Improved quality of life following constraint-induced movement therapy is associated with gains in arm use, but not motor improvement

Abstract

Background: Constraint-induced movement therapy (CI therapy) is one of few treatments for upper extremity (UE) hemiparesis that has been shown to result in motor recovery and improved quality of life in chronic stroke. However, the extent to which treatment-induced improvements in motor function versus daily use of the more affected arm independently contribute to improved quality of life remains largely unexplored.

Objective: The objective of this study is to identify whether motor function or daily use of a hemiparetic arm has a greater influence on quality of life after CI therapy.

Methods: Two cohorts of participants with chronic stroke received either in-person CI therapy (n = 29) or video-game home-based CI therapy (n = 16). The two cohorts were combined and the motor-related outcomes (Wolf Motor Function Test, Action Research Arm Test, Motor Activity Log [MAL]) and quality of life (Stroke-Specific Quality of Life) were jointly modeled to assess the associations between outcomes.

Results: The only outcome associated with improved quality of life was the MAL. Improvements in quality of life were not restricted to motor domains, but generalized to psychosocial domains as well.

Conclusions: Results suggest that improved arm use during everyday activities is integral to maximizing quality of life gains during motor rehabilitation for chronic post-stroke UE hemiparesis. In contrast, gains in motor function were not associated with increases in quality of life. These findings further support the need to implement techniques into clinical practice that promote arm use during daily life if improving quality of life is a main goal of treatment. ClinicalTrials.gov Registration Numbers: NCT01725919 and NCT03005457.

Keywords: Constraint-induced movement therapy; behaviour change; chronic stroke; hemiparesis; motor recovery; quality of life; transfer package.

Conflict of interest statement

Disclosure of Interest

Authors Borstad and Gauthier are shareholders of Games That Move You, PBC, a company that commercialized the technology utilized in the gaming cohort. Conflict management plans have been put in place by the University to ensure the integrity of the research. Authors Kelly and Kline report no conflicts of interest.

Figures

Figure 1.

Score change per question in SSQoL for 1-point increase in MAL by Domain: Improvements in quality of life were not limited to motor domains and appear to generalize to other domains.

Figure 2.

Scatterplots showing the posterior mean residual for ARAT, WMFT, and MAL plotted against the posterior mean residual of SSQoL. Least squares regression line and 95% confidence bands are shown on each plot. A strong linear relationship exists between the MAL and SSQoL while no relationship exists between either the WMFT or ARAT and the SSQoL.