Functional strength training and movement performance therapy produce analogous improvement in sit-to-stand early after stroke: early-phase randomised controlled trial

Kerr, Andrew; Clark, Allan; Cooke, Emma; Rowe, Peter; Pomeroy, Valerie M.

doi:10.1016/j.physio.2015.12.006

Cited by 23 publications

(29 citation statements)

References 33 publications

(37 reference statements)

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“…All participants continued to receive routine CPT throughout the trial provided by the usual clinical team. The content and dose (amount in minutes) of CPT was recorded on a standardised form ( 52 ) using the same procedure as in earlier trials ( 32 , 39 – 41 , 55 – 57 ). A CPT-only group was not employed in this trial since additional therapy is known to be beneficial ( 21 , 58 ), and the routine dose of CPT may be suboptimal ( 32 , 41 , 55 , 57 , 59 – 61 ).…”

Section: Methodsmentioning

confidence: 99%

“…The hands-on and sensory stimulation components of CPT, that focus on restoring movement quality, i.e., efficient, smooth, timely, coordinated movement with normal alignment or symmetry of body structures before retraining functional movement, is called MPT ( 39 ). The MPT elements of CPT consist of the hands-on therapy focussed on joint/soft tissue mobilisation, facilitation of muscle activity, and movement and somatosensory stimulation.…”

Section: Methodsmentioning

confidence: 99%

“…It also addressed the lack of investigation of the cost-effectiveness of physical therapy interventions ( 21 ). The two well-characterised physical therapies providing the context for investigation are used in conventional physical therapy (CPT): functional strength training (FST) focussed on improving the ability to perform everyday tasks ( 32 – 41 ); and movement performance therapy (MPT) focussed on improving the quality of movement during performance of everyday tasks ( 32 , 39 – 43 ), referred to as extra CPT in early phase studies ( 32 , 39 – 41 ). A recent systematic review concluded that such conceptually different physical therapies are probably no less or more effective than each other ( 4 ) although early phase trials indicate variation between people in their response to FST and MPT ( 32 , 41 , 44 , 45 ).…”

Section: Introductionmentioning

confidence: 99%

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Functional Strength Training and Movement Performance Therapy for Upper Limb Recovery Early Poststroke—Efficacy, Neural Correlates, Predictive Markers, and Cost-Effectiveness: FAST-INdiCATE Trial

et al. 2018

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BackgroundVariation in physiological deficits underlying upper limb paresis after stroke could influence how people recover and to which physical therapy they best respond.ObjectivesTo 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.DesignExplanatory 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.ParticipantsWith 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.InterventionsConventional 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.OutcomesThe 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.AnalysisCovariance 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.Results288 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.ConclusionsThere 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 registrationCurrent Controlled Trials: ISRCT 19090862,

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Functional Strength Training and Movement Performance Therapy for Upper Limb Recovery Early Poststroke—Efficacy, Neural Correlates, Predictive Markers, and Cost-Effectiveness: FAST-INdiCATE Trial

et al. 2018

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“…efficient, smooth, timely, co-ordinated movement with normal alignment or symmetry of body structures prior to retraining functional movement) can be termed MPT. 36 MPT is 'therapist dependent', particularly when there is limited voluntary muscle activation; the therapist monitors and provides intrinsic feedback on movement performance through skilled observation, handling and facilitation techniques. Therapist-led hands-on guidance and feedback assists practice of functional tasks.…”

Section: Trial Intervention: Movement Performance Therapymentioning

confidence: 99%

“…MPT is the component of routine CPT that is focused on enhancing the quality of the movements required for the performance of everyday functional tasks. 28,[35][36][37][38] Such conceptually different physical therapies have been found in a meta-analysis to be no more or less effective than each other. 39 However, in both of our early-phase trials we found marked variation within people in their response to MPT and to FST.…”

Section: Chapter 1 Introductionmentioning

confidence: 99%

Functional strength training versus movement performance therapy for upper limb motor recovery early after stroke: a RCT

et al. 2018

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Background Not all stroke survivors respond to the same form of physical therapy in the same way early after stroke. The response is variable and a detailed understanding of the interaction between specific physical therapies and neural structure and function is needed. Objectives To determine if upper limb recovery is enhanced more by functional strength training (FST) than by movement performance therapy (MPT), to identify the differences in the neural correlates of response to (1) FST and (2) MPT and to determine whether or not pretreatment neural characteristics can predict recovery in response to (1) FST and (2) MPT. Design Randomised, controlled, observer-blind, multicentre trial with embedded explanatory investigations. An independent facility used computer-generated randomisation for participants’ group allocation. Setting In-patient rehabilitation, participants’ homes, university movement analysis facilities and NHS or university neuroimaging departments in the UK. Participants People who were between 2 and 60 days after stroke in the territory of the anterior cerebral circulation, with some voluntary muscle contraction in the more affected upper limb but not full function. Interventions Routine rehabilitation [conventional physical therapy (CPT)] plus either MPT or FST in equal doses during a 6-week intervention phase. FST was progressive resistive exercise provided during training of functional tasks. MPT was therapist ‘hands-on’ sensory input and guidance for production of smooth and accurate movement. Main outcomes Action Research Arm Test (ARAT) score for clinical efficacy. Neural measures were made of corticocortical [fractional anisotropy (FA) from corpus callosum midline], corticospinal connectivity (asymmetry of corticospinal tracts FA) and resting motor threshold of paretic biceps brachii (pBB) and extensor carpi radialis muscles (derived from transcranial magnetic stimulation). Analysis Change in ARAT scores were analysed using analysis of covariance models adjusted for baseline variables and randomisation strata. Correlation coefficients were calculated between change in neural measures and change in ARAT score per group and for the whole sample. An interaction term was calculated for each baseline neural measure and ARAT score change from baseline to outcome. Results A total of 288 participants were randomised [mean age 72.2 (standard deviation 12.5) years; mean ARAT score of 25.5 (18.2); n = 283]. For the 240 participants with ARAT measurements at baseline and outcome, the mean change scores were FST + CPT = 9.70 (11.72) and MPT + CPT = 7.90 (9.18). The group difference did not reach statistical significance (least squares mean difference 1.35, 95% confidence interval –1.20 to 3.90; p = 0.298). Correlations between ARAT change scores and baseline neural values ranged from –0.147 (p = 0.385) for whole-sample corticospinal connectivity (n = 37) to 0.199 (p = 0.320) for MPT + CPT resting motor threshold pBB (n = 27). No statistically significant interaction effects were found between baseline neural variables and change in ARAT score. There were no differences between groups in adverse events. Limitations The number of participants in the embedded explanatory investigation was lower than expected. Conclusions The small difference in upper limb improvement in response to FST and MPT did not reach statistical significance. Baseline neural measures neither correlated with upper limb recovery nor predicted therapy response. Future work Needs to continue investigation of the variability of response to specific physical therapies in people early after stroke. Trial registration Current Controlled Trials ISRCTN19090862 and National Research Ethics Service reference number 11/EE/0524. Funding This project was funded by the Efficacy and Mechanism Evaluation programme, a Medical Research Council and National Institute for Health Research partnership.

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Physical fitness training for stroke patients

Saunders

Sanderson

Hayes

et al. 2020

Cochrane Database of Systematic Reviews

143

153

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Functional strength training and movement performance therapy produce analogous improvement in sit-to-stand early after stroke: early-phase randomised controlled trial

Abstract: Please cite this article as: Kerr A, Clark A, Cooke EV, Rowe P, Pomeroy VM, Functional strength training and movement performance therapy produce analogous improvement in sit-to-stand early after stroke: early-phase randomised controlled trial, Physiotherapy (2016), http://dx

Cited by 23 publications

References 33 publications

Functional Strength Training and Movement Performance Therapy for Upper Limb Recovery Early Poststroke—Efficacy, Neural Correlates, Predictive Markers, and Cost-Effectiveness: FAST-INdiCATE Trial

Functional Strength Training and Movement Performance Therapy for Upper Limb Recovery Early Poststroke—Efficacy, Neural Correlates, Predictive Markers, and Cost-Effectiveness: FAST-INdiCATE Trial

Functional strength training versus movement performance therapy for upper limb motor recovery early after stroke: a RCT

Physical fitness training for stroke patients

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