Is forced use of the paretic upper limb beneficial? A randomized pilot study during subacute post-stroke recovery

Objective: To evaluate the effect of two weeks of forced use of the paretic upper limb, as a supplement to the rehabilitation programme in the subacute phase after stroke, on self-rated use of that limb. Design: A randomized, non-blind, parallel group, clinical, before-and-after trial. A forced use group and a conventional group were followed up one and three months after intervention. Setting: In- and outpatient units of rehabilitation at a University Hospital. Subjects: Thirty patients were allocated to two groups, 15 in each, 1-6 months (mean 2.4) after stroke onset. Twenty-six patients completed the study. Interventions: The patients of both groups participated in two weeks of daily training on weekdays. In addition, the forced use group wore a restraining sling on the non-paretic arm for up to 6 hours per weekday. Main measure: The Motor Activity Log; patients scored 0-5 for 30 daily tasks concerning both amount of use and quality of movement. Results: The forced use group tended to achieve larger improvements immediately post-intervention, but this was not clearly demonstrated. The small differences also levelled out up to the three-month follow-up, with both groups earning an approximately 1.0 score point on both scales of the Motor Activity Log. Conclusions: This pilot study did not reveal any additional benefit of forced use on self-rated performance in daily use of the paretic upper limb. Both groups performed fairly extensive, active training with a similar duration, amount and content.