Promoting arm movement practice with a novel wheelchair armrest early after stroke: a randomized controlled trial

Abstract

Chronic upper extremity (UE) impairment is common after stroke. This study aimed to evaluate both the feasibility and preliminary clinical effects of Boost, a novel wheelchair-mounted rehabilitation device designed to assist individuals in UE motor recovery during inpatient rehabilitation. Thirty-five stroke inpatients were randomized to perform additional UE exercises alongside standard therapy, using either Boost or a therapist-customized booklet for self-practice. Feasibility outcomes included the volume of self-directed practice completed and participants’ ability to integrate Boost sessions into routine inpatient care. Clinical outcomes included the UE Fugl-Meyer (UEFM) Exam, Box and Block Test, Motor Activity Log, Modified Ashworth Scale, shoulder subluxation, and shoulder pain. At baseline, mean days post-stroke were 11.9 ± 4.6 (SD) and 13.1 ± 5.9, and UEFM scores were 20.5 ± 10.1 and 21.0 ± 13.5 for the intervention and control groups, respectively. Intervention durations averaged 11.9 ± 4.0 and 17.2 ± 8.8 days, respectively. Participants in the Boost group completed 3,359 ± 3,137 (median: 5,698, Q1 = 913, Q3 = 6,611) arm movements. No significant between-group clinical differences were found at the three-month follow-up. However, the Boost group showed a trend toward greater UEFM improvement immediately post-intervention (11.8 vs. 6.9 points, p  = 0.06). Importantly, UEFM gains were predicted by the number of Boost exercises performed ( p  = 0.02, R²=0.34). Subgroup analysis revealed that patients with less severe impairment (baseline UEFM > 21) achieved significantly greater UEFM improvements at discharge with Boost compared to controls (15.8 vs. 7.8 points, p  = 0.01). Boost use was feasible and enabled participants to complete thousands of UE movements during routine inpatient rehabilitation without direct supervision. While this added practice did not lead to significant between-group differences in clinical outcomes, preliminary findings suggest potential short-term benefits—particularly for individuals with less severe impairment—that warrant evaluation in larger, adequately powered trials. Trial registration : This study was registered at ClinicalTrials.gov with the title “Comparing Different Rehabilitation Exercise Strategies for Improving Arm Recovery After Stroke (Boost)” in May 2023; registration number: NCT05880940.