Introduction: Stroke survivors often experience persistent upper extremity (UE) deficits and diminished ADLs. The Critical Periods After Stroke Study (CPASS) found that intensive UE therapy initiated 2–3 months post-stroke produced greatest motor recovery at 12 months. (Dromerick et al., 2021). The Stroke Impact Scale (SIS) determined if benefits extended to patient-reported outcomes. Hypothesis: SIS scores would parallel UE motor recovery for participants randomized to early acute&subacute additional therapy. Methods: 72 patients were adaptively randomized to acute, subacute, chronic, or control groups. Intervention groups received usual care and 20 hours of individualized, task-specific UE therapy. The Activity Card Sort (ACS) identified preferred UE activity goals (Barth et al., 2023). A standardized protocol anchored to participant-selected activities guided therapy while maintaining standardization and quantification. SIS domains were assessed at baseline, 6 months, and 12 months. Longitudinal analyses used generalized estimating equations (GEE) adjusting for baseline, with group, time, and group-by-time terms included. Results: All SIS domains showed significant group&time main effects. Early intervention groups demonstrated strongest SIS recovery curves. Physical Function: Acute and subacute groups scored higher at 6 and 12 months than control (12-month mean: acute 77.6, subacute 76.2, control 70.4). Communication: Acute participants demonstrated significant gains versus controls (p=0.001),controls declined over time. Memory: Acute and subacute groups preserved memory function, surpassing controls at 12 months (p<0.05), while chronic and control groups declined. Social Participation: Acute and subacute groups gained immediate and sustained benefits (~10 points higher than control at 12 months). Chronic participants improved gradually but reached comparable levels. Perceived Recovery: Acute and subacute groups reported significantly greater recovery at 6 months (p=0.015&p=0.0002 vs control), with sustained benefits at 12 months. Conclusions: Early initiation of individualized, activity-focused UE therapy enhances motor recovery and meaningful improvement in patient-reported quality of life, participation, and recovery. Acute and subacute treatment yielded benefits across SIS domains, while chronic intervention was less robust. CPASS findings demonstrate that timing and content of rehabilitation optimizes functional and self-reported outcomes.
Barth et al. (Thu,) studied this question.