Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial

Arch Phys Med Rehabil. 2018 Dec;99(12):2399-2407. doi: 10.1016/j.apmr.2018.03.017. Epub 2018 Apr 25.

Abstract

Objective: We investigated the treatment effects of a home-based rehabilitation program compared with clinic-based rehabilitation in patients with stroke.

Design: A single-blinded, 2-sequence, 2-period, crossover-designed study.

Setting: Rehabilitation clinics and participant's home environment.

Participants: Individuals with disabilities poststroke.

Interventions: During each intervention period, each participant received 12 training sessions, with a 4-week washout phase between the 2 periods. Participants were randomly allocated to home-based rehabilitation first or clinic-based rehabilitation first. Intervention protocols included mirror therapy and task-specific training.

Main outcome measures: Outcome measures were selected based on the International Classification of Functioning, Disability and Health. Outcomes of impairment level were the Fugl-Meyer Assessment, Box and Block Test, and Revised Nottingham Sensory Assessment. Outcomes of activity and participation levels included the Motor Activity Log, 10-meter walk test, sit-to-stand test, Canadian Occupational Performance Measure, and EuroQoL-5D Questionnaire.

Results: Pretest analyses showed no significant evidence of carryover effect. Home-based rehabilitation resulted in significantly greater improvements on the Motor Activity Log amount of use subscale (P=.01) and the sit-to-stand test (P=.03) than clinic-based rehabilitation. The clinic-based rehabilitation group had better benefits on the health index measured by the EuroQoL-5D Questionnaire (P=.02) than the home-based rehabilitation group. Differences between the 2 groups on the other outcomes were not statistically significant.

Conclusions: The home-based and clinic-based rehabilitation groups had comparable benefits in the outcomes of impairment level but showed differential effects in the outcomes of activity and participation levels.

Trial registration: ClinicalTrials.gov NCT02364232.

Keywords: Rehabilitation; Stroke; Treatment outcome; Upper limb.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Aged
  • Combined Modality Therapy
  • Cross-Over Studies
  • Disability Evaluation
  • Female
  • Functional Laterality
  • Home Care Services*
  • Humans
  • International Classification of Functioning, Disability and Health
  • Male
  • Middle Aged
  • Motor Activity
  • Patient Participation / statistics & numerical data
  • Recovery of Function
  • Rehabilitation Centers*
  • Single-Blind Method
  • Stroke / physiopathology*
  • Stroke Rehabilitation / methods*
  • Task Performance and Analysis
  • Treatment Outcome

Associated data

  • ClinicalTrials.gov/NCT02364232