Abstract
Objectives
The primary objective was to compare the benefits of single (COT1) versus double (COT2) dose of conventional occupational therapy (COT) in improving voluntary hand function in individuals with incomplete, sub-acute C3–C7 spinal cord injury (SCI). The secondary objective was to compare these two interventions versus functional electrical stimulation therapy plus COT (FES + COT).
Design
Retrospective analysis.
Setting
Inpatient spinal cord rehabilitation center, Toronto.
Participants
Individuals with traumatic incomplete sub-acute SCI.
Interventions
Data from Phases I and II (ClinicalTrials.gov ID NCT00221117) randomized control trials were pooled together for the purpose of this study. Participants in the COT1 group received 45 hours of therapy, the COT2 group received 80 hours of therapy, and the FES + COT group received 40 hours of COT therapy +40 hours of FES therapy.
Outcome measures
We analyzed the functional independence measure (FIM) and the spinal cord independence measure (SCIM) self-care sub-scores.
Results
The mean change scores on the FIM self-care sub-score for the COT1, COT2, and FES + COT groups were 12.8, 10, and 20.1 points, respectively. Similarly, the mean change scores on the SCIM self-care sub-score for the COT1, COT2, and FES + COT groups were, 2.6, 3.16, and 10.2 points, respectively.
Conclusion
Increased rehabilitation intensity alone may not always be beneficial. The type of intervention plays a significant role in determining functional changes. In this instance, receiving one (COT1) or two (COT2) doses of COT resulted in similar outcomes, however, FES + COT therapy yielded much better outcomes compared to COT1 and COT2 interventions.
Acknowledgments
The authors acknowledge Dr Vera Zivanovic, Jennifer Holmes, Marlene Adams, and Sylvia Haycock for providing assistance with participant recruitment and with delivery of research therapy to the study participants.