Forced Use of the Upper Extremity in Chronic Stroke Patients: Results From a Single-Blind Randomized Clinical Trial
Abstract
BACKGROUND AND PURPOSE: Of all stroke survivors, 30% to 66% are unable to use their affected arm in performing activities of daily living. Although forced use therapy appears to improve arm function in chronic stroke patients, there is no conclusive evidence. This study evaluates the effectiveness of forced use therapy. METHODS: In an observer-blinded randomized clinical trial, 66 chronic stroke patients were allocated to either forced use therapy (immobilization of the unaffected arm combined with intensive training) or a reference therapy of equally intensive bimanual training, based on Neuro-Developmental Treatment, for a period of 2 weeks. Outcomes were evaluated on the basis of the Rehabilitation Activities Profile (activities), the Action Research Arm (ARA) test (dexterity), the upper extremity section of the Fugl-Meyer Assessment scale, the Motor Activity Log (MAL), and a Problem Score. The minimal clinically important difference (MCID) was determined at the onset of the study. RESULTS: One week after the last treatment session, a significant difference in effectiveness in favor of the forced use group compared with the bimanual group (corrected for baseline differences) was found for the ARA score (3.0 points; 95% CI, 1.3 to 4.8; MCID, 5.7 points) and the MAL amount of use score (0.52 points; 95% CI, 0.11 to 0.93; MCID, 0.50). The other parameters revealed no significant differential effects. One-year follow-up effects were observed only for the ARA. The differences in treatment effect for the ARA and the MAL amount of use scores were clinically relevant for patients with sensory disorders and hemineglect, respectively. CONCLUSIONS: The present study showed a small but lasting effect of forced use therapy on the dexterity of the affected arm (ARA) and a temporary clinically relevant effect on the amount of use of the affected arm during activities of daily living (MAL amount of use). The effect of forced use therapy was clinically relevant in the subgroups of patients with sensory disorders and hemineglect, respectively.
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Cites
The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance
Fugl-Meyer, A., Jääskö, L., Leyman, I., Olsson, S., & Steglind, S. (1975) · Journal of Rehabilitation Medicine · doi:10.2340/1650197771331 · Cited by 5,564 · see citing works
Clinical Trials: A Practical Approach.
Hill, I. D., & Pocock, S. (1984) · Biometrics · doi:10.2307/2531186 · Cited by 2,951 · see citing works
Technique to improve chronic motor deficit after stroke.
Taub, E., Miller, N. E., Novack, T. A., Cook, E. W., Fleming, W. C., Nepomuceno, C., Connell, J., & Crago, J. E. (1993) · PubMed · Cited by 1,557 · see citing works
Lyle, R. C. (1981) · International Journal of Rehabilitation Research · doi:10.1097/00004356-198112000-00001 · Cited by 1,335 · see citing works
Recovery of upper extremity function in stroke patients: The Copenhagen stroke study
Nakayama, H., Jørgensen, H. S., Raaschou, H. O., & Olsen, T. S. (1994) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/0003-9993(94)90161-9 · Cited by 1,057 · see citing works
Measurement in Neurological Rehabilitation
Cole, M. (1993) · Neurology · doi:10.1212/wnl.43.2.459-b · Cited by 1,015 · see citing works
Reliability of the Fugl-Meyer Assessment of Sensorimotor Recovery Following Cerebrovascular Accident
Duncan, P. W., Propst, M., & Nelson, S. G. (1983) · Physical Therapy · doi:10.1093/ptj/63.10.1606 · Cited by 962 · see citing works
WOLF, S., LeCraw, D. E., BARTON, L., & Jann, B. B. (1989) · Experimental Neurology · doi:10.1016/s0014-4886(89)80005-6 · Cited by 900 · see citing works
Effects of Constraint-Induced Movement Therapy on Patients With Chronic Motor Deficits After Stroke
Miltner, W. H. R., Bauder, H., Sommer, M., Dettmers, C., & Taub, E. (1999) · Stroke · doi:10.1161/01.str.30.3.586 · Cited by 591 · see citing works
Mini-mental state examination in neurological patients.
Dick, J., Guiloff, R. J., Stewart, A., Blackstock, J., Bielawska, C., Paul, E. A., & MARSDEN, C. D. (1984) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.47.5.496 · Cited by 473 · see citing works
Predicting Disability in Stroke—A Critical Review of the Literature
Kwakkel, G., WAGENAAR, R. C., Kollen, B. J., & Lankhorst, G. J. (1996) · Age and Ageing · doi:10.1093/ageing/25.6.479 · Cited by 467 · see citing works
Self-citationConstraint-induced movement therapy: A new approach to treatment in physical rehabilitation.
Taub, E., Crago, J. E., & Uswatte, G. (1998) · Rehabilitation Psychology · doi:10.1037/0090-5550.43.2.152 · Cited by 265 · see citing works
Sensory loss in stroke patients: Effective training of tactile and proprioceptive discrimination
Carey, L. M., Matyas, T. A., & Oke, L. E. (1993) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/0003-9993(93)90158-7 · Cited by 261 · see citing works
Somatosensory deafferentation research with monkeys : implications for rehabilitation medicine
Taub, E. (1980) · Medical Entomology and Zoology · Cited by 242 · see citing works
Therapy Impact on Functional Recovery in Stroke Rehabilitation
Kwakkel, G., Kollen, B. J., & WAGENAAR, R. C. (1999) · Physiotherapy · doi:10.1016/s0031-9406(05)67198-2 · Cited by 225 · see citing works
Self-citationSROKE RECOVERY: HE CAN BUT DOES HE?
Andrews, K. L., & Steward, J. (1979) · Lara D. Veeken · doi:10.1093/rheumatology/18.1.43 · Cited by 201 · see citing works
Effect of Forced Use of the Upper Extremity of a Hemiplegic Patient on Changes in Function
Ostendorf, C. G., & Wolf, S. L. (1981) · Physical Therapy · doi:10.1093/ptj/61.7.1022 · Cited by 183 · see citing works
Weerdt, W. J. G. D. (1985) · Physiotherapy Canada · doi:10.3138/ptc.37.2.065 · Cited by 182 · see citing works
A controlled trial of the retraining of the sensory function of the hand in stroke patients.
Yekutiel, M., & Guttman, E. (1993) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.56.3.241 · Cited by 170 · see citing works
WAGENAAR, R. C., Meijer, O. G., van Wieringen, P. C. W., Kuik, D. J., Hazenberg, G. J., Lindeboom, J., Wichers, F., & Rijswijk, H. (2020) · Journal of Rehabilitation Medicine · doi:10.2340/16501977902218 · Cited by 146 · see citing works
Self-citationBehavioral psychology in rehabilitation medicine : clinical applications
Ince, L. P. (1980) · Medical Entomology and Zoology · Cited by 99 · see citing works
van Bennekom, C. A. M., Jelles, F., & Lankhorst, G. J. (1995) · Disability and Rehabilitation · doi:10.3109/09638289509166712 · Cited by 83 · see citing works
Self-citationReview article : Physiotherapy in the rehabilitation of stroke: a review
Ashburn, A., Cj, P., & Souza, L. H. D. (1993) · Clinical Rehabilitation · doi:10.1177/026921559300700410 · Cited by 68 · see citing works
Responsiveness of the Rehabilitation Activities Profile and the Barthel Index
van Bennekom, C. A. M., Jelles, F., Lankhorst, G. J., & Bouter, L. M. (1996) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(95)00559-5 · Cited by 66 · see citing works
Self-citationSensory loss in the hand after sensory stroke: therapeutic rationale.
Dannenbaum, R., & Dykes, R. W. (1988) · PubMed · Cited by 60 · see citing works
van Bennekom, C. A. M., Jelles, F., Lankhorst, G. J., & Bouter, L. M. (1995) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/s0003-9993(95)80502-8 · Cited by 48 · see citing works
Self-citationTaub, E. (1996) · Medical Entomology and Zoology · Cited by 45 · see citing works
Inter- and intra-rater agreement of the rehabilitation activities profile
Jelles, F. (1995) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(94)00152-g · Cited by 42 · see citing works
Effects of stroke rehabilitation, I : a critical review of the literature
Wagenaar, R. (1991) · Medical Entomology and Zoology · Cited by 41 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 6
- Bots ML, Feskens EJM, Gijsen R, Grobbee DE. Beroerte. In: Maas IAM, Gijsen R, Lobbezoo IE, Poos MJJC, eds. Volksgezondheid Toekomst Verkenning 1997, I: De gezondheidstoestand: een actualisering. Maarssen, Netherlands: Elsevier/De Tijdstroom; 1997:451-462.
- Wagenaar RC. Functional Recovery After Stroke [PhD thesis]. Amsterdam, Netherlands: VU University Press; 1990.
- Davies PM. Steps to Follow: A Guide to the Treatment of Adult Hemi- plegia. Berlin, Germany: Springer Verlag; 1985.
- Wagenaar RC, Meijer OG. Effects of stroke rehabilitation, II: a critical review of the literature. J Rehabil Sci. 1991;4:97-108.
- Lezak MD. Neurophysiological Assessment. New York, NY: Oxford University Press; 1995.
- Bronfort G. Efficacy of Manual Therapies of the Spine [PhD thesis]. Amsterdam, Netherlands: Thesis Publishers Amsterdam; 1997.
Cited by
Sorted by citations
What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis
Veerbeek, J. M., van Wegen, E., van Peppen, R., van der Wees, P. J., Hendriks, E., Rietberg, M., & Kwakkel, G. (2014) · PLoS ONE · doi:10.1371/journal.pone.0087987 · Cited by 1,203 · see citing works
Lum, P. S., Burgar, C. G., Shor, P. C., Majmundar, M., & Van der Loos, M. (2002) · Archives of Physical Medicine and Rehabilitation · doi:10.1053/apmr.2001.33101 · Cited by 1,159 · see citing works
Virtual Environments for Motor Rehabilitation: Review
Holden, M. K. (2005) · CyberPsychology & Behavior · doi:10.1089/cpb.2005.8.187 · Cited by 1,154 · see citing works
The impact of physical therapy on functional outcomes after stroke: what's the evidence?
Van Peppen, R. P., Kwakkel, G., Wood-Dauphinee, S., Hendriks, H. J., Van der Wees, P. J., & Dekker, J. (2004) · Clinical Rehabilitation · doi:10.1191/0269215504cr843oa · Cited by 942 · see citing works
Physical fitness training for stroke patients
Saunders, D. H., Sanderson, M., Hayes, S., Kilrane, M., Greig, C. A., Brazzelli, M., & Mead, G. E. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003316.pub6 · Cited by 759 · see citing works
Timmermans, A. A., Seelen, H. A., Willmann, R. D., & Kingma, H. (2009) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/1743-0003-6-1 · Cited by 483 · see citing works
Very Early Constraint-Induced Movement during Stroke Rehabilitation (VECTORS): A single-center RCT
Dromerick, A. W., Lang, C. E., Birkenmeier, R. L., Wagner, J. M., Miller, J. P., Videen, T. O., Powers, W. J., Wolf, S. L., & Edwards, D. F. (2009) · Neurology · doi:10.1212/wnl.0b013e3181ab2b27 · Cited by 399 · see citing works
Sterr, A., Elbert, T., Berthold, I., Kölbel, S., Rockstroh, B., & Taub, E. (2002) · Archives of Physical Medicine and Rehabilitation · doi:10.1053/apmr.2002.35108 · Cited by 276 · see citing works
The Effectiveness of the Bobath Concept in Stroke Rehabilitation: What is the Evidence?
Kollen, B. J., Lennon, S., Lyons, B., Wheatley-Smith, L., Scheper, M., Buurke, J. H., Halfens, J., Geurts, A. C. H., & Kwakkel, G. (2009) · Stroke · doi:10.1161/strokeaha.108.533828 · Cited by 274 · see citing works
Outcomes of the Bobath concept on upper limb recovery following stroke
Luke, C., Dodd, K. J., & Brock, K. (2004) · Clinical Rehabilitation · doi:10.1191/0269215504cr793oa · Cited by 148 · see citing works
Paci, M. (2003) · Journal of Rehabilitation Medicine · doi:10.1080/16501970306106 · Cited by 131 · see citing works
van Vliet, P. M. (2005) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp.2004.040436 · Cited by 115 · see citing works
Ploughman, M., & Corbett, D. (2004) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2004.01.018 · Cited by 106 · see citing works
Effectiveness of the Bobath concept in the treatment of stroke:A systematic review
Díaz-Arribas, M. J., Martín-Casas, P., Cano-de-la-Cuerda, R., & Plaza-Manzano, G. (2020) · Disability and Rehabilitation · doi:10.1080/09638288.2019.1590865 · Cited by 76 · see citing works
The Bobath Concept (NDT) as rehabilitation in stroke patients: A systematic review
Pathak, A., Gyanpuri, V., Dev, P., & Dhiman, N. R. (2021) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_528_21 · Cited by 60 · see citing works
“These treatment techniques are MRP,[18,28] forced use therapy,[19] Robot therapy,[20] POWM,[21] Arm BASIS augmented exercise therapy,[22] gait training,[23] RAS,[26] Constraint‐Induced Movement Therapy,[30] meaningful task-specific training.”
BackgroundMethodInfluentialSong, X., van de Ven, S. S., Chen, S., Kang, P., Gao, Q., Jia, J., & Shull, P. B. (2022) · Frontiers in Physiology · doi:10.3389/fphys.2022.811950 · Cited by 47 · see citing works
- Authors
- van der Lee, J. H., Wagenaar, R. C., Lankhorst, G. J., Vogelaar, T. W., Devillé, W. L., & Bouter, L. M.
- Affiliations
- From the Departments of Rehabilitation Medicine (J.H. van der L., G.J.L., T.W.V.) and Physical Therapy (R.C.W.), University Hospital Vrije Universiteit, and Institute for Research in Extramural Medicine, Vrije Universiteit (J.H. van der L., G.J.L., W.L.D., L.M.B.), Amsterdam, the Netherlands.
- Vrije Universiteit Amsterdam (NL)
- Venue
- Stroke
- Published
- 1999-11
- Volume
- 30
- Issue
- 11
- Pages
- 2369-2375
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W2083958711
- Cited by
- 745
- References
- 29
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 2 · 2023: 14 · 2022: 17 · 2021: 23 · 2020: 28 · 2019: 18 · 2018: 22 · 2017: 15 · 2016: 21 · 2015: 22 · 2014: 24 · 2013: 40 · 2012: 38
- FWCI
- 21.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- VU Research Portal (submittedVersion)
- Topics
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Spatial Neglect and Hemispheric Dysfunction
- Keywords
- chronic stroke, upper limb, upper limb function, bimanual training, activities of daily living, hemispatial neglect, sensory disturbances, arm immobilization
- MeSH terms
- Stroke Rehabilitation, Activities of Daily Living, Aged, Arm, Chronic Disease, Female, Follow-Up Studies, Hemiplegia, Humans, Immobilization, Male, Middle Aged, Motor Activity, Motor Skills, Movement, Sensation Disorders, Single-Blind Method, Treatment Outcome, Physical Therapy Modalities
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