AUTHOR=Hunter Susan M. , Johansen-Berg Heidi , Ward Nick , Kennedy Niamh C. , Chandler Elizabeth , Weir Christopher John , Rothwell John , Wing Alan M. , Grey Michael J. , Barton Garry , Leavey Nick Malachy , Havis Claire , Lemon Roger N. , Burridge Jane , Dymond Amy , Pomeroy Valerie M. 

TITLE=Functional Strength Training and Movement Performance Therapy for Upper Limb Recovery Early Poststroke—Efficacy, Neural Correlates, Predictive Markers, and Cost-Effectiveness: FAST-INdiCATE Trial

JOURNAL=Frontiers in Neurology

VOLUME=Volume 8 - 2017

YEAR=2018

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2017.00733

DOI=10.3389/fneur.2017.00733

ISSN=1664-2295

ABSTRACT=Background:  Variation in physiological deficits underlying upper limb paresis after stroke could influence how people recover and to which physical therapy they best respond. 
Objectives:  To determine whether functional strength training (FST) improves upper limb recovery more than movement performance therapy (MPT).  To identify: (a) neural correlates of response, and (b) whether pre-intervention neural characteristics predict response.  
Design: Explanatory investigations within a randomised, controlled, observer-blind, multi-centre trial. Randomization was computer-generated and concealed by an independent facility until baseline measures were completed. Primary time point was outcome, after the six-week intervention phase.  Follow-up was at six months after stroke.
Participants: with some voluntary muscle contraction in the paretic upper limb, not full dexterity, when recruited up to 60 days after an anterior cerebral circulation territory stroke.
Interventions: conventional physical therapy (CPT) plus either MPT or FST for up to 90 minutes-a-day, five days-a-week for six weeks.  FST was “hands-off” progressive resistive exercise cemented into functional task training.  MPT was “hands-on” sensory/facilitation techniques for smooth and accurate movement. 
Outcomes:  The primary efficacy measure was the Action Research Arm Test (ARAT). Neural measures: fractional anisotropy (FA) corpus callosum midline; asymmetry of corticospinal tracts FA; and resting motor threshold of motor evoked potentials. 
Analysis: of covariance models tested ARAT change from baseline.  At outcome: correlation coefficients assessed relationship between change in ARAT and neural measures; an interaction term assessed whether baseline neural characteristics predicted response.
Results: 288 participants had: mean age of 72.2 (standard deviation 12.5) years and mean ARAT 25.5 (18.2).  For 240 participants with ARAT at baseline and outcome the mean change was 9.70 (11.72) for FST+CPT; and 7.90 (9.18) for MPT+CPTwhich did not differ statistically (p=0.298). Correlations between ARAT change scores and baseline neural values were between 0.199, p=0.320, for MPT+CPT resting motor threshold (n=27) and -0.147, p=0.385, for asymmetry of corticospinal tracts FA (n=37).   Interaction effects between neural values and ARAT change between baseline and outcome were not statistically significant.  
Conclusions: There was no significant difference in upper limb improvement between FST and MPT.  Baseline neural measures did not correlate with upper limb recovery or predict therapy response.