Comparison of functional and qualitative data following robot assisted therapy and modified constraint induced movement therapy with sub-acute stroke patients : a pilot randomised controlled trial

Student thesis: Doctoral Thesis

Abstract

Introduction: Upper limb (UL) impairment is the most common disabling deficit after stroke. Despite evidence to support the use of two UL rehabilitation interventions; modified constraint induced movement therapy (mCIMT) and robot assisted therapy (RAT) as a means to improve stroke survivors’ function and quality of life, the literature thus far has failed to directly compare the effects of each nor fully explore user acceptability. This makes it difficult for clinicians to offer targeted and appropriate interventions to stratified patient groups depending on individual circumstances. This research looked to directly compare impairment, activity, and participation outcomes following programmes of mCIMT and RAT in the subacute phase after stroke. Participant and therapist views of the two interventions were also explored, including the barriers and facilitators to uptake in clinical practice. Methods: A mixed methods approach was used in this research. Thirteen participants were recruited between December 2014 and May 2018 into a pilot randomised controlled trial, and assigned to groups receiving normal treatment (NT) only, mCIMT + NT, or RAT + NT. Semistructured interviews were completed with participants immediately following completion of intervention, and an online survey with therapists conducted in January 2019, with an aim to better understand uptake and acceptability of mCIMT and RAT. Additionally, to help inform future studies, a small validity study (n=4) was undertaken to test the feasibility and validity of accelerometry as a measure of spontaneous everyday arm use within UL rehabilitation studies. Results: Comparison between groups indicate participants who underwent a programme of mCIMT had a tendency to achieve more meaningful improvements across all domains, compared to those who underwent a programme of RAT. Despite some participants responding well, and citing benefits to both interventions, uptake of CIMT and RAT remains low in clinical practice within NHS Scotland. Barriers identified echo those described in previous studies, with inadequate staffing, resources and training highlighted by therapists. Themes were identified in semi-structured interviews with stroke patients which may help us to further understand the acceptability of the interventions. Results of the small accelerometry study showed good acceptability of the device by participants and add further support to the validity of using this measure within stroke UL rehabilitation trials. Data from accelerometers placed on the wrist would appear to have greatest construct validity as an outcome measure, compared with data from accelerometers placed on the upper arm.Care should be taken not to generalise these findings due to small participant numbers. Discussion/Conclusion: Recommendations for a future larger scale study directly comparing the effects of mCIMT and RAT are provided. If these evidence-based interventions are to be embedded in clinical practice, service leads should consider commonly identified barriers to implementation. Further qualitative research is needed to help understand the rolemotivation plays in patient uptake and attrition of both interventions.
Date of Award1 Sept 2022
Original languageEnglish
Awarding Institution
  • University Of Strathclyde
SponsorsLanarkshire NHS & University of Strathclyde
SupervisorAndy Kerr (Supervisor) & Philip Rowe (Supervisor)

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