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Upper limb isokinetic strengthening versus passive mobilization in patients with chronic stroke: a randomized controlled trial
Coroian F, Jourdan C, Bakhti K, Palayer C, Jaussent A, Picot M-C, Mottet D, Julia M, Bonnin H-Y, Laffont I
Archives of Physical Medicine and Rehabilitation 2018 Feb;99(2):321-328
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To assess the benefit of isokinetic strengthening of the upper limb (UL) in patients with chronic stroke as compared to passive mobilization. DESIGN: Randomized blinded assessor controlled trial. SETTING: Physical medicine and rehabilitation departments of 2 university hospitals. PARTICIPANTS: Patients (n = 20) with incomplete hemiplegia (16 men; mean age, 64 y; median time since stroke, 32 mo). INTERVENTIONS: A 6-week comprehensive rehabilitation program, 3 d/wk, 3 sessions/d. In addition, a 45-minute session per day was performed using an isokinetic dynamometer, with either isokinetic strengthening of elbow and wrist flexors/extensors (isokinetic strengthening group) or passive joint mobilization (control group). MAIN OUTCOME MEASURES: The primary endpoint was the increase in Upper Limb Fugl-Meyer Assessment (UL-FMA) score at day 45 (T1). Secondary endpoints were increases in UL-FMA scores, Box and Block Test scores, muscle strength, spasticity, and Barthel Index at T1, T2 (3 mo), and T3 (6 mo). RESULTS: Recruitment was stopped early because of excessive fatigue in the isokinetic strengthening group. The increase in UL-FMA score at t1 was 3.5 +/- 4.4 in the isokinetic strengthening group versus 6.0 +/- 4.5 in the control group (p = 0.2). Gains in distal UL-FMA scores were larger (3.1 +/- 2.8) in the control group versus 0.6 +/- 2.5 in the isokinetic strengthening group (p = 0.05). No significant group difference was observed in secondary endpoints. Mixed models confirmed those results. Regarding the whole sample, gains from baseline were significant for the UL-FMA at T1 (+4.8; p < 0.001), T2, and T3 and for the Box and Block Test at T1 (+3; p = 0.013) and T2. CONCLUSIONS: In a comprehensive rehabilitation program, isokinetic strengthening did not show superiority to passive mobilization for UL rehabilitation. Findings also suggest a sustained benefit in impairments and function of late UL rehabilitation programs for patients with stroke.

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