Article

Initial severity of upper-limb motor impairment and exercise
intensity are important predictors of improved upper-limb function during stroke
rehabilitation. Initial severity of motor impairment, however, is not modifiable
by rehabilitation, and increased one-on-one treatment is not always feasible.
Alternative methods to increase intensity and improve upper-limb function are
needed. The purpose of this study was to examine caregiver involvement
in upper-limb treatment as a method to improve upper-limb function. DESIGN: This
study was a secondary analysis of a multi-site randomized controlled trial for
upper-limb recovery during subacute inpatient stroke rehabilitation. METHODS:
Data from 50 individuals with subacute stroke who were randomly assigned to the
experimental group (upper-limb exercise) were used for the analysis. Outcome
variables were measured at baseline and at completion of the 4-week intervention.
Group comparisons between participants with caregiver support and participants
without caregiver support were done using an analysis of variance. Using the
Fugl-Meyer Upper-Limb Motor Impairment Scale and time spent in treatment
(intensity) as covariates, a multivariate regression analysis was performed to
determine the additive value of caregiver support on upper-limb function, as
measured by change scores on the Chedoke Arm and Hand Activity Inventory and the
Motor Activity Log. RESULTS: Group comparisons revealed that participants with
caregiver support had improved upper-limb function compared with those without
caregiver support and were more likely to increase the amount of time spent doing
exercise. The multiple regression analysis showed that Fugl-Meyer score,
treatment intensity, and caregiver support were significant predictors of
upper-limb improvement (R(2)=.240-.292). In the regression models, caregiver
support accounted for 5% to 9% of upper-limb improvement. LIMITATIONS: Support
was coded as a dichotomous variable, and thus the degree of support or
qualitative nature of support was not captured. CONCLUSIONS: Involvement of
caregivers was a determinant of improved upper-limb function over and above
initial severity of motor impairment and exercise intensity. Further research is
needed to determine the optimal qualitative and quantitative elements of
caregiver involvement in stroke rehabilitation in order to maximize results.

Langue : ANGLAIS