EFFECTIVENESS OF TASK-ORIENTED TRAINING ON MOTOR FUNCTION RECOVERY IN STROKE PATIENTS: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background : Stroke is a major cause of chronic neurological disability, and the motor impairment is experienced by about
80% of stroke patients. Task-Oriented Training (TOT) is an experimental rehabilitation paradigm based on the science of
motor learning and experience-dependent neuroplasticity and aims to fill the functional specificity gap of traditional
physiotherapy. Although a strong international evidence base, there is a paucity of rigorous locally-conducted randomized
controlled trial data available on Indian populations, and this constrains direct clinical translation in this high-burden
situation.
Objective : To assess the efficacy of a six-week intensive Task-Oriented Training protocol on (1) the recovery of motor
functions by the use of Motor Assessment Scale, and (2) the functional independence of activities of daily living through the
use of the Barthel Index in subacute stroke patients undergoing rehabilitation at the Pacific Medical College and Hospital,
Udaipur.
Study Design: Single-blind, parallel-group randomized controlled trial (RCT).
Setting: Pacific Medical College and Hospital (PMCH), Department of Physiotherapy, Bedla, Udaipur, Rajasthan, India.
Duration of study: 8 months
Participants: Sixty adults (40 - 70 years) with first-time ischemic or hemorrhagic stroke (16 months post-stroke), stable
medical conditions to participate in active rehabilitation, and preserved cognitive ability (MMSE 24) were recruited by
purposive sampling and randomized (1:1) to experimental (TOT + conventional physiotherapy, n=30) or control
(conventional physiotherapy )
Interventions: The experimental group was given a structured TOT (45 - 60 min/session: sit-to-stand, reaching and
grasping, gait training, stair-climbing, object manipulation exercises with progressive overload) as well as traditional
physiotherapy (20 - 30 min/session). The control group was provided with only conventional physiotherapy (45 - 60
min/session). The two groups trained six weeks five days per week.
Outcome Measures: Barthel Index (BI; 0- 100) and Motor Assessment Scale (MAS; 0 - 48), which were assessed at
baseline and post-intervention (Day 43) by a blind assessor.
Result : There were statistically significant within-group improvements in both groups (p < 0.001). The improvement in BI
was 23.83 points (47.13%; t = 32.56) in the experimental group (TOT) compared to 12.13 points (23.71 % t = 25.73) in
controls - a difference in BI points between the groups of 11.70 points (approximately twice the gain in functional
independence). The MAS mean improvement was 11.13 points (59.43%; t = 30.30) in the TOT group versus 5.63 points
(30.29%; t = 17.82) in controls — an inter-group difference of 5.50 MAS points. After the intervention, 83.3% of TOT group
depended to at least moderate level (BI 61-90) against 43.3% of the controls and 53.3% TOT group evolved into mild
impairment against 6.7% controls. All paired t-tests were significant (t-critical = 2.045, df = 29, α = 0.05, two-tailed). The
alternative hypothesis (H₁) was accepted for all four comparisons.
Conclusion: Task-Oriented Training in addition to conventional physiotherapy leads to much larger and clinically
significant increases in motor function and functional independence than conventional physiotherapy alone in subacute
stroke patients. TOT is a clinically feasible, resource-appropriate intervention and is suggested to be systematically
implemented within the stroke rehabilitation programs in Indian healthcare facilities.