Structured Abstract
Stroke Structured Abstract - S #19
Individualized, self-administered home therapy using a program of written and illustrated exercises may improve stroke clients' motor ability
CITATION: Turton, A. & Fraser, C. (1990). The use of home therapy programmes for improving recovery of upper limb following stroke. British Journal of Occupational Therapy, 53, 457-462.
LEVEL OF EVIDENCE: IIC2b
RESEARCH QUESTION
What is the effect of home therapy programs for improving stroke patients' reaching movement?
DESIGN
Experimental design without randomization. Subjects were assigned to a home therapy group or a control group in alternate runs of five.
SAMPLING PROCEDURE/INCLUSION CRITERIA
Stroke patients were included if discharged from inpatient care in the Rehab Unit at Addenbrooke's Hospital, Cambridge, U.K., between September 1986 and November 1987 and met inclusion criteria, which was demonstrating less than 95% of normal performance on a peg transfer test. Those with sensory or proprioceptive problems in addition to motor deficits were eligible to participate. Patients with apraxia or perceptual or cognitive impairments could also be accommodated if they could understand instructions.
SAMPLE
|
N = 22 |
Male = 12 |
Female = 10 |
Mean age = 58 |
|
|
LCVA = 13 |
RCVA = 9 |
Attrition = NR |
|
x |
Acute |
|
Chronic |
NR = Not Reported
OUTCOME MEASURES
(R = Reliability established; V = Validity established)
Southern Motor Group's Motor Assessment - R
Ten-Hole Peg Test - R
INTERVENTION DESCRIPTION
Experimental Group: Home therapy group was provided with a booklet and a program of exercises that were considered appropriate to each individual's stage of recovery and to the problems they presented.
Control Group: Visited at home for assessment only; no home therapy programs were provided.
WHO DELIVERED INTERVENTION
OT
SETTING
Home
FREQUENCY & DURATION
Three to four home visits for an average duration of 9 weeks. The home therapy program was to be done two or three times a day. Compliance ranged from 11% to 100+%, with an average of 68%.
RESULTS
Between Groups/Conditions/Times:
Southern Motor Group's Motor Assessment: UE Reaching Subtest: The mean change scores were 1.58 and 0.2 for the experimental and control groups, respectively (Mann Whitney U = 39, p = .08, φ = .30).
Timed Ten-Hole Peg Test: The mean change scores were 4 seconds and -1.1 second for the experimental and control groups, respectively (Mann Whitney U = 24.5, p = .01, φ = .50).
Within Groups/Conditions/Times: Not tested
THREATS TO VALIDITY
Cointervention: Some patients received outpatient therapy.
Expectation: The therapists were aware of the research hypothesis.
Instrumentation: Ceiling and floor effects.
AUTHORS' CONCLUSIONS
Results indicate that some patients can benefit from home therapy. Arm and hand movement improved when repeated exercises were carried out by patients at home.
REVIEWERS' CONCLUSIONS
The home therapy group showed more improvement than the control group. Providing patients with an exercise program designed for their individual needs could effectively enhance patients' motor ability.
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice-Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Hui-ing Ma, ScD, OTR, and Catherine A. Trombly, ScD, OTR/L, FAOTA.
For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
Copyright 2003 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent.
