Boot Camp: A Randomized Cross-Over Trial of Intensive Upper-Limb Rehabilitation After Chronic Stroke

BackgroundStroke recovery is often incomplete. There is a need to robustly evaluate evidence for intensive stroke rehabilitation.ObjectiveInvestigate feasibility, safety, and preliminary evidence of effectiveness for Boot Camp; a pragmatic, intensive, group-based, 5-week upper-limb rehabilitation program for individuals with chronic stroke.MethodsA pragmatic randomized cross-over trial allocated individuals with chronic stroke to Boot Camp or usual care. Boot Camp delivered 90 hours of upper-limb rehabilitation in a group setting over 5 weeks. Feasibility was evaluated with recruitment rates, adherence, program completion, acceptability, and safety. Clinical characteristics including time since stroke, age, and corticospinal tract integrity were documented. The primary outcome measure was the Fugl-Meyer Upper Extremity (FM-UE). Secondary measures assessed upper-limb activity, quality of life, and self-efficacy. Interviews at the completion of Boot Camp provided insights into participant experiences.ResultsThirty-nine individuals consented, with 38 completing the program (22 male, age 61.5 ± 14.8 years, 2.8 ± 3.4 years since stroke). Feasibility criteria for recruitment, program completion, acceptability, and safety were met, but not adherence to full therapy amount. Boot Camp led to large gains in the FM-UE scores (10.2 ± 4.8, P < .001), upper-limb activity (7.3 ± 8.7, P < .001), quality of life (9.3 ± 22.1, P = .012), and self-efficacy (6.1 ± 13.5, P = .023). Participants reported themes of intensity matters, variety generally works, peer support, goals are motivating.ConclusionBoot Camp was feasible, safe, and led to large and meaningful gains in upper-limb outcomes in individuals with chronic stroke.