Changes in Upper-Extremity Functional Capacity and Daily Performance During Outpatient Occupational Therapy for People With Stroke

Doman, Caitlin; Waddell, Kimberly J.; Bailey, Ryan R.; Moore, Jennifer L.; Lang, Catherine E.

doi:10.5014/ajot.2016.020891

Cited by 66 publications

(66 citation statements)

References 48 publications

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“…Results showed a high degree of variability in UL capacity and performance, with a small minority of patients demonstrating concordance between improved capacity and improved performance. The results challenge a common assumption among therapists that improvements in capacity observed in the clinic translate into improved performance in daily life [38].…”

Section: Inefficiencies In Our Current Approach To Medical Rehabilitamentioning

confidence: 64%

The Digital Health Revolution and People with Disabilities: Perspective from the United States

Jones

DeRuyter

Morris

2020

IJERPH

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This article serves as the introduction to this special issue on Mobile Health and Mobile Rehabilitation for People with Disabilities. Social, technological and policy trends are reviewed. Needs, opportunities and challenges for the emerging fields of mobile health (mHealth, aka eHealth) and mobile rehabilitation (mRehab) are discussed. Healthcare in the United States (U.S.) is at a critical juncture characterized by: (1) a growing need for healthcare and rehabilitation services; (2) maturing technological capabilities to support more effective and efficient health services; (3) evolving public policies designed, by turns, to contain cost and support new models of care; and (4) a growing need to ensure acceptance and usability of new health technologies by people with disabilities and chronic conditions, clinicians and health delivery systems. Discussion of demographic and population health data, healthcare service delivery and a public policy primarily focuses on the U.S. However, trends identified (aging populations, growing prevalence of chronic conditions and disability, labor shortages in healthcare) apply to most countries with advanced economies and others. Furthermore, technologies that enable mRehab (wearable sensors, in-home environmental monitors, cloud computing, artificial intelligence) transcend national boundaries. Remote and mobile healthcare delivery is needed and inevitable. Proactive engagement is critical to ensure acceptance and effectiveness for all stakeholders.

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Section: Inefficiencies In Our Current Approach To Medical Rehabilitamentioning

confidence: 64%

The Digital Health Revolution and People with Disabilities: Perspective from the United States

Jones

DeRuyter

Morris

2020

IJERPH

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“…9 Six examples of individual patients from the baseline data of this same cohort can be seen in Figure 2 of Bailey et al NNR 2015. Examples of how individual density plots change over time in persons with stroke can be seen in Figure 4B of Hayward et al 47 and in Figure 1 in Doman et al 27 …”

Section: Methodsmentioning

confidence: 99%

Does Task-Specific Training Improve Upper Limb Performance in Daily Life Poststroke?

Waddell

Strube

Bailey

et al. 2016

Neurorehabil Neural Repair

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128

105

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Background A common assumption is that changes in upper limb (UL) capacity, or what an individual is capable of doing, translate to improved UL performance in daily life, or what an individual actually does. This assumption should be explicitly tested for individuals with UL paresis post-stroke. Objective To examine changes in UL performance after an intensive, individualized, progressive, task-specific UL intervention for individuals at least 6 months post-stroke. Methods Secondary analysis on 78 individuals with UL paresis who participated in a Phase II, single-blind, randomized parallel dose-response trial. Participants were enrolled in a task-specific intervention for 8 weeks. Participants were randomized into 1 of 4 treatment groups with each group completing different amounts of UL movement practice. UL performance was assessed with bilateral, wrist-worn accelerometers once a week for 24 hours throughout the duration of the study. The six accelerometer variables were tested for change and the influence of potential modifiers using hierarchical linear modeling. Results No changes in UL performance were found on any of the 6 accelerometer variables used to quantify UL performance. Neither changes in UL capacity nor the overall amount of movement practice influenced changes in UL performance. Stroke chronicity, baseline UL capacity, concordance, and ADL status significantly increased the baseline starting points but did not influence the rate of change (slopes) for participants. Conclusions Improved motor capacity resulting from an intensive outpatient UL intervention does not appear to translate to increased UL performance outside the clinic.

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“…Previous research has noted distinct recovery profiles during inpatient [4,5] and outpatient [6] rehabilitation. Firstly, survivors may demonstrate improvements in both capacity and performance after stroke.…”

Section: Introductionmentioning

confidence: 93%

“…what a person can do in the clinical environment) and performance (i.e. does a person actually use their UL in real world environments outside of the clinic) [2]. However, UL recovery post stroke is unlikely to be this simplistic [3].…”

Section: Introductionmentioning

confidence: 99%

Recovery of upper limb function is greatest early after stroke but does continue to improve during the chronic phase: a two-year, observational study

Borschmann

Hayward

2020

Physiotherapy

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Objectives Investigate upper limb (UL) capacity and performance from <14-days to 24-months post stroke. Design Longitudinal study of participants with acute stroke, assessed ≤14-days, 6-weeks, 3-, 6-, 12-, 18-, and 24-months post stroke. Setting Two acute stroke units. Main outcome measures Examination of UL capacity using Chedoke McMaster Stroke Assessment (combined arm and hand scores, 0-14), performance using Motor Activity Log (amount of movement and quality of movement, scored 0-5), and grip strength (kg) using Jamar dynamometer. Random effects regression models were performed to explore the change in outcomes at each time point. Routine clinical imaging was used to describe stroke location as cortical, subcortical or mixed. Results Thirty-four participants were enrolled: median age 67.7 years (IQR 60.7-76.2), NIHSS 11.5 (IQR 8.5-16), female n = 10 (36%). The monthly rate of change for all measures was consistently greatest in the 6-weeks post baseline. On average, significant improvements were observed to 12-months in amount of use (median improvement 1.81, 95% CI 1.35 to 2.27) and strength (median improvement 8.29, 95% CI 5.90 to 10.67); while motor capacity (median improvement 4.70, 95% CI 3.8 to 5.6) and quality of movement (median improvement 1.83, 95% CI 1.37 to 2.3) improved to 18-months post stroke. Some individuals were still demonstrating gains at 24-months post stroke within each stroke location group. Conclusion This study highlights that the greatest rate of improvement of UL capacity and performance occurs early post stroke. At the group level, improvements were evident at 12-to 18-months post stroke, but at the individual level improvements were observed at 24-months.Clinical trial registration ACTRN12612000123842.

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Changes in Upper-Extremity Functional Capacity and Daily Performance During Outpatient Occupational Therapy for People With Stroke

Cited by 66 publications

References 48 publications

The Digital Health Revolution and People with Disabilities: Perspective from the United States

The Digital Health Revolution and People with Disabilities: Perspective from the United States

Does Task-Specific Training Improve Upper Limb Performance in Daily Life Poststroke?

Recovery of upper limb function is greatest early after stroke but does continue to improve during the chronic phase: a two-year, observational study

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