Analysis of upper limb muscle strength in the early phase of brain stroke

Purpose: The aim of this study was to determine the muscles with the lowest strength in nonaffected (non-A) and affected upper limb (A), to assess differences between men and women and to correlate these values with age in patients after stroke. Methods: Sixty hospitalized in Neurorehabilitation Ward patients (40 male, 20 female), 1-2 weeks after stroke, were enrolled to the study. Their age ranged from 50 to 80 years with a mean (sd) of 65,5 (18,7) years. Muscle force values from upper limb muscles were measured using the MicroFet 2 hand-held dynamometer. The results are displayed in newtons [N], mean values of muscular force, effect sizes and confidence intervals displayed as Cohen’s d and 95% CI were determined. Moreover, we made the coefficients correlation for differences in muscular force versus the Rivermead Motor Assessment (RMA) arm section. Results: Strength of (A) upper limb in comparison to (non-A) was 39% weaker. The severely affected muscle groups were the shoulder flexion 41% (women) versus 46% (men); elbow flexion 39% (women) versus 31% (men); wrist extension 36% (women) versus 42% (men). No significant correlations were found between muscle strength results and RMA or age. Conclusions: Muscle force of (A) upper limb after stroke demonstrates 39% decrease. Men show more significant decrease than women (40% vs 35%). Functional assessment in RMA values show the better results in women (4,9 ± 4,1) than men (3,4 ± 3,2)

Clinical replicability of rehabilitation interventions in randomized controlled trials reported in main journals is inadequate

Objective: The objective of this study was to study if randomized controlled trials (RCTs) in rehabilitation (a field where complex interventions prevail) published in main journals include all the details needed to replicate the intervention in clinical practice (clinical replicability). Study Design and Setting: Forty-seven rehabilitation clinicians of 5 professions from 7 teams (Belgium, Italy, Malaysia, Pakistan, Poland, Puerto Rico, the USA) reviewed 76 RCTs published by main rehabilitation journals exploring 14 domains chosen through consensus and piloting. Results: The response rate was 99%. Inter-rater agreement was moderate/good. All clinicians considered unanimously 12 (16%) RCTs clinically replicable and none not replicable. At least one \u201cabsent\u201d information was found by all participants in 60 RCTs (79%), and by a minimum of 85% in the remaining 16 (21%). Information considered to be less well described (8\u201319% \u201cperfect\u201d information) included two providers (skills, experience) and two delivery (cautions, relationships) items. The best described (50\u201379% \u201cperfect\u201d) were the classic methodological items included in CONSORT (descending order: participants, materials, procedures, setting, and intervention). Conclusion: Clinical replicability must be considered in RCTs reporting, particularly for complex interventions. Classical methodological checklists such as CONSORT are not enough, and also Template for Intervention Description and Clinical replication do not cover all the requirements. This study supports the need for field-specific checklists