Norwegian constraint-induced therapy multisite trial: Adherence to treatment protocol applied early after stroke

Abstract

Objective: To investigate to what degree patients adhered to a modified constraint-induced movement therapy protocol, and to explore factors associated with the results. Design: Prospective follow-up of the intervention arm in a randomized controlled trial. Subjects: Twenty-four patients within 28 days after stroke.Methods: The protocol specified 180 min of treatment/day for 10 days. Therapy schedules were used to calculate the time spent in shaping, task practice and transfer package, as well as movement quality, perceived exertion and treatment progression. Results: The participants spent a mean of 91.3% of the in-tended time for treatment. Time spent practicing tasks was 30 min less than the intended 150 min, whereas slightly more time than intended was spent on the transfer package. Of the time spent in shaping, 33% was spent in pure activity. The remainder was used on feedback, task set-up, and rests. Adherence was positively associated with treatment progres-sion (r= 0.74) and negatively associated with age (r= –0.65). Women were less likely to use the mitt (r = –0.55).Conclusion: Overall adherence was good; however, time spent in motor activity was only one-third of total treatment time. The parameters in the constraint-induced movement therapy protocol should be individually adjusted early after stroke.