Rehabilitation your way: A randomized trial comparing home-based and self-managed web versus paper programs to improve arm and hand function after stroke
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Background
Home-based, self-managed stroke rehabilitation can complement limited healthcare resources. Computer-based programs offer a potential for rehabilitation without the need for complex technology or direct therapist supervision.
Objective
To compare effectiveness of a home-based web rehabilitation program (STRONG) versus a paper exercise program (PEP) for stroke-related upper extremity disability.
Methods
In this single-blind randomized controlled trial 43 participants with stroke were stratified by motor ability and motivation, then randomly assigned to either STRONG (n=22) or PEP (n=21). Training consisted of a 6-week intervention phase (at least 1 hour daily, 5 days weekly), followed by a 6-week follow-up phase with optional training. Primary outcomes were Fugl-Meyer Upper Extremity Assessment (FMA) and the streamlined timed Wolf Motor Function Test (WMFT-T). Secondary outcomes Motor Activity Log (MAL), WMFT-Function (WMFT-F), Stroke Motivation Scale, and Self-Efficacy Scale.
Results
Neither program showed superiority in FMA or WMFT-T. Within-group FMA improvements were similar (Strong: 1.8 points vs PEP: 2.1 points at post-training; 3.3 vs 1.9 at follow-up). However, STRONG participants reported better arm and hand use in daily activities (MAL) at post-training and follow-up. Additionally, STRONG participants showed higher self-efficacy at post-training, though this difference was not maintained at follow-up.
Conclusion
Both programs led to modest motor improvements. While STRONG did not outperform PEP in the primary outcomes, participants reported using their affected arm and hand more in daily activities and higher program continuation after the intervention period. Results suggest that home-based, self-managed rehabilitation combining exercises with daily tasks appears beneficial for stroke survivors post-standard rehabilitation.
Clinicaltrials.gov identifier: NCT03484182
