Ward, Brander, Kelly (online early, 2019). Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square programme. Journal of Neurology, Neurosurgery & Psychiatry

Nick Ward’s team at Queen Square (London) have published outcomes of 224 stroke survivors attending their NHS UL rehabilitation programme (a 3-week day program, 90 hours total, up to 6 hours of practice daily, with 1:1 therapist supervision). This is an observational study, not an RCT, of people referred by GPs/doctors to an NHS-funded program.  Median time post stroke= 18 months.

Good description provided of the task-specific retraining program (see ‘intervention’ page 2) with 2 sessions conducted per day, some 1:1, some group session. Coaching is a key part of the program.

Fugl-Meyer UL change: median score 26 at baseline, 34 after 3 weeks, 35 at 6 weeks, 37 after 6 months. This represents a clinically important change, which was maintained and improved further after discharge.

ARAT change: median score 18 at baseline, 29 after 3 weeks 26 after 6 weeks, 27 after 6 months. Again this represents a clinically important change in UL function, which was maintained after discharge.

Repetitions are not reported in this paper but are likely to follow. The authors refer to an RCT by McCabe et al (2015) in Archives Phys Med & Rehab which investigated the effects of 300 hours of UL rehab (n=48), a study I haven’t read, so worthwhile reading these two studies together in your journal club.