Category: Stroke; Complementary Integrative Rehabilitation Medicine
Objective : To test the efficacy of a collaborative approach to stroke rehabilitation, called Music Upper Limb Therapy Integrated (MULT-I), that combines music therapy and occupational therapy in a group setting to improve physical, emotional and social well-being.
Design : A mixed-methods randomized controlled trial was performed, with participants randomly assigned to either the MULT-I treatment intervention or a self-led home exercise program (HEP), which served as the control intervention. Physical, emotional and social well-being were evaluated pre- and post-intervention.
Setting : Participants were recruited from a rehabilitation hospital. The MULT-I intervention took place at the hospital, and the control intervention took place at the participant's home.
Participants (or Animals, Specimens, Cadavers) : Thirty adults post stroke were recruited and randomly assigned to either the MULT-I intervention or the HEP control intervention. Of these, 25 participants (n=13 for MULT-I and n=12 for HEP) completed the pre- and post-intervention assessments and the assigned intervention.
Interventions : Participants in the MULT-I intervention received combined music therapy and occupational therapy twice a week for 6 weeks in groups of five. Participants in the HEP control group received a regimen of self-led exercises to improve physical function, to be completed twice a week for 6 weeks.
Main Outcome Measure(s) : We hypothesized that the synergistic effects of combined music therapy and occupational therapy would lead to greater improvement in physical function in the MULT-I group as compared to the HEP control group, as measured by the upper limb Fugl-Meyer Scale (FMS). We expected secondary gains in emotional and social well-being (assessed using the Patient Health Questionnaire (PHQ)-9, World Health Organization (WHO) well-being index, the stroke-specific quality of life scale (SS-QOL), and the stroke impact scale (SIS)) for the MULT-I group.
Results : Despite randomization, the HEP control group showed lower depression on the PHQ-9 and disability on the Modified Rankin Scale compared with the MULT-I group pre-intervention. Controlling for pre-intervention depression and disability, the mean improvement on the FMS did not show significant between group differences. However, there was a significant interaction between group and baseline depression such that higher depression scores at baseline were associated with increased improvement in outcomes for the MULT-I group compared with the HEP group on the upper limb FMS (p = 0.017), PHQ-9 (p
Conclusions : The experience of physical activity in an emotionally supportive and enjoyable social environment created by the MULT-I intervention may contribute to greater improvement in individuals with baseline emotional impairment.
Anna Palumbo– Doctoral Student, NYU, New York, New York