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Upper Limb Isokinetic Strengthening Versus Passive Mobilization in Patients With Chronic Stroke: A Randomized Controlled Trial

Published:September 22, 2017DOI:https://doi.org/10.1016/j.apmr.2017.08.490

      Highlights

      • No benefit of isokinetic strengthening of elbow and wrist muscles in chronic stroke.
      • Isokinetic strengthening of the upper arm may be harmful in patients with chronic stroke.
      • A 6-week program of intensive rehabilitation in chronic stroke is promising.

      Abstract

      Objective

      To assess the benefit of isokinetic strengthening of the upper limb (UL) in patients with chronic stroke as compared to passive mobilization.

      Design

      Randomized blinded assessor controlled trial.

      Setting

      Physical Medicine and Rehabilitation departments of 2 university hospitals.

      Participants

      Patients (N=20) with incomplete hemiplegia (16 men; mean age, 64y; median time since stroke, 32mo).

      Interventions

      A 6-week comprehensive rehabilitation program, 3d/wk, 3 sessions/d. In addition, a 45-minute session per day was performed using an isokinetic dynamometer, with either isokinetic strengthening of elbow and wrist flexors/extensors (isokinetic strengthening group) or passive joint mobilization (control group).

      Main Outcome Measures

      The primary endpoint was the increase in Upper Limb Fugl-Meyer Assessment (UL-FMA) score at day 45 (t1). Secondary endpoints were increases in UL-FMA scores, Box and Block Test scores, muscle strength, spasticity, and Barthel Index at t1, t2 (3mo), and t3 (6mo).

      Results

      Recruitment was stopped early because of excessive fatigue in the isokinetic strengthening group. The increase in UL-FMA score at t1 was 3.5±4.4 in the isokinetic strengthening group versus 6.0±4.5 in the control group (P=.2). Gains in distal UL-FMA scores were larger (3.1±2.8) in the control group versus 0.6±2.5 in the isokinetic strengthening group (P=.05). No significant group difference was observed in secondary endpoints. Mixed models confirmed those results. Regarding the whole sample, gains from baseline were significant for the UL-FMA at t1 (+4.8; P<.001), t2, and t3 and for the Box and Block Test at t1 (+3; P=.013) and t2.

      Conclusions

      In a comprehensive rehabilitation program, isokinetic strengthening did not show superiority to passive mobilization for UL rehabilitation. Findings also suggest a sustained benefit in impairments and function of late UL rehabilitation programs for patients with stroke.

      Keywords

      List of abbreviations:

      BBT (Box and Block Test), UL (upper limb), UL-FMA (Upper Limb Fugl-Meyer Assessment)
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