FAST INdiCATE Trial protocol. Clinical efficacy of functional strength training for upper limb motor recovery early after stroke

neural correlates and prognostic indicators

Valerie M Pomeroy, Nick S Ward, Heidi Johansen-Berg, Paulette van Vliet, Jane Burridge, Susan M Hunter, Roger N Lemon, John Rothwell, Christopher J Weir, Alan Wing, Andrew A Walker, Niamh Kennedy, Garry Barton, Richard J Greenwood, Alex McConnachie, FAST INdICATE Investigators, Phyo Kyaw Myint

Research output: Contribution to journalArticle

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Abstract

RATIONALE: Functional strength training in addition to conventional physical therapy could enhance upper limb recovery early after stroke more than movement performance therapy plus conventional physical therapy.

AIMS: To determine (a) the relative clinical efficacy of conventional physical therapy combined with functional strength training and conventional physical therapy combined with movement performance therapy for upper limb recovery; (b) the neural correlates of response to conventional physical therapy combined with functional strength training and conventional physical therapy combined with movement performance therapy; (c) whether any one or combination of baseline measures predict motor improvement in response to conventional physical therapy combined with functional strength training or conventional physical therapy combined with movement performance therapy.

DESIGN: Randomized, controlled, observer-blind trial.

STUDY: The sample will consist of 288 participants with upper limb paresis resulting from a stroke that occurred within the previous 60 days. All will be allocated to conventional physical therapy combined with functional strength training or conventional physical therapy combined with movement performance therapy. Functional strength training and movement performance therapy will be undertaken for up to 1·5 h/day, five-days/week for six-weeks.

OUTCOMES AND ANALYSIS: Measurements will be undertaken before randomization, six-weeks thereafter, and six-months after stroke. Primary efficacy outcome will be the Action Research Arm Test. Explanatory measurements will include voxel-wise estimates of brain activity during hand movement, brain white matter integrity (fractional anisotropy), and brain-muscle connectivity (e.g. latency of motor evoked potentials). The primary clinical efficacy analysis will compare treatment groups using a multilevel normal linear model adjusting for stratification variables and for which therapist administered the treatment. Effect of conventional physical therapy combined with functional strength training versus conventional physical therapy combined with movement performance therapy will be summarized using the adjusted mean difference and 95% confidence interval. To identify the neural correlates of improvement in both groups, we will investigate associations between change from baseline in clinical outcomes and each explanatory measure. To identify baseline measurements that independently predict motor improvement, we will develop a multiple regression model.

Original languageEnglish
Pages (from-to)240-245
Number of pages6
JournalInternational Journal of Stroke
Volume9
Issue number2
Early online date12 Sep 2013
DOIs
Publication statusPublished - Feb 2014

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Resistance Training
Clinical Protocols
Upper Extremity
Stroke
Therapeutics
Brain
Motor Evoked Potentials

Keywords

  • Brain
  • Brain Mapping
  • Disability Evaluation
  • Exercise Therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Image Processing, Computer-Assisted
  • Male
  • Movement Disorders
  • Oxygen
  • Prognosis
  • Recovery of Function
  • Statistics as Topic
  • Stroke
  • Time Factors
  • Transcranial Magnetic Stimulation
  • Treatment Outcome
  • Upper Extremity

Cite this

FAST INdiCATE Trial protocol. Clinical efficacy of functional strength training for upper limb motor recovery early after stroke : neural correlates and prognostic indicators. / Pomeroy, Valerie M; Ward, Nick S; Johansen-Berg, Heidi; van Vliet, Paulette; Burridge, Jane; Hunter, Susan M; Lemon, Roger N; Rothwell, John; Weir, Christopher J; Wing, Alan; Walker, Andrew A; Kennedy, Niamh; Barton, Garry; Greenwood, Richard J; McConnachie, Alex; FAST INdICATE Investigators ; Myint, Phyo Kyaw.

In: International Journal of Stroke, Vol. 9, No. 2, 02.2014, p. 240-245.

Research output: Contribution to journalArticle

Pomeroy, VM, Ward, NS, Johansen-Berg, H, van Vliet, P, Burridge, J, Hunter, SM, Lemon, RN, Rothwell, J, Weir, CJ, Wing, A, Walker, AA, Kennedy, N, Barton, G, Greenwood, RJ, McConnachie, A, FAST INdICATE Investigators & Myint, PK 2014, 'FAST INdiCATE Trial protocol. Clinical efficacy of functional strength training for upper limb motor recovery early after stroke: neural correlates and prognostic indicators', International Journal of Stroke, vol. 9, no. 2, pp. 240-245. https://doi.org/10.1111/ijs.12179
Pomeroy, Valerie M ; Ward, Nick S ; Johansen-Berg, Heidi ; van Vliet, Paulette ; Burridge, Jane ; Hunter, Susan M ; Lemon, Roger N ; Rothwell, John ; Weir, Christopher J ; Wing, Alan ; Walker, Andrew A ; Kennedy, Niamh ; Barton, Garry ; Greenwood, Richard J ; McConnachie, Alex ; FAST INdICATE Investigators ; Myint, Phyo Kyaw. / FAST INdiCATE Trial protocol. Clinical efficacy of functional strength training for upper limb motor recovery early after stroke : neural correlates and prognostic indicators. In: International Journal of Stroke. 2014 ; Vol. 9, No. 2. pp. 240-245.
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AU - Pomeroy, Valerie M

AU - Ward, Nick S

AU - Johansen-Berg, Heidi

AU - van Vliet, Paulette

AU - Burridge, Jane

AU - Hunter, Susan M

AU - Lemon, Roger N

AU - Rothwell, John

AU - Weir, Christopher J

AU - Wing, Alan

AU - Walker, Andrew A

AU - Kennedy, Niamh

AU - Barton, Garry

AU - Greenwood, Richard J

AU - McConnachie, Alex

AU - FAST INdICATE Investigators

AU - Myint, Phyo Kyaw

N1 - © 2013 The Authors. International Journal of Stroke published by John Wiley & Sons Ltd on behalf of World Stroke Organization. Funded by: Efficacy and Mechanism Evaluation programme. Grant Number: 10/60/30 Medical Research Council (MRC)

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N2 - RATIONALE: Functional strength training in addition to conventional physical therapy could enhance upper limb recovery early after stroke more than movement performance therapy plus conventional physical therapy.AIMS: To determine (a) the relative clinical efficacy of conventional physical therapy combined with functional strength training and conventional physical therapy combined with movement performance therapy for upper limb recovery; (b) the neural correlates of response to conventional physical therapy combined with functional strength training and conventional physical therapy combined with movement performance therapy; (c) whether any one or combination of baseline measures predict motor improvement in response to conventional physical therapy combined with functional strength training or conventional physical therapy combined with movement performance therapy.DESIGN: Randomized, controlled, observer-blind trial.STUDY: The sample will consist of 288 participants with upper limb paresis resulting from a stroke that occurred within the previous 60 days. All will be allocated to conventional physical therapy combined with functional strength training or conventional physical therapy combined with movement performance therapy. Functional strength training and movement performance therapy will be undertaken for up to 1·5 h/day, five-days/week for six-weeks.OUTCOMES AND ANALYSIS: Measurements will be undertaken before randomization, six-weeks thereafter, and six-months after stroke. Primary efficacy outcome will be the Action Research Arm Test. Explanatory measurements will include voxel-wise estimates of brain activity during hand movement, brain white matter integrity (fractional anisotropy), and brain-muscle connectivity (e.g. latency of motor evoked potentials). The primary clinical efficacy analysis will compare treatment groups using a multilevel normal linear model adjusting for stratification variables and for which therapist administered the treatment. Effect of conventional physical therapy combined with functional strength training versus conventional physical therapy combined with movement performance therapy will be summarized using the adjusted mean difference and 95% confidence interval. To identify the neural correlates of improvement in both groups, we will investigate associations between change from baseline in clinical outcomes and each explanatory measure. To identify baseline measurements that independently predict motor improvement, we will develop a multiple regression model.

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KW - Brain

KW - Brain Mapping

KW - Disability Evaluation

KW - Exercise Therapy

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Image Processing, Computer-Assisted

KW - Male

KW - Movement Disorders

KW - Oxygen

KW - Prognosis

KW - Recovery of Function

KW - Statistics as Topic

KW - Stroke

KW - Time Factors

KW - Transcranial Magnetic Stimulation

KW - Treatment Outcome

KW - Upper Extremity

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JO - International Journal of Stroke

JF - International Journal of Stroke

SN - 1747-4930

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