Tesis

Perbandingan Efektivitas Latihan Graded Repetitive Arm Supplementary Program dengan Latihan Modified Constraint- Induced Movement Therapy Terhadap Fungsi Anggota Gerak Atas pada Pasien Stroke Iskemik Fase Subakut = Comparison of the Effectiveness of Graded Repetitive Arm Supplementary Program Exercise with modified Constraint-Induced Movement Therapy Exercise on the Function of Upper Limb in Subacute Phase Ischemic Stroke Patients.

Tujuan penelitian ini untuk membandingkan efektivitas latihan bilateral Graded Repetitive Arm Supplementary Program (GRASP) dengan latihan unilateral modified Constraint-Induced Movement Therapy (mCIMT) terhadap fungsi anggota gerak atas pada pasien stroke iskemik fase subakut. Desain penelitian ini adalah randomized controlled trial dengan subjek penelitian adalah pasien stroke iskemik fase subakut serangan pertama yang mengalami hemiparesis satu sisi dan telah memenuhi kriteria inklusi dan ekslusi. Subjek diambil secara consecutive sampling dan dilakukan randomisasi jenis latihan yang akan diterima. Secara keseluruhan, penelitian ini merekrut masing-masing 9 subjek pada kelompok latihan GRASP dan kelompok latihan mCIMT, yang disertakan dalam proses randomisasi. Latihan dilakukan di rumah, 1 sesi / hari dengan durasi tiap sesi 40-60 menit selama 6 hari / minggu. Khusus untuk kelompok latihan mCIMT dilakukan pengekangan anggota gerak atas sisi sehat menggunakan mitt selama 6 jam berturut per hari selama masa aktif dan latihan dilakukan selama masa pengekangan ini. Fungsi anggota gerak atas dinilai menggunakan Fugl-Meyr Assessment Upper Extremity (FMA-UE) dan Chedoke Arm and Hand Activity Inventory (CAHAI). Penilaian dilakukan saat sebelum latihan (T0), setelah 2 minggu latihan (T1) dan setelah 4 minggu latihan (T2). Tidak terdapat perbedaan bermakna pada perbaikan fungsi anggota gerak atas kedua kelompok latihan setelah menerima intervensi latihan selama 2 minggu, kenaikan perbedaan rerata nilai FMA-UE kelompok latihan GRASP sebesar 3,67±1,94 dan kelompok latihan mCIMT sebesar 3,11±1,54 dengan nilai p= 0,510; kenaikan perbedaan rerata nilai CAHAI pada kelompok latihan GRASP sebesar 5,33±3,46 {median 4,00(2,00-13,00)} dan kelompok latihan mCIMT sebesar 3,11±1,27 {median 3,00(2,00-6,00)} dengan nilai p= 0,050. Setelah 4 minggu latihan antara kedua kelompok juga tidak terdapat perbedaan bermakna dengan kenaikan perbedaan rerata nilai FMA-UE pada kelompok latihan GRASP sebesar 8,67±4,47 {median 8,00(5,0020,00)} dan kelompok latihan mCIMT sebesar 8,56±2,07 {median 8,00(5,00-12,00)} dengan nilai p= 0,489; kenaikan perbedaan rerata nilai CAHAI pada kelompok latihan GRASP sebesar 13,44±4,85 dan kelompok latihan mCIMT sebesar 10,11±2,62 dengan nilai p= 0,088. Oleh karena itu, dapat disimpulkan bahwa latihan bilateral GRASP sama efektifnya dengan latihan mCIMT dalam meningkatkan fungsi anggota gerak atas yang dapat digunakan sebagai alternatif latihan tambahan di rumah.
Kata kunci: fungsi tangan, stroke iskemik, randomized controlled study, graded repetitive arm supplementary program, modified constraint-induced movement therapy


The purpose of this study was to compare the effectiveness of the Graded Repetitive Arm Supplementary Program (GRASP) bilateral exercise with modified Constraint-Induced Movement Therapy (mCIMT) unilateral exercise on upper limb function in subacute ischemic stroke patients. This study is a randomized controlled trial with recruitment of subacute phase first attack ischemic stroke patients who had one-sided hemiparesis, and had fulfilled the inclusion and exclusion criteria. Subjects were taken by consecutive sampling and randomization of exercise intervention was done. In total, this study recruited 9 subjects in each of the GRASP exercise group and mCIMT exercise group, adhering to the randomization process. Exercise was done at home, 1 session / day with a duration of each session 40-60 minutes for 6 days / week. Specifically for the mCIMT training group the limbs were restrained on the healthy side using mitt for 6 consecutive hours per day during the active period and the exercises were carried out during this restraint period. Upper limb function was assessed using the Fugl-Meyr Assessment Upper Extremity (FMA-UE) and Chedoke Arm and Hand Activity Inventory (CAHAI). Assessment was done just before training (T0), after 2 weeks of training (T1) and after 4 weeks of training (T2). There was no significant difference in the improvement of upper limb function in the two exercise groups after receiving intervention for 2 weeks, increasing mean difference in FMA-UE score of the GRASP exercise group was 3.67 ± 1.94 and the mCIMT exercise group was 3.11 ± 1.54 with P = 0.510; increasing mean difference in CAHAI score of the GRASP exercise group was 5.33 ± 3.46 {median 4.00 (2.00-13.00)} and the mCIMT exercise group was 3.11 ± 1.27 {median 3.00 (2.00-6.00)} with P = 0.050. After 4 weeks of training between the two groups there were also no significant differences with increasing mean difference in FMA-UE score of the GRASP exercise group was 8.67 ± 4.47 {median 8.00 (5.00-20.00)} and the mCIMT exercise group was 8.56 ± 2.07 {median 8.00 (5.00-12.00)} with P = 0.489; increasing mean difference in CAHAI score of the GRASP exercise group was 13.44 ± 4.85 and the mCIMT exercise group was 10.11 ± 2.62 with P = 0.088. Therefore, it could be seen that GRASP bilateral exercise is as effective as mCIMT exercise in improving upper limb function which can be used as an alternative to additional exercise at home
Keywords: hand function, ischemic stroke, randomized controlled study, graded repetitive arm supplementary program, modified constraint-induced movement therapy