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Effects of training with a passive hand orthosis and games at home in chronic stroke: a pilot randomised controlled trial [with consumer summary]
Nijenhuis SM, Prange-Lasonder GB, Stienen AHA, Rietman JS, Buurke JH
Clinical Rehabilitation 2017 Feb;31(2):207-216
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVES: To compare user acceptance and arm and hand function changes after technology-supported training at home with conventional exercises in chronic stroke. Secondly, to investigate the relation between training duration and clinical changes. DESIGN: A randomised controlled trial. SETTING: Training at home, evaluation at research institute. SUBJECTS: Twenty chronic stroke patients with severely to mildly impaired arm and hand function. INTERVENTIONS: Participants were randomly assigned to six weeks (30 minutes per day, six days a week) of self-administered home-based arm and hand training using either a passive dynamic wrist and hand orthosis combined with computerised gaming exercises (experimental group) or prescribed conventional exercises from an exercise book (control group). MAIN MEASURES: Main outcome measures are the training duration for user acceptance and the Action Research Arm Test for arm and hand function. Secondary outcomes are the Intrinsic Motivation Inventory, Fugl-Meyer assessment, Motor Activity Log, Stroke Impact Scale and grip strength. RESULTS: The control group reported a higher training duration (189 versus 118 minutes per week, p = 0.025). Perceived motivation was positive and equal between groups (p = 0.935). No differences in clinical outcomes over training between groups were found (p = 0.165). Changes in Box and Block Test correlated positively with training duration (p = 0.001). CONCLUSIONS: Both interventions were accepted. An additional benefit of technology-supported arm and hand training over conventional arm and hand exercises at home was not demonstrated. Training duration in itself is a major contributor to arm and hand function improvements.

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