1558 - Upper extremity repetitive task practice improves health-related quality of life and participation in social roles in persons with chronic stroke: A randomized clinical trial

Objectives: Stroke often results in physical and social impairments leading to functional dependence in activities of daily living (ADLs), which significantly impact health related quality of life (HRQoL) and mood. Aerobic exercise has been incorporated into stroke rehabilitation to improve motor recovery, cognitive function, and overall HRQoL. This study aims to investigate the effects of forced rate exercise coupled with upper extremity repetitive task practice (FE+RTP) and time-matched upper extremity repetitive task practice (RTP) alone on HRQoL and mood in individuals with stroke to provide insights into optimizing stroke rehabilitation protocols.

Design: A single-center, parallel-group, rater blinded randomized clinical trial was conducted at the Cleveland Clinic. Participants received one of the following interventions: FE+RTP or time-matched RTP alone. Both groups completed twenty-four, 90-minute sessions three times a week for eight sessions. Stroke impact scale (SIS), patient-reported outcomes measurement information system (PROMIS)-29 and center for epidemiology studies-depression scale (CES-D) were used to assess HRQoL and mood at baseline, end of treatment (EOT), EOT+6 months and EOT+12 months.

Results: 29 patients completed FE+RTP and 28 patients completed RTP alone. Both groups improved significantly at each time point in the following SIS domains: physical problems, feelings, ADLs, mobility, hand use, meaningful activities and overall recovery. Participants in both groups demonstrated significant improvement in participation domain of PROMIS-29. Depressive symptomatology as measured by CES-D also improved from baseline to EOT-6. Observed improvements were maintained at 6- and 12-months follow up time points in both groups. There were no significant group differences in any of the outcomes. Nevertheless, FE effectively reduced the dose of RTP needed by half.

Conclusions: Both interventions were comparably effective in improving most of the domains of HRQoL however, FE did not enhance these effects. Upper Extremity RTP appears to be an effective approach in improving most domains of HRQoL in individuals with chronic stroke.