Abstract:
Background: Stroke is the third greatest cause of death in New Zealand (NZ) with approximately 7,000 new strokes in NZ every year. Increases in stroke numbers and rising pressures on hospital staff and resources have highlighted the need to develop effective rehabilitation interventions that are based on current evidence. Interventions for upper limb rehabilitation should be specific, meaningful, involve multiple repetitions and must be task specific. However, every patient is unique and individual barriers to rehabilitation must be considered to ensure appropriate interventions are selected. Among these novel therapy modalities are combined interventions which incorporate two otherwise separate therapies. Objective: The primary objective of this research trial is to examine the effect that mirror therapy combined with functional electrical stimulation (FES) has on upper limb motor recovery and functional outcome for a sample of people admitted to the comprehensive stroke unit at Waikato hospital following a stroke. Participants: Recruitment of participants occurred over 13 months (August 2013 - September 2014) within the comprehensive stroke unit at Waikato hospital. There were 378 participants that were screened for the trial and 86.5% (327) were excluded as they did not fulfil the required inclusion criteria. A total of 50 participants were registered and randomised into one of three treatment arms within this trial. Methods: Participants were recruited on admission to the CSU at Waikato Hospital and randomly assigned through simple randomisation to the FES group, Mirror Therapy group or the combined FES with Mirror therapy group. Participants received approximately 30 minutes of therapy daily in addition to their usual rehabilitation programme. Sociodemographic and health information was collected at recruitment together with admission dates and medical diagnoses. Blinded assessments were undertaken at baseline and at discharge post stroke by a registered physiotherapist and a clinical nurse specialist. Results: The Action Research Arm Test (ARAT) and the Fugl-Meyer Upper Extremity (FMUE) revealed statistically significant differences between follow up ARAT scores between FES and mirror therapy through adjusted ANOVA models. However, no statistical differences were found when compared with FES combined with mirror therapy. Conclusion: The theory of combining interventions deserves further research and should be explored further. Combined intervention pathways may have the potential to enhance stroke rehabilitation, improve functional outcomes and help reduce the overall burden of stroke.