Upper Limb Isokinetic Strengthening Versus Passive Mobilization in Patients With Chronic Stroke: A Randomized Controlled Trial

Flavia Coroian; Claire Jourdan; Karima Bakhti; Claire Palayer; Audrey Jaussent; Marie-Christine Picot; Denis Mottet; Marc Julia; Huey-Yune Bonnin; Isabelle Laffont

doi:10.1016/j.apmr.2017.08.490

Upper Limb Isokinetic Strengthening Versus Passive Mobilization in Patients With Chronic Stroke: A Randomized Controlled Trial

Arch Phys Med Rehabil. 2018 Feb;99(2):321-328. doi: 10.1016/j.apmr.2017.08.490. Epub 2017 Sep 22.

Authors

Affiliations

¹ Physical Medicine and Rehabilitation Department, Montpellier University Hospital, Montpellier, France; Euromov, Montpellier University, Montpellier, France.
² Physical Medicine and Rehabilitation Department, Montpellier University Hospital, Montpellier, France.
³ Medical Information Department, Montpellier University Hospital, Montpellier, France.
⁴ Euromov, Montpellier University, Montpellier, France.
⁵ Euromov, Montpellier University, Montpellier, France; Physical Medicine and Rehabilitation Department, Nimes University Hospital, Grau du Roi, France.
⁶ Physical Medicine and Rehabilitation Department, Montpellier University Hospital, Montpellier, France; Euromov, Montpellier University, Montpellier, France. Electronic address: [email protected].

PMID: 28947166
DOI: 10.1016/j.apmr.2017.08.490

Abstract

Objective: To assess the benefit of isokinetic strengthening of the upper limb (UL) in patients with chronic stroke as compared to passive mobilization.

Design: Randomized blinded assessor controlled trial.

Setting: Physical Medicine and Rehabilitation departments of 2 university hospitals.

Participants: Patients (N=20) with incomplete hemiplegia (16 men; mean age, 64y; median time since stroke, 32mo).

Interventions: A 6-week comprehensive rehabilitation program, 3d/wk, 3 sessions/d. In addition, a 45-minute session per day was performed using an isokinetic dynamometer, with either isokinetic strengthening of elbow and wrist flexors/extensors (isokinetic strengthening group) or passive joint mobilization (control group).

Main outcome measures: The primary endpoint was the increase in Upper Limb Fugl-Meyer Assessment (UL-FMA) score at day 45 (t1). Secondary endpoints were increases in UL-FMA scores, Box and Block Test scores, muscle strength, spasticity, and Barthel Index at t1, t2 (3mo), and t3 (6mo).

Results: Recruitment was stopped early because of excessive fatigue in the isokinetic strengthening group. The increase in UL-FMA score at t1 was 3.5±4.4 in the isokinetic strengthening group versus 6.0±4.5 in the control group (P=.2). Gains in distal UL-FMA scores were larger (3.1±2.8) in the control group versus 0.6±2.5 in the isokinetic strengthening group (P=.05). No significant group difference was observed in secondary endpoints. Mixed models confirmed those results. Regarding the whole sample, gains from baseline were significant for the UL-FMA at t1 (+4.8; P<.001), t2, and t3 and for the Box and Block Test at t1 (+3; P=.013) and t2.

Conclusions: In a comprehensive rehabilitation program, isokinetic strengthening did not show superiority to passive mobilization for UL rehabilitation. Findings also suggest a sustained benefit in impairments and function of late UL rehabilitation programs for patients with stroke.

Trial registration: ClinicalTrials.gov NCT01554137.

Keywords: Dynamometer; Muscle strength; Rehabilitation; Stroke; Upper extremity.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Chronic Disease
Female
Humans
Male
Middle Aged
Physical Therapy Modalities*
Stroke / physiopathology*
Stroke Rehabilitation / methods*
Treatment Outcome
Upper Extremity / physiopathology*

Associated data

ClinicalTrials.gov/NCT01554137