 37). Interaction effects between neural values and ARAT change between baseline and outcome were not statistically significant.Conclusions: There was no significant difference in upper limb improvement between FST and MPT. Baseline neural measures did not correlate with upper limb recovery or predict therapy response.Trial registration: Current Controlled Trials: ISRCT 19090862, http://www.controlled-trials.com",
keywords = "stroke, rehabilitation, physical therapy, transcranial magnetic stimulation, magnetic resonance, imaging, upper limb, prediction",
author = "Hunter, {Susan M.} and Heidi Johansen-Berg and Nick Ward and Kennedy, {Niamh C.} and Elizabeth Chandler and Weir, {Christopher John} and John Rothwell and Wing, {Alan M.} and Grey, {Michael J.} and Garry Barton and Leavey, {Nick Malachy} and Claire Havis and Lemon, {Roger N.} and Jane Burridge and Amy Dymond and Pomeroy, {Valerie M.}",
note = "UIR Compliant - evidence uploaded to other files. OPEN ACCESS article",
year = "2018",
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doi = "10.3389/fneur.2017.00733",
language = "English",
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Hunter, SM, Johansen-Berg, H, Ward, N, Kennedy, NC, Chandler, E, Weir, CJ, Rothwell, J, Wing, AM, Grey, MJ, Barton, G, Leavey, NM, Havis, C, Lemon, RN, Burridge, J, Dymond, A & Pomeroy, VM 2018, 'Functional Strength Training and Movement Performance Therapy for upper limb recovery early post-stroke – efficacy, neural correlates, predictive markers and cost-effectiveness: FAST-INdiCATE trial', Frontiers in Neurology, vol. 8, pp. 1-24. https://doi.org/10.3389/fneur.2017.00733

Functional Strength Training and Movement Performance Therapy for upper limb recovery early post-stroke – efficacy, neural correlates, predictive markers and cost-effectiveness: FAST-INdiCATE trial. / Hunter, Susan M.; Johansen-Berg, Heidi; Ward, Nick; Kennedy, Niamh C.; Chandler, Elizabeth; Weir, Christopher John; Rothwell, John; Wing, Alan M.; Grey, Michael J.; Barton, Garry; Leavey, Nick Malachy; Havis, Claire; Lemon, Roger N.; Burridge, Jane; Dymond, Amy; Pomeroy, Valerie M.

In: Frontiers in Neurology, Vol. 8, 25.01.2018, p. 1-24.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Functional Strength Training and Movement Performance Therapy for upper limb recovery early post-stroke – efficacy, neural correlates, predictive markers and cost-effectiveness: FAST-INdiCATE trial

AU - Hunter, Susan M.

AU - Johansen-Berg, Heidi

AU - Ward, Nick

AU - Kennedy, Niamh C.

AU - Chandler, Elizabeth

AU - Weir, Christopher John

AU - Rothwell, John

AU - Wing, Alan M.

AU - Grey, Michael J.

AU - Barton, Garry

AU - Leavey, Nick Malachy

AU - Havis, Claire

AU - Lemon, Roger N.

AU - Burridge, Jane

AU - Dymond, Amy

AU - Pomeroy, Valerie M.

N1 - UIR Compliant - evidence uploaded to other files. OPEN ACCESS article

PY - 2018/1/25

Y1 - 2018/1/25

N2 - Background: Variation in physiological deficits underlying upper limb paresis after stroke could influence how people recover and to which physical therapy they best respond.Objectives: To determine whether functional strength training (FST) improves upper limb recovery more than movement performance therapy (MPT). To identify: (a) neural correlates of response and (b) whether pre-intervention neural characteristics predict response.Design: Explanatory investigations within a randomised, controlled, observer-blind, and multicentre trial. Randomisation was computer-generated and concealed by an independent facility until baseline measures were completed. Primary time point was outcome, after the 6-week intervention phase. Follow-up was at 6 months after stroke.Participants: With some voluntary muscle contraction in the paretic upper limb, not full dexterity, when recruited up to 60 days after an anterior cerebral circulation territory stroke.Interventions: Conventional physical therapy (CPT) plus either MPT or FST for up to 90 min-a-day, 5 days-a-week for 6 weeks. FST was “hands-off” progressive resistive exercise cemented into functional task training. MPT was “hands-on” sensory/facilitation techniques for smooth and accurate movement.Outcomes: The primary efficacy measure was the Action Research Arm Test (ARAT). Neural measures: fractional anisotropy (FA) corpus callosum midline; asymmetry of corticospinal tracts FA; and resting motor threshold (RMT) of motor-evoked potentials.Analysis: Covariance models tested ARAT change from baseline. At outcome: correlation coefficients assessed relationship between change in ARAT and neural measures; an interaction term assessed whether baseline neural characteristics predicted response.Results: 288 Participants had: mean age of 72.2 (SD 12.5) years and mean ARAT 25.5 (18.2). For 240 participants with ARAT at baseline and outcome the mean change was 9.70 (11.72) for FST + CPT and 7.90 (9.18) for MPT + CPT, which did not differ statistically (p = 0.298). Correlations between ARAT change scores and baseline neural values were between 0.199, p = 0.320 for MPT + CPT RMT (n = 27) and −0.147, p = 0.385 for asymmetry of corticospinal tracts FA (n = 37). Interaction effects between neural values and ARAT change between baseline and outcome were not statistically significant.Conclusions: There was no significant difference in upper limb improvement between FST and MPT. Baseline neural measures did not correlate with upper limb recovery or predict therapy response.Trial registration: Current Controlled Trials: ISRCT 19090862, http://www.controlled-trials.com

AB - Background: Variation in physiological deficits underlying upper limb paresis after stroke could influence how people recover and to which physical therapy they best respond.Objectives: To determine whether functional strength training (FST) improves upper limb recovery more than movement performance therapy (MPT). To identify: (a) neural correlates of response and (b) whether pre-intervention neural characteristics predict response.Design: Explanatory investigations within a randomised, controlled, observer-blind, and multicentre trial. Randomisation was computer-generated and concealed by an independent facility until baseline measures were completed. Primary time point was outcome, after the 6-week intervention phase. Follow-up was at 6 months after stroke.Participants: With some voluntary muscle contraction in the paretic upper limb, not full dexterity, when recruited up to 60 days after an anterior cerebral circulation territory stroke.Interventions: Conventional physical therapy (CPT) plus either MPT or FST for up to 90 min-a-day, 5 days-a-week for 6 weeks. FST was “hands-off” progressive resistive exercise cemented into functional task training. MPT was “hands-on” sensory/facilitation techniques for smooth and accurate movement.Outcomes: The primary efficacy measure was the Action Research Arm Test (ARAT). Neural measures: fractional anisotropy (FA) corpus callosum midline; asymmetry of corticospinal tracts FA; and resting motor threshold (RMT) of motor-evoked potentials.Analysis: Covariance models tested ARAT change from baseline. At outcome: correlation coefficients assessed relationship between change in ARAT and neural measures; an interaction term assessed whether baseline neural characteristics predicted response.Results: 288 Participants had: mean age of 72.2 (SD 12.5) years and mean ARAT 25.5 (18.2). For 240 participants with ARAT at baseline and outcome the mean change was 9.70 (11.72) for FST + CPT and 7.90 (9.18) for MPT + CPT, which did not differ statistically (p = 0.298). Correlations between ARAT change scores and baseline neural values were between 0.199, p = 0.320 for MPT + CPT RMT (n = 27) and −0.147, p = 0.385 for asymmetry of corticospinal tracts FA (n = 37). Interaction effects between neural values and ARAT change between baseline and outcome were not statistically significant.Conclusions: There was no significant difference in upper limb improvement between FST and MPT. Baseline neural measures did not correlate with upper limb recovery or predict therapy response.Trial registration: Current Controlled Trials: ISRCT 19090862, http://www.controlled-trials.com

KW - stroke

KW - rehabilitation

KW - physical therapy

KW - transcranial magnetic stimulation

KW - magnetic resonance

KW - imaging

KW - upper limb

KW - prediction

U2 - 10.3389/fneur.2017.00733

DO - 10.3389/fneur.2017.00733

M3 - Article

VL - 8

SP - 1

EP - 24

JO - Frontiers in Neurology

T2 - Frontiers in Neurology

JF - Frontiers in Neurology

SN - 1664-2295

ER -