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

Abstract Background 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. Method 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. Results 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). Conclusions 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.