Dexamphetamine improves upper extremity outcome during rehabilitation after stroke: a pilot randomized controlled trial.
Author(s): Schuster C, Maunz G, Lutz K, Kischka U, Sturzenegger R, Ettlin T
Affiliation(s): Reha Rheinfelden, Rheinfelden, Switzerland.
Publication date & source: 2011-10, Neurorehabil Neural Repair., 25(8):749-55. Epub 2011 Jun 28.
BACKGROUND: For early inpatient stroke rehabilitation, the effectiveness of amphetamine combined with physiotherapy varies across studies. OBJECTIVE: To investigate whether the recovery of activities of daily living (ADL, primary outcome) and motor function (secondary outcome) can be improved by dexamphetamine added to physiotherapy. METHODS: In a double-blind, placebo-controlled trial, 16 patients, from 918 who were screened, were randomized to the experimental group (EG, dexamphetamine + physiotherapy) or control group (CG, placebo + physiotherapy). Both groups received multidisciplinary inpatient rehabilitation. Dexamphetamine (10 mg oral) or placebo was administered 2 days per week before physiotherapy. ADL and motor function were measured using the Chedoke-McMaster Stroke Assessment (CMSA) twice during baseline, every week during the 5-week treatment period, and at follow-up 1 week, 6 months, and 12 months after intervention. RESULTS: The majority of ineligible patients had too little paresis, were on anticoagulants, or had a stroke >60 days prior to entry. Participants (EG, n = 7, age 70.3 +/- 10 years, 5 women, 37.9 +/- 9 days after stroke; CG, n = 9, age 65.2 +/- 17 years, 3 women, 40.3 +/- 9 days after stroke) did not differ at baseline except for the leg subscale. Analysis of variance from baseline to 1 week follow-up revealed significant improvements in favor of EG for subscales ADL (P = .023) and arm function (P = .020) at end of treatment. No adverse events were detected. CONCLUSION: In this small trial that was based on prior positive trials, significant gains in ADL and arm function suggest that the dose and timing of dexamphetamine can augment physiotherapy. Effect size calculation suggests inclusion of at least 25 patients per group in future studies.