Video game rehabilitation for outpatient stroke (VIGoROUS): A multi-site randomized controlled trial of in-home, self-managed, upper-extremity therapy.

Autor:	Gauthier LV; University of Massachusetts Lowell, Dept. Physical Therapy and Kinesiology., Nichols-Larsen DS; The Ohio State University, School of Health and Rehabilitation Sciences., Uswatte G; University of Alabama Birmingham, Dept. of Psychology., Strahl N; Providence Medford Medical Center., Simeo M; OhioHealth Neurological Rehabilitation., Proffitt R; University of Missouri, Dept. of Occupational Therapy., Kelly K; Ohio State University, Dept of Neurology., Crawfis R; Ohio State University, Dept of Computer Science., Taub E; University of Alabama Birmingham, Dept. of Psychology., Morris D; University of Alabama Birmingham, Dept. of Physical Therapy., Lowes LP; Nationwide Children's Hospital., Mark V; University of Alabama Birmingham, Dept. of Physical Medicine and Rehabilitation., Borstad A; College of St. Scholastica, Dept. of Physical Therapy.
Jazyk:	angličtina
Zdroj:	EClinicalMedicine [EClinicalMedicine] 2021 Dec 17; Vol. 43, pp. 101239. Date of Electronic Publication: 2021 Dec 17 (Print Publication: 2022).
DOI:	10.1016/j.eclinm.2021.101239
Abstrakt:	Background: Integrating behavioral intervention into motor rehabilitation is essential for improving paretic arm use in daily life. Demands on therapist time limit adoption of behavioral programs like Constraint-Induced Movement (CI) therapy, however. Self-managed motor practice could free therapist time for behavioral intervention, but there remains insufficient evidence of efficacy for a self-management approach. Methods: This completed, parallel, five-site, pragmatic, single-blind trial established the comparative effectiveness of using in-home gaming self-management as a vehicle to redirect valuable therapist time towards behavioral intervention. Community-dwelling adults with post-stroke (>6 months) mild/moderate upper extremity hemiparesis were randomized to receive one of 4 different interventions over a 3-week period: 5 h of behaviorally-focused intervention plus gaming self-management (Self-Gaming), the same with additional behaviorally-focused telerehabilitation (Tele-Gaming), 5 h of Traditional motor-focused rehabilitation, or 35 h of CI therapy. Primary outcomes assessed everyday arm use (Motor Activity Log Quality of Movement, MAL) and motor speed/function (Wolf Motor Function Test, WMFT) immediately before treatment, immediately after treatment, and 6 months later. Intent-to-treat analyses were implemented with linear mixed-effects models on data gathered from March 15, 2016 to November 21, 2019. ClinicalTrials.gov, NCT02631850. Results: Of 193 enrolled participants, 167 began treatment and were analyzed, 150 (90%) completed treatment, and 115 (69%) completed follow-up. Tele-Gaming and Self-Gaming produced clinically meaningful MAL gains that were 1·0 points (95% CI 0·8 to 1·3) and 0·8 points (95% CI 0·5 to 1·0) larger than Traditional care, respectively. Self-Gaming was less effective than CI therapy (-0·4 points, 95% CI -0·6 to -0·2), whereas Tele-Gaming was not (-0·2 points, 95% CI -0·4 to 0·1). Six-month retention of MAL gains across all groups was 57%. All had similar clinically-meaningful WMFT gains; six-month retention of WMFT gains was 92%. Interpretation: Self-managed motor-gaming with behavioral telehealth visits has outcomes similar to in-clinic CI therapy. It addresses most access barriers, requiring just one-fifth as much therapist time that is redirected towards behavioral interventions that enhance the paretic arm's involvement in daily life. Funding: PCORI, NIH. Competing Interests: Drs. Gauthier, Borstad, Lowes, and Crawfis co-founded Games That Move You, PBC to commercialize the gaming technology utilized in this research; conflict management plans were put in place through The Ohio State University prior to conducting this trial to ensure research integrity. (© 2021 The Author(s).)
Databáze:	MEDLINE
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