Repository logo
  • English
  • 中文
Log In
Have you forgotten your password?
  1. Home
  2. College of Medicine / 醫學院
  3. Occupational Therapy / 職能治療學系所
  4. The Effects of Treatment Intensity and Dose-Response Relationship in Robot-Assisted Stroke Rehabilitation
 
  • Details

The Effects of Treatment Intensity and Dose-Response Relationship in Robot-Assisted Stroke Rehabilitation

Date Issued
2011
Date
2011
Author(s)
Hsieh, Yu-wei
URI
http://ntur.lib.ntu.edu.tw//handle/246246/257501
Abstract
Background and purposes Stroke remains a compelling public health issue worldwide. With high percentages of stroke survivors left with motor deficits, motivating the search for effective rehabilitation to improve motor recovery. Robot-assisted therapy (RT) has emerged as a prominent approach in the last decade that incorporates successful therapeutic elements of motor rehabilitation into its design. However, scientific evidence for the effects of the RT on clinical outcomes and physiological responses in stroke patients remains limited. Also, there is a need to identify the proper level of treatment intensity to elucidate the dose-response relations. This dissertation consisted of two parts of study: Efficacy Study of Robot-Assisted Therapy, and Clinimetric Study of Outcomes. In the first part of study, the purposes were (1) to investigate the treatment effects of RT relative to a comparison treatment (CT) in patients with stroke on clinical outcomes, (2) to test the dose-response relations by using 2 RT groups with higher- and lower-intensity, and (3) to examine the effects of intensive RT on a biomarker of oxidative stress (i.e., 8-hydroxy-2''-deoxyguanosine [8-OHdG]). In the second part of study, the purposes were to define the appropriate populations for RT and to examine the clinimetric properties of outcomes used in RT. Methods A total of 54 patients with stroke were recruited in this study and were randomized into the higher-intensity RT, the lower-intensity RT, or the CT group for a 4-week intervention. Primary outcome measures, including the Fugl-Meyer Assessment (FMA) and Medical Research Council scale (MRC), were administered to patients before intervention, at midterm (2 weeks after intervention), and immediately after intervention. Secondary outcomes, including Box and Block Test (BBT), modified Ashworth scale (MAS), Motor Activity Log (MAL), and physical domains of the Stroke Impact Scale (SIS), were administered to patients before and after intervention. In addition, urinary 8-OHdG levels of patients, pain and fatigue evaluation were also investigated as adverse responses. Two-way repeated measures analysis of covariance (ANCOVA) was used to evaluate the effects of primary outcomes among the 3 groups at 3 assessments. ANCOVA was used to examine treatment effects of secondary outcomes among the 3 groups. To represent the dose-response relations between the 2 RT groups with different intensities, the recovery rates and dose-response curves of each outcome were examined. Moreover, multiple regression models were used to identify the significant predictors for primary outcomes. The capacity of outcome measures to capture minimal clinically important changes after RT and the responsiveness of outcomes were also examined. Results Each group had 18 patients who participated in the study. For the primary outcomes, there was a significant group × time interaction effect (F3.4, 83.8 = 3.95, P = 0.01) on the FMA-total score. All 3 groups showed significant within-group gains in the FMA from baseline to midterm and from baseline to posttreatment (all P < 0.05). The higher-intensity RT group had significantly higher improvements in the FMA than the other 2 groups at midterm and posttreatment (all P < 0.05). On the MRC, no significant group × time interaction effect was found (F4, 100 = 1.41, P = 0.24). The analysis revealed a significant time main effect (F2, 100 = 4.54, P = 0.01), but there was no significant differences for the group main effect (F2, 50 = 0.87, P = 0.43). For the secondary outcomes, a significant difference in the BBT among the 3 groups was observed (F2, 50 = 4.68, P = 0.01). Post hoc analysis revealed that the higher-intensity RT and CT groups had greater gains in the BBT than the lower-intensity RT group. However, the improvements in the MAS, MAL, and physical domains of the SIS did not show significant difference among the 3 groups. For the adverse responses, the mean ratings of fatigue and pain of the 3 groups were mild (mean scores < 3). Further, there were no significant differences in the 8-OHdG levels among the 3 groups (P = 0.24) and the mean 8-OHdG levels of the 3 groups were in the normal reference range. In addition, recovery rates of the higher-intensity RT group were significantly higher than those of the lower-intensity RT group at midterm and at posttreatment, particular in the FMA (P < 0.05) and the BBT (P = 0.05). The initial severity levels of the patients were found to affect their treatment effects on the primary outcomes. The patients in a middle range of motor deficits or muscle weakness gained most improvements after the higher-intensity RT. For the second part of study, motor ability of the distal part of the upper extremity, RT treatment group, and amount of affected hand use in daily activities were significantly predictive of the FMA model (adjusted R2 = 0.662, P < 0.01) after RT. Motor ability of the distal part of the upper extremity and RT treatment group were the significant predictors for the MRC model (adjusted R2 = 0.597, P < 0.01) after RT. Moreover, there were about 20% to 40% of the patients receiving RT with clinically meaningful improvement on the outcomes. The outcome measures used in this study had large responsiveness in detecting improved changes after RT (standardized response mean = 0.96 to 1.69). Conclusions The findings of this study suggest that the higher-intensity RT intervention had better treatment effects, especially in upper-extremity motor ability, than the other 2 interventions. Recovery rates of the higher-intensity RT group were greater than those of the lower-intensity RT group on motor outcomes. The initial severity levels of the patients were found to affect their treatment outcomes after the higher-intensity RT. The better predictors for motor ability and muscle power outcomes after RT were motor ability of the distal part of the upper extremity and RT treatment group. The outcome measures used in this study are responsive to improvements of stroke patients after RT. The intervention protocols in this study generally can be tolerated by the participants without exacerbation of pain or fatigue and did not increase more oxidative stress after treatment. Based on the results, the higher-intensity RT is suggested to deliver in chronic stoke with moderate to mild motor deficits to improve motor recovery. The overall results enrich our understandings of treatment effects, dose-response relations, oxidative responses, prediction models, and clinimetrics of outcomes after robot-assisted rehabilitation in stroke patients. The promising results and experiences provide insights for continued study of these critical issues in stroke rehabilitation to contribute to evidence-based neurorehabilitation.
Subjects
stroke
robot-assisted therapy
treatment dosage
oxidative stress
randomized controlled trial
SDGs

[SDGs]SDG3

Type
thesis
File(s)
Loading...
Thumbnail Image
Name

ntu-100-D96429001-1.pdf

Size

23.32 KB

Format

Adobe PDF

Checksum

(MD5):9ca8757f59f69152f765e35336171905

臺大位居世界頂尖大學之列,為永久珍藏及向國際展現本校豐碩的研究成果及學術能量,圖書館整合機構典藏(NTUR)與學術庫(AH)不同功能平台,成為臺大學術典藏NTU scholars。期能整合研究能量、促進交流合作、保存學術產出、推廣研究成果。

To permanently archive and promote researcher profiles and scholarly works, Library integrates the services of “NTU Repository” with “Academic Hub” to form NTU Scholars.

總館學科館員 (Main Library)
醫學圖書館學科館員 (Medical Library)
社會科學院辜振甫紀念圖書館學科館員 (Social Sciences Library)

開放取用是從使用者角度提升資訊取用性的社會運動,應用在學術研究上是透過將研究著作公開供使用者自由取閱,以促進學術傳播及因應期刊訂購費用逐年攀升。同時可加速研究發展、提升研究影響力,NTU Scholars即為本校的開放取用典藏(OA Archive)平台。(點選深入了解OA)

  • 請確認所上傳的全文是原創的內容,若該文件包含部分內容的版權非匯入者所有,或由第三方贊助與合作完成,請確認該版權所有者及第三方同意提供此授權。
    Please represent that the submission is your original work, and that you have the right to grant the rights to upload.
  • 若欲上傳已出版的全文電子檔,可使用Open policy finder網站查詢,以確認出版單位之版權政策。
    Please use Open policy finder to find a summary of permissions that are normally given as part of each publisher's copyright transfer agreement.
  • 網站簡介 (Quickstart Guide)
  • 使用手冊 (Instruction Manual)
  • 線上預約服務 (Booking Service)
  • 方案一:臺灣大學計算機中心帳號登入
    (With C&INC Email Account)
  • 方案二:ORCID帳號登入 (With ORCID)
  • 方案一:定期更新ORCID者,以ID匯入 (Search for identifier (ORCID))
  • 方案二:自行建檔 (Default mode Submission)
  • 方案三:學科館員協助匯入 (Email worklist to subject librarians)

Built with DSpace-CRIS software - Extension maintained and optimized by 4Science