Original research
Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial

https://doi.org/10.1016/j.apmr.2018.03.017Get rights and content

Abstract

Objective

We investigated the treatment effects of a home-based rehabilitation program compared with clinic-based rehabilitation in patients with stroke.

Design

A single-blinded, 2-sequence, 2-period, crossover-designed study.

Setting

Rehabilitation clinics and participant’s home environment.

Participants

Individuals with disabilities poststroke.

Interventions

During each intervention period, each participant received 12 training sessions, with a 4-week washout phase between the 2 periods. Participants were randomly allocated to home-based rehabilitation first or clinic-based rehabilitation first. Intervention protocols included mirror therapy and task-specific training.

Main Outcome Measures

Outcome measures were selected based on the International Classification of Functioning, Disability and Health. Outcomes of impairment level were the Fugl-Meyer Assessment, Box and Block Test, and Revised Nottingham Sensory Assessment. Outcomes of activity and participation levels included the Motor Activity Log, 10-meter walk test, sit-to-stand test, Canadian Occupational Performance Measure, and EuroQoL-5D Questionnaire.

Results

Pretest analyses showed no significant evidence of carryover effect. Home-based rehabilitation resulted in significantly greater improvements on the Motor Activity Log amount of use subscale (P=.01) and the sit-to-stand test (P=.03) than clinic-based rehabilitation. The clinic-based rehabilitation group had better benefits on the health index measured by the EuroQoL-5D Questionnaire (P=.02) than the home-based rehabilitation group. Differences between the 2 groups on the other outcomes were not statistically significant.

Conclusions

The home-based and clinic-based rehabilitation groups had comparable benefits in the outcomes of impairment level but showed differential effects in the outcomes of activity and participation levels.

Section snippets

Study design and procedure

This study was a single-blinded, 2-sequence, 2-period, crossover design in which each participant received 2 interventions (fig 1). During each period, participants received 12 intervention sessions for 4 weeks. They were randomly assigned to receive home-based rehabilitation first versus clinic-based rehabilitation first. After a 4-week washout period, the group that received home-based rehabilitation first received the clinic-based rehabilitation, and vice versa.

The same trained therapist

Participants’ baseline characteristics

The study initially enrolled 26 patients from December 2014 to November 2016, and the data of the patients who completed each of the 2 study periods of intervention and assessment were analyzed (see fig 2). Table 2 summarizes the baseline characteristics of the 24 participants included in study period 1. No significant differences were found in the baseline characteristics between the 2 treatment groups (P=.21-.94).

During study period 1, 8.3% of patients dropped out of each group; and during

Discussion

In this 2-period, crossover study, we demonstrated that the home-based and clinic-based rehabilitation has differential benefits on different aspects of health outcomes. Patients in the home-based group demonstrated better improvements on the AOU of their affected UE in daily tasks measured by the MAL-AOU and lower extremity force measured by the sit-to-stand test than the clinic-based group. The improved scores on the MAL-AOU and sit-to-stand test also exceeded or approached minimal clinically

Conclusions

The implementation of a home-based stroke rehabilitation intervention with patient-oriented goals resulted in mixed outcomes. The home-based rehabilitation demonstrated better improvements in the amount the affected UE was used in daily tasks and in lower extremity force, whereas the clinic-based rehabilitation enhanced self-perceived health status. Further studies are suggested to investigate how to integrate home-based and clinic-based interventions in patients with different stroke phases,

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    Supported by Chang Gung Memorial Hospital (grant no. CMRPD1E0391) and partly supported by the Healthy Aging Research Center at Chang Gung University (grant no. EMRPD1F0321), Chang Gung Memorial Hospital (grant nos. CMRPD1C0401-403, BMRP553, and BMRPD25), and the National Health Research Institutes (grant no. NHRI-EX106-10604PI) in Taiwan.

    Clinical Trial Registration No.: NCT02364232.

    Disclosures: none.

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    © 2018 by the American Congress of Rehabilitation Medicine