Advertisement

Response to Letter to the Editor

Published:February 10, 2020DOI:https://doi.org/10.1016/j.apmr.2020.01.003
      We thank Dr Jang for his interest in our recent article titled “The Effects of a Robot-Assisted Arm Training Plus Hand Functional Electrical Stimulation on Recovery After Stroke: A Randomized Clinical Trial.”
      • Straudi S.
      • Baroni A.
      • Mele S.
      • et al.
      Effects of a robot-assisted arm training plus hand functional electrical stimulation on recovery after stroke: a randomized clinical trial.
      He suggests considering stroke site lesion, arm severity, and corticospinal tract (CST) integrity as potential sources of bias in our results, given that all these variables can affect spontaneous recovery in a subacute phase after stroke. His useful comments point toward some methodologic issues that are shared by most upper limb stroke rehabilitation research. In our study, we did not use stratification. Instead, we performed a simple block randomization, without any stratification for patients’ baseline characteristics. This approach is consistent with most of the stroke trials published so far.
      • Borschmann K.
      • Hayward K.S.
      • Raffelt A.
      • Churilov L.
      • Kramer S.
      Rationale for intervention and dose is lacking in stroke recovery trials: a systematic review.
      Indeed, a recent meta-analysis revealed that only 21.6% of stroke trials used stratification of participants, and that it was more common in larger trials.
      • Borschmann K.
      • Hayward K.S.
      • Raffelt A.
      • Churilov L.
      • Kramer S.
      Rationale for intervention and dose is lacking in stroke recovery trials: a systematic review.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Straudi S.
        • Baroni A.
        • Mele S.
        • et al.
        Effects of a robot-assisted arm training plus hand functional electrical stimulation on recovery after stroke: a randomized clinical trial.
        Arch Phys Med Rehabil. 2019 Nov 1; ([Epub ahead of print])
        • Borschmann K.
        • Hayward K.S.
        • Raffelt A.
        • Churilov L.
        • Kramer S.
        Rationale for intervention and dose is lacking in stroke recovery trials: a systematic review.
        Stroke Res Treat. 2018; 2018: 8087372
        • Bernhardt J.
        • Hayward K.S.
        • Dancause N.
        • et al.
        A stroke recovery trial development framework: consensus-based core recommendations from the Second Stroke Recovery and Rehabilitation Roundtable.
        Int J Stroke. 2019; 14: 792-802
        • Frenkel-Toledo S.
        • Fridberg G.
        • Ofir S.
        • et al.
        Lesion location impact on functional recovery of the hemiparetic upper limb.
        PLoS One. 2019; 14e0219738
        • Stinear C.M.
        • Byblow W.D.
        • Ackerley S.J.
        • Smith M.C.
        • Borges V.M.
        • Barber P.A.
        PREP2: a biomarker-based algorithm for predicting upper limb function after stroke.
        Ann Clin Transl Neurol. 2017; 4: 811-820

      Linked Article