A Randomized Control Trial of a Virtually Delivered Program for Increasing Upper Limb Activity After Stroke
Lisa Simpson, Ruth Barclay, Mark Bayley, Penelope M. A. Brasher, Sean P. Dukelow, Bradley J. MacIntosh, Marilyn MacKay-Lyons, Carlo Menon, W. Ben Mortenson, Tzu–Hsuan Peng, Courtney L. Pollock, Sepideh Pooyania, Noah D. Silverberg, Robert Teasell, Jennifer Yao, Janice J. Eng
Abstract
Background Upper limb activity following stroke is low, which may limit recovery. We investigated whether a virtually-delivered upper limb program, that included a wearable device with reach-to-grasp feedback, would increase upper limb activity after stroke. Methods This was a parallel-group, assessor-blinded, randomized control trial conducted at 6 sites across 5 provinces of the CanStroke Recovery Trials Platform between 2020 to 2022. Participants (n = 73) were community-living, less than 1 year post stroke, and had residual arm movement and upper limb use limitations. Participants were randomized via a central web-based randomization service to receive a virtually delivered program (Virtual Arm Boot Camp [V-ABC], n = 36) or waitlist control (n = 37) receiving usual care. V-ABC consisted of a home exercise program, feedback from a wrist-worn device to monitor reach-to-grasp counts, and 6 virtual sessions with a trained therapist over 3 weeks. The primary outcome was the average daily reach-to-grasp counts over 3 days at 4 weeks post baseline assessment. Secondary outcomes included upper limb function, self-reported use, and quality of life. Within-subject changes between pre, post treatment, and 2 months follow up for all participants were also examined as a tertiary analysis. Results The V-ABC group demonstrated greater average daily reach-to-grasp counts (primary outcome) at 4 weeks compared to control (mean difference = 368, 95% confidence interval = 6-730, P = .046). Conclusions This study provided evidence that a virtually delivered upper limb program that consists of exercise, feedback from a wearable device, and therapist support can increase real-world upper limb activity following stroke. Clinical Trial Registration: NCT04232163.