| Summary: | Virtual Reality interventions are increasingly being researched with regard to their role in upper limb rehabilitation following stroke. Despite emerging evidence to demonstrate their efficacy in increasing motor function, there is weaker evidence to demonstrate an effect on performance in daily living activities. The Motor Activity Log (MAL) was used as a secondary outcome measure in the Wii Stroke Therapy for Arm Rehabilitation (Wii STAR) feasibility Randomised Controlled Trial, to explore whether there is any change in patients’ perceptions of how well, and how often they used their paretic upper limb during daily living activities (ADL) .
Method: 27 patients aged 18 or over, with residual arm dysfunction following stroke and, no longer receiving any other intensive rehabilitation were randomly allocated to either the intervention or control groups. The intervention was a low cost, virtual reality system that translates movements of the hand, fingers and thumb into game play. It was left in participants’ homes for eight weeks and they were advised to use it three times a day for periods of no more than 20 minutes. Frequency and duration of use were automatically recorded. The control group received no more than usual care. Patients were assessed at three time points using the Wolf Motor Function Test (WMFT), Nine-Hole Peg Test, and Nottingham Extended Activities of Daily Living as well as the Motor Activity Log.
Results: There was a significantly greater change from baseline in the intervention group on the MAL Amount of Use subscale and MAL Total Activities attempted where the other outcome measures (with the exception of the WMFT- Grip at 4 weeks ) did not show a difference. The MAL did correlate with some of the other measures on absolute scores, but not on change scores, although, there was a trend towards a correlation between duration of gameplay with change in the MAL Total Activities Attempted at 8 weeks.
Discussion
The results suggest that the MAL can pick up a difference when other outcome measures cannot. However, the small sample size and limited use of the intervention could mean that these results are due to a Type II error. The lack of correlations between the MAL and other outcome measures on change scores is consistent with earlier research indicating it is measuring a different aspect of recovery.
Conclusion:
The MAL 30 item version should be used as an outcome measure in studies which evaluate interventions targeting paretic upper limb after stroke, as it appears to be able to detect improvements, where measures of function, dexterity or ADL may not capture improvements. Additionally the MAL Total Activities Attempted should also be recorded, as it did show a difference between the two groups and a trend towards correlating with gameplay duration in the intervention group.
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